Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy

Philip Verdonck, Alain F. Kalmar, Koen Suy, Thomas Geeraerts, Marcel Vercauteren, Alex Mottrie, Andre M. De Wolf, Jan F.A. Hendrickx

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background: During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath diameter (ONSD) measurement, may warn us that the mechanism of protective cerebrospinal fluid (CSF) shifts becomes exhausted. Methods: After obtaining IRB approval and written informed consent, ONSD was measured by ocular ultrasound in 20 ASA Iâ€"II patients at various stages of the RALRP procedure: baseline awake, after induction, after applying the CO2PP, during head-down position, after resuming the supine position, in the postoperative anaesthesia care unit, and on day one postoperatively. Cerebral perfusion pressure (CPP) was calculated as the mean arterial (MAP) minus central venous pressure (CVP). Results: The ONSD did not change during head-down position, although the CVP increased from 4.2(2.5) mm Hg to 27.6(3.8) mm Hg. The CPP was decreased 70 min after assuming the head-down position until 15 min after resuming the supine position, but remained above 60 mm Hg at all times. Conclusion: Even though ICP has been documented to increase during CO2PP and head-down positioning, we did not find any changes in ONSD during head-down position. These results indicate that intracranial blood volume does not increase up to a point that CSF migration as a compensation mechanism becomes exhausted, suggesting any increases in ICP are likely to be small.

Original languageEnglish (US)
Article numbere0111916
JournalPloS one
Issue number11
StatePublished - Nov 2014

ASJC Scopus subject areas

  • General Agricultural and Biological Sciences
  • General
  • General Biochemistry, Genetics and Molecular Biology


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