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Non-invasive intracranial pressure monitoring and its applicability in spaceflight
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Uma das principais prioridades na saúde de astronautas que realizam viagens de longa duração, são achados neuro-oftalmológicos atualmente definidos como Spaceflight-Associated Neuro-ocular Syndrome (SANS). Estes achados consistem em alterações oculares como papiledema, achatamento do globo ocular e dilatação da bainha do nervo óptico. Estas alterações foram já demonstradas em vários artigos que avaliaram astronautas, não só após longa exposição a ambientes de microgravidade, como após exposições mais curtas. Apesar de etiologicamente multifatorial e ainda parcialmente compreendido, as semelhanças que este síndrome apresenta com a hipertensão intracraniana idiopática sugere que estas alterações possam derivar de variações ou aumento da pressão intracraniana (PIC). No entanto, para se medir a PIC, o atual gold standard para a sua medição consiste na colocação de um sensor intraventricular e/ou intraparenquimatoso ou na realização de uma punção lombar. Além dos riscos e complicações que uma medição invasiva acarreta, conceptualmente manifesta-se problemático executar num contexto de viagem espacial. Como tal, torna-se essencial descobrir um método não-invasivo acessível, portátil e fiável de monitorizar a PIC durante esse tipo de viagens.
Neuro-ophthalmic findings collectively defined as Spaceflight-Associated Neuro-ocular Syndrome (SANS) are one of the leading health priorities in astronauts engaging in long duration spaceflight or prolonged microgravity exposure. Though multifactorial in etiology, similarities to terrestrial idiopathic intracranial hypertension (IIH) suggest these changes may result from an increase or impairing in intracranial pressure (ICP). Finding a portable, accessible and reliable method of monitoring ICP is, therefore, crucial in long duration spaceflight. A review of recent literature was conducted on PubMed using the search terms “non-invasive intracranial pressure”. The search retrieved several different methods, that were subsequently grouped by approach and technique. Majority of publications included the use of ultrasound-based methods, with variable accuracies. One of which, non-invasive ICP estimation by optical nerve sheath diameter measurement (nICP_ONSD) presented highest statistical correlation and prediction values to invasive ICP, with area under the curve (AUC) ranging from 0,75 to 0,964. One study even considers a combination of ONSD with transcranial doppler (TCD) for an even higher performance. Other methods, such as near-infrared spectroscopy (NIRS) show positive and promising results (good statistical correlation with invasive techniques when measuring cerebral perfusion pressure (CPP): r = 0,83). However, for its accessibility, portability and accuracy, ONSD presents itself as the up to date most reliable non-invasive ICP surrogate and a valuable spaceflight asset.
Neuro-ophthalmic findings collectively defined as Spaceflight-Associated Neuro-ocular Syndrome (SANS) are one of the leading health priorities in astronauts engaging in long duration spaceflight or prolonged microgravity exposure. Though multifactorial in etiology, similarities to terrestrial idiopathic intracranial hypertension (IIH) suggest these changes may result from an increase or impairing in intracranial pressure (ICP). Finding a portable, accessible and reliable method of monitoring ICP is, therefore, crucial in long duration spaceflight. A review of recent literature was conducted on PubMed using the search terms “non-invasive intracranial pressure”. The search retrieved several different methods, that were subsequently grouped by approach and technique. Majority of publications included the use of ultrasound-based methods, with variable accuracies. One of which, non-invasive ICP estimation by optical nerve sheath diameter measurement (nICP_ONSD) presented highest statistical correlation and prediction values to invasive ICP, with area under the curve (AUC) ranging from 0,75 to 0,964. One study even considers a combination of ONSD with transcranial doppler (TCD) for an even higher performance. Other methods, such as near-infrared spectroscopy (NIRS) show positive and promising results (good statistical correlation with invasive techniques when measuring cerebral perfusion pressure (CPP): r = 0,83). However, for its accessibility, portability and accuracy, ONSD presents itself as the up to date most reliable non-invasive ICP surrogate and a valuable spaceflight asset.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Medição não invasiva da pressão intracraniana Doppler transcraniano Spaceflight-Associated Neuro-ocular Syndrome Optical nerve sheath diameter Neurocirurgia