Avaliação ultrassonográfica da distensão da bainha do nervo óptico, relacionada com os padrões de curva de pressão intracranianas em portadores de neoplasias encefálicas

Abstract

BACKGROUND: The assessment of intracranial pressure (ICP) is crucial for a good management of patients affected by a series of pathologies, among which: traumatic brain injury, stroke, hydrocephalus, expansive processes, such as tumors or abscesses and even in the differential diagnosis of dementia and cognitive- behavioral alterations. ICP values ​​between 20 and 30 mmHg are serious and require urgent intervention, values ​​between 30 and 40 mmHg usually led the patient to a comatose state, and values ​​maintained above 40 mmHg most often indicate a prognosis of death. Invasive methods, however, have complications that, when they occur, can aggravate the patient's condition, such as bleeding and infections. Some studies have already been carried out evaluating the ICP of several pathologies, such as hydrocephalus, epilepsy and traumatic brain injury, using a new minimally invasive method. However, there are no comparative studies in relation to the data found in the measurement of ICP between this new non-invasive method and the images of distension of the optic nerve sheath in patients with brain cancer. This study is important so that we can understand this relationship and understand the possible variations found between the distension of the optic nerve sheath measured by ultrasound, comparing it with the measurements of cerebral intracranial pressure by a non-invasive method and later comparing it with the Karnofsky scale. OBJECTIVES: To analyze the ultrasonographic distension of the optic nerve sheath together with the morphology of intracranial pressure waves measured with a non- invasive transducer in patients diagnosed with expanding brain injury; compare the magnitude of distension of the Optic Nerve Sheath together with the intracranial pressure by non-invasive transducer comparing with the degree of functionality of the patient based on the Karnofsky scale. METHODOLOGY: It will be a unicentric, analytical, prospective cohort study. A sample of 29 (twenty nine) patients was calculated who will undergo a protocol of pre and postoperative measurements of non-invasive ICP and transorbital Ultrasonography (USG). Subsequently, these data will be compared with the functional condition of these patients, through the Karnofsky Scale. RESULTS: When P2/P1_pre is correlated with USG_pre, a negative correlation of 0.462 is found with p< 0.05 and when P2/P1_post is analyzed with USG_post, a negative correlation of 0.4797 is found with p < 0.05. The results found in relation to transorbital ultrasonography were not statistically significant. CONCLUSIONS: the results demonstrate that the USG analysis was able to show, in a short period of time, from the immediate postoperative period, the decrease in the distension of the optic nerve sheath after the neurosurgical procedure. However with p>0.05. This study failed to show the same relationship when analyzing the non- invasive sensor. The results of P2/P1_pre was 1.16 (which in the initial study protocol) corresponds to the gray zone and P2/P1_post 1.19, which corresponds to the same zone. When Pearson's correlation was performed between USG_pre_mean 5.40mm and P2/P1_pre 1.16, the result was negative 0.462 with p < 0.05. This fact demonstrates that while the optic nerve sheath declined, the sensor result increased. The same proportion was also evidenced in the USG_post_mean and P2/P1_post correlation was negative 0.4797 with p<0.05.