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Non-invasive intracranial pressure estimation using ultrasonographic measurement of area of optic nerve subarachnoid space
  1. Yue Zhang1,
  2. Kai Cao2,
  3. Ruiqi Pang1,
  4. Ning Wang3,
  5. Xin Qu3,
  6. Jun Kang4,
  7. Ningli Wang1,2,5,
  8. Hanruo Liu2,5
  1. 1 Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
  2. 2 Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
  3. 3 Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
  4. 4 Department of Neurosurgery, Beijing Tongren Hospital, Beijing, China
  5. 5 School of Information and Electronics, Beijing Institute of Technology, Beijing, China
  1. Correspondence to Dr Hanruo Liu, Beijing Institute of Ophthalmology, Beijing, China; hanruo.liu{at}


Objective To verify whether the area of the ONSAS (ONSASA) obtained by transorbital ultrasonography can be used to accurately evaluate the intracranial pressure (ICP).

Methods The recorded indexes included the optic nerve diameter, the optic nerve sheath diameter (ONSD), the width of both sides of the ONSAS (ONSASW) at 3 mm from the optic nerve head and the entire ONSASA outlined between 3 and 7 mm. After exploring and comparing five models to describe the relationship between body mass index (BMI), mean arterial blood pressure (MABP), ONSASA and ICP, the best model was determined.

Results In all, 90 patients with neurological diseases undergoing continuous invasive ICP monitoring were included in the study. In the training group, the correlation coefficient for the association between the ICP and ONSASA (Pearson’s correlation r=0.953) was higher than that for the association of the ICP with the ONSD (r=0.672; p<0.0001) and ONSASW at 3 mm behind the globe (r=0.691; p<0.0001). In the training group, the weighting function for prediction of the ICP was as follows: non-invasive ICP=2.050×ONSASA−0.051×BMI +0.036*MABP−5.837. With 20 mm Hg as the cut-off point for a high or low ICP, the sensitivity and specificity of ONSASA predicting ICP was 1.00 and 0.92. Receiver operator curve analysis revealed that the calculated cut-off value for predicting elevated ICP was 19.96 (area under curve= 0.960, 95% CI 0.865 to 1.00).

Conclusion Measurement of the ONSASA using ultrasonography can serve as a practical method for rapid and non-invasive quantification for evaluating ICP through an accurate mathematical formula with the BMI and MABP considered as contributing parameters.

Trial registration number The study was registered in the Chinese Clinical Trial Registry (Study no ChiCTR2100045274).

  • Optic Nerve
  • Glaucoma

Data availability statement

No data are available. Not available.

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Data availability statement

No data are available. Not available.

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  • YZ and KC contributed equally.

  • Correction notice The second affiliation has been updated since this article was first published.

  • Contributors YZ and KC contributed equally to this work. YZ, KC, HL, NinglW and NingW contributed to the conception and design. NingW, XQ, RP, YZ, KC, Kang Jun and HL performed the experiments, analysed data and wrote the manuscript. NinglW, XQ and RP participated in the collection of patient characteristics. HL is responsible for the overall content as the guarantor. All authors read and approved the final manuscript.

  • Funding This work was supported by Beijing Nova program (Z191100001119072) and National Natural Science Foundation of China (82171051).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.