This study aimed to compare the effects of propofol-based anesthesia and propofol-ketamine anesthesia on optic nerve sheath diameter (ONSD) in patients undergoing elective endovascular treatment of unruptured intracranial aneurysms. ONSD, measured using ultrasonography, is a non-invasive surrogate marker of intracranial pressure. In addition, intraoperative hemodynamic parameters, cerebral oxygenation, and anesthetic requirements were evaluated to assess the safety and physiological impact of the two anesthesia techniques.

Endovascular treatment of unruptured intracranial aneurysms requires anesthetic strategies that maintain cerebral perfusion and hemodynamic stability while minimizing increases in intracranial pressure. Optic nerve sheath diameter (ONSD) measurement using ultrasonography is a widely accepted non-invasive method for assessing intracranial pressure changes.

This study included adult patients who underwent elective endovascular treatment for unruptured intracranial aneurysms. Patients were managed with either propofol-based anesthesia or a combination of propofol and ketamine according to routine clinical practice.

ONSD measurements were performed at predefined time points during the perioperative period, and changes in ONSD were analyzed. In addition, intraoperative mean arterial pressure, heart rate, end-tidal carbon dioxide levels, regional cerebral oxygen saturation, vasopressor requirements, and total anesthetic consumption were recorded.

The primary objective of the study was to compare changes in ONSD between the two anesthesia techniques. Secondary objectives included evaluation of hemodynamic stability, cerebral oxygenation, and anesthetic requirements.

Inclusion Criteria:

• Age between 18 and 75 years
• Patients scheduled for elective endovascular treatment of unruptured intracranial aneurysms
• ASA physical status I-III
• Glasgow Coma Scale score of 15
• Ability to read and write and provide written informed consent

Exclusion Criteria:

• Age under 18 or over 75 years
• ASA physical status IV or higher
• History of ocular disease or previous eye surgery
• Presence of giant aneurysm
• Increased intracranial pressure
• Coronary artery disease
• Psychiatric or neurological disorders interfering with consent or assessment
• Emergency surgical indication

Adult patients aged 18-75 years with unruptured intracranial aneurysms scheduled for elective endovascular treatment under general anesthesia at Ankara City Hospital Bilkent.

Individual participant data (IPD) will not be made publicly available due to ethical and institutional restrictions, as well as patient confidentiality considerations. The study was conducted as a single-center academic thesis, and data sharing was not specified in the informed consent.