Early Prediction of Post-Dural Puncture Headache Using Ultrasound-Measured Optic Nerve Sheath Diameter in Cesarean Section Patients: A Prospective Observational Study
Early Prediction of Post-Dural Puncture Headache Using Ultrasound-Measured Optic Nerve Sheath Diameter in Cesarean Section Patients: A Prospective Observational Study
The Optic Nerve Sheath Diameter (ONSD), measured non-invasively by bedside ultrasound, is a well-established surrogate for intracranial pressure (ICP), as the optic nerve sheath is continuous with the intracranial dura mater and its subarachnoid space is filled with cerebrospinal fluid (CSF). While ONSD is typically used to detect elevated ICP (with a cut-off often > 5.0-5.7 mm for ICP > 20 mmHg), studies investigating PDPH have paradoxically shown a reduction in ONSD post-spinal anesthesia, correlating with the state of intracranial hypotension.
Previous research has demonstrated that a lower ONSD or a significant decrease in ONSD values 24 hours post-puncture is associated with PDPH development. A study determined that an ONSD at 24 hours of less than 0.40 cm was the best predictor for PDPH. Our study aims to specifically investigate the utility of the immediate change in ONSD to offer a bedside, real-time assessment of risk.
Inclusion Criteria:
Exclusion Criteria:
Pre-existing headache disorders (e.g., migraine, chronic tension-type headache)
Known ophthalmic conditions (e.g., optic neuropathy, glaucoma)
Inability to cooperate with ONSD(Optic Nerve Sheath Diameter) ultrasound measurements or follow-up
Allergy to local anesthetics
Emergency cesarean section
Contraindications to spinal anesthesia:
Preexisting hypertension on medication
Pre-eclampsia with severe features (suggested for separate study)
Known cardiac disease with hemodynamic instability
Allergy to study drugs
Fetal distress or non-reassuring cardiotocography (CTG)
Body Mass Index (BMI) >40 kg/m²
Refusal to sign informed consent
nevenabdo@azhar.edu.eg+201060383012