Hipotensión intracraneal relacionada con la derivación de líquido cefalorraquídeo (LCR): Prueba dinámica por ultrasonido del diámetro de la vaina del nervio óptico (ONSD), una nueva técnica de apoyo diagnóstico
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sep 16, 2024
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Resumen
Introducción: El sobredrenaje de líquido cefalorraquídeo (LCR) es una complicación conocida de los procedimientos de derivación en hidrocefalia, mientras que su fisiopatología, diagnóstico y conceptos terapéuticos siguen siendo temas de discusión. En este contexto, la hipotensión intracraneal está bien documentada. La ecografía del diámetro de la vaina del nervio óptico (ONSD) es un procedimiento emergente validado para la hipertensión intracraneal. Recientemente, se ha propuesto su utilidad diagnóstica para pacientes con síndrome de hipotensión intracraneal espontánea. Material y Método: Presentamos tres casos de cefalea asociada a shunt de LCR donde se sospecha de hipotensión intracraneal. La prueba dinámica por ecografía del diámetro de la vaina del nervio óptico, una técnica novedosa y no invasiva, se presenta como un método complementario para el diagnóstico y seguimiento del paciente. En todos los casos se reemplazaron las válvulas del shunt de LCR, logrando así la resolución completa de los síntomas y la normalización de la prueba dinámica por ecografía. Conclusión: Aunque se trata de una serie de casos limitada, creemos que la prueba dinámica por ecografía del ONSD puede ser una técnica útil para el diagnóstico y seguimiento del paciente con cefalea relacionada con el shunt de LCR en la que se sospecha sobredrenaje. Esta serie de casos parece ser el primer informe que evalúa la utilidad de la prueba dinámica por ecografía del ONSD para la evaluación no invasiva de la cefalea relacionada con el shunt de LCR, dejando un interesante campo de investigación en este complejo contexto clínico.
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Palabras clave
Sobredrenaje de líquido cefalorraquídeo, hipotensión intracraneal, ecografía dinámica, diámetro de la vaina del nervio óptico, cefalea relacionada con shunt, evaluación no invasiva
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2. Cheok S, Chen J, Lazareff J (2014) The truth and coherence behind the concept of overdrainage of cerebrospinal fluid in hydrocephalic patients. Childs Nerv Syst 30(4):599–606
3. Rekate, H. L. (2008). Shunt-related headaches: The slit ventricle syndromes. Childs Nervous System,24(4), 423-430.
4. Olson S (2004) The problematic slit ventricle syndrome. A review of the literature and proposed algorithm for treatment. Pediatr Neurosurg 40(6):264–269
5. Khorasani L, Sikorski CW, Frim DM (2004) Lumbar CSF shunting preferentially drains the cerebral subarachnoid over the ventricular spaces: implications for the treatment of slit ventricle síndrome. Pediatr Neurosurg 40(6):270–276
6. Dubourg, J., Javouhey, E., Geeraerts, T., Messerer, M., & Kassai, B. (2011). Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: A systematic review and meta-analysis. Intensive Care Medicine,37(7), 1059-1068.
7. Moretti, R., & Pizzi, B. (2011). Ultrasonography of the optic nerve in neurocritically ill patients. Acta Anaesthesiologica Scandinavica,55(6), 644-652.
8. Robba, C., Santori, G., Czosnyka, M., Corradi, F., Bragazzi, N., Padayachy, L., . . . Citerio, G. (2018). Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: A systematic review and meta-analysis. Intensive Care Medicine,44(8), 1284-1294.
9. Ohle, R., Mcisaac, S. M., Woo, M. Y., & Perry, J. J. (2015). Sonography of the Optic Nerve Sheath Diameter for Detection of Raised Intracranial Pressure Compared to Computed Tomography. Journal of Ultrasound in Medicine,34(7), 1285-1294.
10. Lochner, P., Fassbender, K., Knodel, S., Andrejewski, A., Lesmeister, M., Wagenpfeil, G., . . . Brigo, F. (2018). B-Mode Transorbital Ultrasonography for the Diagnosis of Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis. Ultraschall in Der Medizin - European Journal of Ultrasound.
