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Non-invasive intracranial pressure estimation using ultrasonographic measurement of area of optic nerve subarachnoid space
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  • Published on: 20 October 2023
    Letter to the Editor: Non-invasive intracranial pressure estimation using ultrasonographic measurement of area of optic nerve subarachnoid space
    • Hanspeter E Killer, Ophthalmologist/Professor Department of Biomedicine, University Hospital Basel & University Basel, Basel, Switzerland
    • Other Contributors:
      • Achmed Pircher, Ophthalmologist
      • David Fleischman, Ophthalmologist/Professor

    Dear Editor:

    We read the paper on non-invasive intracranial pressure determination by Zhang et al(1) with great interest and hope. We fully agree that the search for non-invasive intracranial pressure (ICP) evaluations is of high importance and should be continued. The Bland-Altman plot showing the difference between predicted and intracranially measured pressure looks very impressive. There are, however, still a few points and limits we would like to address concerning the anatomy of the optic nerve, the optic canal, and the basic concept the authors used.

    Cerebrospinal fluid (CSF) from the intracranial subarachnoid spaces and the subarachnoid space of the optic nerve (SAS -ON) communicate via the optic canal. Using three-dimensional reconstruction of the optic canal in normal tension glaucoma (NTG) patients, this was found to be narrower than in an age-related cohort of normals,(2) thus questioning the patency of the CSF pathway between the pituitary cistern and the SAS-ON. Further, optic canal dimensions in a normal population are quite variable amongst individuals, and even between orbits within the same individual.(3) These facts largely influence the results the authors present. Further, studies in patients with NTG and patients with elevated ICP (such as patients with idiopathic intracranial hypertension) were shown to have developed an optic nerve sheath compartment syndrome. In such cases, the CSF dynamics between the intracranial CSF and the CSF in...

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    Conflict of Interest:
    None declared.