2Gaziantep Sehitkamil State Hospital, Neurosurgery, Gaziantep, Türkiye
3Nusaybin State Hospital, Neurosurgery, Mardin, Türkiye DOI : 10.29400/tjgeri.2025.462 Introduction: This study evaluates the prognostic value of optic nerve sheath diameter measurement as a noninvasive indicator of elevated intracranial pressure and its potential role in guiding decompressive surgical decisionmaking in elderly patients with ischemic stroke.
Materials and Method: This multicenter retrospective observational study included patients over 65 years of age who were hospitalized with middle cerebral artery infarction between 2023 and 2025. Patients with intracranial mass lesions, hydrocephalus, orbital pathology, or a history of head trauma were excluded. Preoperative and postoperative optic nerve sheath diameter measurements were obtained using computed tomography at a distance of 3 mm posterior to the optic disc. Clinical and radiological parameters, including Glasgow Coma Scale, Glasgow Outcome Scale, infarct volume, and degree of midline shift, were systematically analyzed.
Results: A total of 97 patients were included (57.7% female; mean age 75.3 ± 8.5 years). The mean preoperative optic nerve sheath diameter was 4.21 ± 0.81 mm. Increased preoperative optic nerve sheath diameter, larger infarct volume, and greater midline shift were significantly associated with lower Glasgow Outcome Scale scores (p = 0.035). An optic nerve sheath diameter threshold above 4.4 mm predicted poorer outcomes, while postoperative optic nerve sheath diameter variation showed no significant correlation with prognosis.
Conclusion: Preoperative optic nerve sheath diameter measurement may serve as a rapid, noninvasive, and reliable parameter for prognostication and for supporting early surgical decision-making in elderly patients with ischemic stroke. However, individualized multidisciplinary evaluation remains crucial given the complex clinical profile of this population.
Keywords : Ischemic Stroke; Intracranial Pressure; Decompressive Craniectomy; Prognosis