11. Garcia Molina, J. (2019). Utilidad diagnóstica de la ecografía de vaina de nervio óptico (evno), como método no invasivo para la detección de hipertensión intracraneal. Estudio prospectivo de 95 mediciones comparado con monitoreo invasivo en Chile. Revista Chilena De Neurocirugía, 45(1), 38–44.
12. Bäuerle, J., Gizewski, E. R., Stockhausen, K. V., Rosengarten, B., Berghoff, M., Grams, A. E., . . . Nedelmann, M. (2011). Sonographic Assessment of the Optic Nerve Sheath and Transorbital Monitoring of Treatment Effects in a Patient with Spontaneous Intracranial Hypotension: Case Report. Journal of Neuroimaging, 23(2), 237-239.
13. Fichtner, J., Ulrich, C. T., Fung, C., Knüppel, C., Veitweber, M., Jilch, A., . . . Beck, J. (2015). Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator. Journal of Neurology, Neurosurgery & Psychiatry,87(6), 650-655.
14. Fichtner, J., Ulrich, C. T., Fung, C., Cipriani, D., Gralla, J., Piechowiak, E. I., . . . Beck, J. (2018). Sonography of the optic nerve sheath diameter before and after microsurgical closure of a dural CSF fistula in patients with spontaneous intracranial hypotension – a consecutive cohort study. _Cephalalgia, _033310241879364.
15. Pudenz RH, Foltz EL (1991) Hydrocephalus: overdrainage by ventricular shunts. A review and recommendations. Surg Neurol 35(3): 200–212
16. Rekate HL (1993) Classification of slit-ventricle syndromes using intracranial pressure monitoring. Pediatr Neurosurg 19(1):15–20
17. Hansen, H., & Helmke, K. (1997). Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. _Journal of Neurosurgery,_34-40.
18. Maissan, I. M., Dirven, P. J., Haitsma, I. K., Hoeks, S. E., Gommers, D., & Stolker, R. J. (2015). Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. _Journal of Neurosurgery,_743-747.
19. Chen, L., Wang, L., Hu, Y., Jiang, X., Wang, Y., & Xing, Y. (2018). Ultrasonic measurement of optic nerve sheath diameter: A non-invasive surrogate approach for dynamic, real-time evaluation of intracranial pressure. British Journal of Ophthalmology.
20. Hassen, G. W., Al-Juboori, M., Koppel, B., Akfirat, G., & Kalantari, H. (2018). Real time optic nerve sheath diameter measurement during lumbar puncture. The American Journal of Emergency Medicine,36(4).
21. Singleton, J., Dagan, A., Edlow, J. A., & Hoffmann, B. (2015). Real-time optic nerve sheath diameter reduction measured with bedside ultrasound after therapeutic lumbar puncture in a patient with idiopathic intracranial hypertension. The American Journal of Emergency Medicine,33(6).
22. Watanabe, A., Horikoshi, T., Uchida, M., Ishigame, K., & Kinouchi, H. (2008). Decreased Diameter of the Optic Nerve Sheath Associated with CSF Hypovolemia: Fig 1. American Journal of Neuroradiology,29(5), 863-864.
23. Rohr, A., Jensen, U., Riedel, C., Baalen, A. V., Fruehauf, M., Bartsch, T., . . . Jansen, O. (2010). MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension. American Journal of Neuroradiology,31(9), 1752-1757.
24. Dubost, C., Gouez, A. L., Zetlaoui, P., Benhamou, D., Mercier, F., & Geeraerts, T. (2011). Increase in optic nerve sheath diameter induced by epidural blood patch: A preliminary report. British Journal of Anaesthesia,107(4), 627-630.
25. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). Cephalalgia,38(1), 1-211.
26. Lochner, P., Czosnyka, M., Naldi, A., Lyros, E., Pelosi, P., Mathur, S., … Robba, C. (2019). Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians. Neurological Sciences, 40(12), 2447–2457
27. Lin, S. D., Kahne, K. R., El Sherif, A., Mennitt, K., Kessler, D., Ward, M. J., & Platt, S. L. (2019). The Use of Ultrasound-Measured Optic Nerve Sheath Diameter to Predict Ventriculoperitoneal Shunt Failure in Children. Pediatric emergency care, 35(4), 268–272. https://doi.org/10.1097/PEC.0000000000001034
28. Cipriani D, Rodriguez B, Häni L, Zimmermann R, Fichtner J, Ulrich CT, Raabe A, Beck J, Z'Graggen WJ. Postural changes in optic nerve and optic nerve sheath diameters in postural orthostatic tachycardia syndrome and spontaneous intracranial hypotension: A cohort study. PLoS One. 2019 Oct 9;14(10):e0223484. doi: 10.1371/journal.pone.0223484. PMID: 31596889; PMCID: PMC6785073.
