Intensive Care Medicine

, Volume 44, Issue 8, pp 1284–1294 | Cite as

Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis

  • Chiara RobbaEmail author
  • Gregorio Santori
  • Marek Czosnyka
  • Francesco Corradi
  • Nicola Bragazzi
  • Llewellyn Padayachy
  • Fabio Silvio Taccone
  • Giuseppe Citerio
Systematic Review



Although invasive intracranial devices (IIDs) are the gold standard for intracranial pressure (ICP) measurement, ultrasonography of the optic nerve sheath diameter (ONSD) has been suggested as a potential non-invasive ICP estimator. We performed a meta-analysis to evaluate the diagnostic accuracy of sonographic ONSD measurement for assessment of intracranial hypertension (IH) in adult patients.


We searched on electronic databases (MEDLINE/PubMed®, Scopus®, Web of Science®, ScienceDirect®, Cochrane Library®) until 31 May 2018 for comparative studies that evaluated the efficacy of sonographic ONSD vs. ICP measurement with IID. Data were extracted independently by two authors. We used the QUADAS-2 tool for assessing the risk of bias (RB) of each study. A diagnostic meta-analysis following the bivariate approach and random-effects model was performed.


Seven prospective studies (320 patients) were evaluated for IH detection (assumed with ICP > 20 mmHg or > 25 cmH2O). The accuracy of included studies ranged from 0.811 (95% CI 0.678‒0.847) to 0.954 (95% CI 0.853‒0.983). Three studies were at high RB. No significant heterogeneity was found for the diagnostic odds ratio (DOR), positive likelihood ratio (PLR) and negative likelihood ratio (NLR), with I2 < 50% for each parameter. The pooled DOR, PLR and NLR were 67.5 (95% CI 29‒135), 5.35 (95% CI 3.76‒7.53) and 0.088 (95% CI 0.046‒0.152), respectively. The area under the hierarchical summary receiver-operating characteristic curve (AUHSROC) was 0.938. In the subset of five studies (275 patients) with IH defined for ICP > 20 mmHg, the pooled DOR, PLR and NLR were 68.10 (95% CI 26.8‒144), 5.18 (95% CI 3.59‒7.37) and 0.087 (95% CI 0.041‒0.158), respectively, while the AUHSROC was 0.932.


Although the wide 95% CI in our pooled DOR suggests caution, ultrasonographic ONSD may be a potentially useful approach for assessing IH when IIDs are not indicated or available (CRD42018089137, PROSPERO).


Intracranial pressure Invasive intracranial devices Optic nerve sheath diameter Ultrasonography Adult patients Meta-analysis 


Compliance with ethical standards

Conflicts of interest

None of the authors have any potential conflict of interest associated with this study.

Ethics and dissemination

Formal ethical approval was not required as primary data were not collected.

Supplementary material

134_2018_5305_MOESM1_ESM.docx (179 kb)
Supplementary material 1 (DOCX 179 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Anaesthesia and Intensive CareSan Martino Policlinico Hospital, IRCCS for OncologyGenoaItaly
  2. 2.Neurosciences Critical Care UnitAddenbrooke’s Hospital, University of CambridgeCambridgeUK
  3. 3.Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
  4. 4.Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics LaboratoryCambridge Biomedical Campus, Addenbrooke’s Hospital, University of CambridgeCambridgeUK
  5. 5.Institute of Electronic Systems, Warsaw University of TechnologyWarsawPoland
  6. 6.Anaesthesia and Intensive Care UnitE.O. Ospedali GallieraGenoaItaly
  7. 7.Department of Health Sciences (DISSAL)University of GenoaGenoaItaly
  8. 8.Paediatric Neurosurgery Unit, Division of Neurosurgery, Faculty of Health SciencesRed Cross War Memorial Children’s Hospital, University of Cape TownCape TownSouth Africa
  9. 9.Department of Intensive CareClinique Universitaire de Bruxelles (CUB) ErasmeBrusselsBelgium
  10. 10.School of Medicine and SurgeryUniversity of Milan-BicoccaMilanItaly

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