Análise da mensuração ultrassonográfica do diâmetro da bainha do nervo óptico como preditor da hipertensão intracraniana: Revisão sistemática da literatura

• Ano de defesa: 2023
• Autor(a) principal: Fábio Santos Esteves Júnior
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; Brasil; ICB - INSTITUTO DE CIÊNCIAS BIOLOGICAS; Programa de Pós-Graduação em Neurociências; UFMG
• Palavras-chave em Português: diâmetro da bainha do nervo óptico; ultrassonografia; hipertensão intracraniana; monitorização; Neurociências; Nervo óptico; Ultrassonografia; Hipertensão intracraniana; Monitoramento
• Link de acesso: http://hdl.handle.net/1843/55833

Introduction: Traumatic brain injury (TBI) is the main cause of severe brain damage in children, with a high morbidity and mortality rate. Identify situations that may increase intracranial pressure (ICP) is important to avoid secondary damage to the brain and may affect crucial decisions that will set the pace for the neurosurgical conduct. Invasive ICP monitoring is the most consolidated method to measure ICP. However, it can bring serious complications such as exposing the patient to operative risks, bleeding situations and infections. In this scenario, non-invasive techniques for predicting intracranial hypertension (ICH), such as the ultrasound method for assessing optic nerve sheath diameter (ONSD), have been gaining ground. These techniques can be performed even in the emergency room, with good sensitivity and specificity. The ONSD is quick to perform and free of radiation. Studies evaluating the use of this technique in children are scarce, but higly necessary to broaden the knowledge and applicability of the test in emergency situations and for critically ill patients. Objectives: The main goal was the evaluation of the applicability of measuring the DBNO as a method of predicting ICH and mortality in pediatric TBI. The secondary objective was to estimate the standard value of normality for measuring the diameter of the optic nerve sheath in children with TBI. Methods: The elaboration of the PICO question was carried out, in addition to the definition of inclusion and exclusion criteria. A systematic review of the literature was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta- Analyzes (PRISMA), using Pubmed and Web of Science databases. Results: Among the 33 studies found in the initial search, only seven studies met the selection inclusion criteria, with four studies designed as longitudinal prospective and three studies as longitudinal retrospective. In all selected articles, the ultrasound method was defined or cited as an effective predictor of ICP elevation. In three studies, only ultrasound was used, in the others, tomography was the exam of choice. Each study showed a different reference value of normality for the DBNO, one of them without citing any value. Examined male patients prevailed, corresponding to the epidemiology of TBI in childhood. Conclusion: There are few studies referring to the ultrasonographic measurement of ONSD in pediatric patients with a potential chance of ICH. This test has a great correlation with predicting situations of increased ICP. However, there is no consensus regarding a normal ONSD value. The high heterogeneity of the avaiable studies contribute to this issue.