29. Sæhle T, Eide PK. Intracranial pressure monitoring in pediatric and adult patients with hydrocephalus and tentative shunt failure: a single-center experience over 10 years in 146 patients. J Neurosurg. 2015 May;122(5):1076-86. doi: 10.3171/2014.12.JNS141029. Epub 2015 Feb 13. PMID: 25679270.
2. Cheok S, Chen J, Lazareff J (2014) The truth and coherence behind the concept of overdrainage of cerebrospinal fluid in hydrocephalic patients. Childs Nerv Syst 30(4):599–606
3. Rekate, H. L. (2008). Shunt-related headaches: The slit ventricle syndromes. Childs Nervous System,24(4), 423-430.
4. Olson S (2004) The problematic slit ventricle syndrome. A review of the literature and proposed algorithm for treatment. Pediatr Neurosurg 40(6):264–269
5. Khorasani L, Sikorski CW, Frim DM (2004) Lumbar CSF shunting preferentially drains the cerebral subarachnoid over the ventricular spaces: implications for the treatment of slit ventricle síndrome. Pediatr Neurosurg 40(6):270–276
6. Dubourg, J., Javouhey, E., Geeraerts, T., Messerer, M., & Kassai, B. (2011). Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: A systematic review and meta-analysis. Intensive Care Medicine,37(7), 1059-1068.
7. Moretti, R., & Pizzi, B. (2011). Ultrasonography of the optic nerve in neurocritically ill patients. Acta Anaesthesiologica Scandinavica,55(6), 644-652.
8. Robba, C., Santori, G., Czosnyka, M., Corradi, F., Bragazzi, N., Padayachy, L., . . . Citerio, G. (2018). Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: A systematic review and meta-analysis. Intensive Care Medicine,44(8), 1284-1294.
9. Ohle, R., Mcisaac, S. M., Woo, M. Y., & Perry, J. J. (2015). Sonography of the Optic Nerve Sheath Diameter for Detection of Raised Intracranial Pressure Compared to Computed Tomography. Journal of Ultrasound in Medicine,34(7), 1285-1294.
10. Lochner, P., Fassbender, K., Knodel, S., Andrejewski, A., Lesmeister, M., Wagenpfeil, G., . . . Brigo, F. (2018). B-Mode Transorbital Ultrasonography for the Diagnosis of Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis. Ultraschall in Der Medizin - European Journal of Ultrasound.
11. Garcia Molina, J. (2019). Utilidad diagnóstica de la ecografía de vaina de nervio óptico (evno), como método no invasivo para la detección de hipertensión intracraneal. Estudio prospectivo de 95 mediciones comparado con monitoreo invasivo en Chile. Revista Chilena De Neurocirugía, 45(1), 38–44.
12. Bäuerle, J., Gizewski, E. R., Stockhausen, K. V., Rosengarten, B., Berghoff, M., Grams, A. E., . . . Nedelmann, M. (2011). Sonographic Assessment of the Optic Nerve Sheath and Transorbital Monitoring of Treatment Effects in a Patient with Spontaneous Intracranial Hypotension: Case Report. Journal of Neuroimaging, 23(2), 237-239.
13. Fichtner, J., Ulrich, C. T., Fung, C., Knüppel, C., Veitweber, M., Jilch, A., . . . Beck, J. (2015). Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator. Journal of Neurology, Neurosurgery & Psychiatry,87(6), 650-655.
14. Fichtner, J., Ulrich, C. T., Fung, C., Cipriani, D., Gralla, J., Piechowiak, E. I., . . . Beck, J. (2018). Sonography of the optic nerve sheath diameter before and after microsurgical closure of a dural CSF fistula in patients with spontaneous intracranial hypotension – a consecutive cohort study. _Cephalalgia, _033310241879364.
