Evaluation Of Prognosis In Patients With Subarachnoid Hemorrhage Using Computed Tomography

Objective:There are few studies on whether ONSD can evaluate the neurological outcome of SAH patients,and there is no uniform standard for the ONSD critical value of increased intracranial pressure.This study retrospectively analyzed the diameter of optic nerve sheath in patients with aneurysmal subarachnoid hemorrhage,to provides references for the selection of surgical indications for craniocerebral decompression surgery and the prognosis of the patients.Methods:From January 2019 to December 2019,109 patients with aneurysmal subarachnoid hemorrhage were selected,including 61 patients treated with interventional surgery,41 patients treated with intracranial aneurysm clipping,and 7 patients without intracranial aneurysm after routine DSA examination.The year of age,sex,diameter of optic nerve sheath,perioperative blood glucose were collected.According to the m RS score,the patients were divided into good prognosis(m RS score ?2)and poor prognosis(m RS score >3).The correlation between clinical characteristics of each group and patient prognosis was analyzed and compared by statistical method.Result:1.Selecting appropriate window width and window position on the CT(we used WW=300,WL=35 in this study)can clearly show the walking of optic nerve sheath,and combined with CT three reconstruction effects,we can clearly measure the ONSD diameter of patients with subarachnoid hemorrhage;2.A total of 109 patients were included in this study,including 78 cases with good prognosis whose mean diameter of optic nerve sheath was(4.96±0.55 mm),and the 95% confidence interval was 4.87~5.07 mm,with a maximum of 5.45 and a minimum of 3.20 mm.The mean diameter of optic nerve sheath was(5.57±0.78)in 31 patients with poor prognosis mm,95% and the confidence interval was 5.28~5.87 mm,in which the minimum value was 4.60 and the maximum value was 6.15 mm;and the mean value of poor prognosis group was higher than that of good prognosis group(P<0.05).There was no significant difference in sex,aneurysm location and hydrocephalus between the two groups.3.The blood glucose combined with ONSD and ONSD/ETD ratio has a good predictive value for the prognosis of patients.Conclusion:1.Optic nerve can be clearly displayed by head CT,and the width of the optic nerve can be measured using selecting the appropriate position.2.Prognosis of patients with subarachnoid hemorrhage was positively correlated with optic nerve sheath width.3.Intracranial hypertension was positively correlated with optic nerve sheath width.4.The width of the optic nerve sheath and the ratio of the transverse meridian of the eyeball were positively correlated with the prognosis of the patients.5.ONSD can combine relevant data to predict the prognosis of subarachnoid hemorrhage,but a larger sample size is needed to determine its critical value.