15. Pudenz RH, Foltz EL (1991) Hydrocephalus: overdrainage by ventricular shunts. A review and recommendations. Surg Neurol 35(3): 200–212
16. Rekate HL (1993) Classification of slit-ventricle syndromes using intracranial pressure monitoring. Pediatr Neurosurg 19(1):15–20
17. Hansen, H., & Helmke, K. (1997). Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. _Journal of Neurosurgery,_34-40.
18. Maissan, I. M., Dirven, P. J., Haitsma, I. K., Hoeks, S. E., Gommers, D., & Stolker, R. J. (2015). Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. _Journal of Neurosurgery,_743-747.
19. Chen, L., Wang, L., Hu, Y., Jiang, X., Wang, Y., & Xing, Y. (2018). Ultrasonic measurement of optic nerve sheath diameter: A non-invasive surrogate approach for dynamic, real-time evaluation of intracranial pressure. British Journal of Ophthalmology.
20. Hassen, G. W., Al-Juboori, M., Koppel, B., Akfirat, G., & Kalantari, H. (2018). Real time optic nerve sheath diameter measurement during lumbar puncture. The American Journal of Emergency Medicine,36(4).
21. Singleton, J., Dagan, A., Edlow, J. A., & Hoffmann, B. (2015). Real-time optic nerve sheath diameter reduction measured with bedside ultrasound after therapeutic lumbar puncture in a patient with idiopathic intracranial hypertension. The American Journal of Emergency Medicine,33(6).
22. Watanabe, A., Horikoshi, T., Uchida, M., Ishigame, K., & Kinouchi, H. (2008). Decreased Diameter of the Optic Nerve Sheath Associated with CSF Hypovolemia: Fig 1. American Journal of Neuroradiology,29(5), 863-864.
23. Rohr, A., Jensen, U., Riedel, C., Baalen, A. V., Fruehauf, M., Bartsch, T., . . . Jansen, O. (2010). MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension. American Journal of Neuroradiology,31(9), 1752-1757.
24. Dubost, C., Gouez, A. L., Zetlaoui, P., Benhamou, D., Mercier, F., & Geeraerts, T. (2011). Increase in optic nerve sheath diameter induced by epidural blood patch: A preliminary report. British Journal of Anaesthesia,107(4), 627-630.
25. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). Cephalalgia,38(1), 1-211.
26. Lochner, P., Czosnyka, M., Naldi, A., Lyros, E., Pelosi, P., Mathur, S., … Robba, C. (2019). Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians. Neurological Sciences, 40(12), 2447–2457
27. Lin, S. D., Kahne, K. R., El Sherif, A., Mennitt, K., Kessler, D., Ward, M. J., & Platt, S. L. (2019). The Use of Ultrasound-Measured Optic Nerve Sheath Diameter to Predict Ventriculoperitoneal Shunt Failure in Children. Pediatric emergency care, 35(4), 268–272. https://doi.org/10.1097/PEC.0000000000001034
28. Cipriani D, Rodriguez B, Häni L, Zimmermann R, Fichtner J, Ulrich CT, Raabe A, Beck J, Z'Graggen WJ. Postural changes in optic nerve and optic nerve sheath diameters in postural orthostatic tachycardia syndrome and spontaneous intracranial hypotension: A cohort study. PLoS One. 2019 Oct 9;14(10):e0223484. doi: 10.1371/journal.pone.0223484. PMID: 31596889; PMCID: PMC6785073.
29. Sæhle T, Eide PK. Intracranial pressure monitoring in pediatric and adult patients with hydrocephalus and tentative shunt failure: a single-center experience over 10 years in 146 patients. J Neurosurg. 2015 May;122(5):1076-86. doi: 10.3171/2014.12.JNS141029. Epub 2015 Feb 13. PMID: 25679270.
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Venegas, D., Salazar, C., Cuevas, J. L., & García, J. (2024). Hipotensión intracraneal relacionada con la derivación de líquido cefalorraquídeo (LCR): Prueba dinámica por ultrasonido del diámetro de la vaina del nervio óptico (ONSD), una nueva técnica de apoyo diagnóstico. Revista Chilena De Neurocirugía, 50(1), 21–26. https://doi.org/10.36593/revchilneurocir.v50i1.437
