MINI REVIEW article
Front. Surg.
Sec. Neurosurgery
This article is part of the Research TopicDoing More with Less: Neurosurgery Strategies and Tricks of the Trade in the Technological EraView all 22 articles
Optic Nerve Changes Detected with Ocular Ultrasonography During Epiduroscopy: A Narrative Review
Provisionally accepted
- 1Konya Education and Research Hospital, Konya, Türkiye
- 2Yıldırım Beyazıt University, Ankara, Ankara, Türkiye
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Background: Epiduroscopy has emerged as a transformative minimally invasive tool for the diagnosis and treatment of spinal diseases. However, the infusion of irrigation fluids and manipulation of epidural structures during the procedure may unintentionally alter intracranial dynamics, leading to transient increases in intracranial pressure (ICP). Objectives: This narrative review aims to evaluate the relationship between epiduroscopy and changes in optic nerve morphology, advocating for the use of ocular ultrasonography (OUS) as a non-invasive monitoring tool. Methods: We consolidated contemporary literature regarding the pathophysiological foundations of optic nerve sheath diameter (ONSD) changes and the clinical utility of OUS during spinal interventions. Results: Ocular ultrasonography allows for real-time, bedside measurement of ONSD, which serves as a reliable indirect indicator of ICP. The optic nerve sheath, being continuous with the subarachnoid space, dilates in response to pressure surges transmitted from the epidural compartment during fluid irrigation. Studies have shown that dynamic monitoring of ONSD can guide intraoperative decisions, such as adjusting irrigation pressure or volume. Conclusion and Future Directions: While OUS is currently subject to operator dependency, it provides a valuable non-invasive adjunct for identifying potential increases in ICP during epiduroscopy. Integrating ONSD evaluations into monitoring protocols may support clinical decision-making and enhance procedural vigilance. Future large-scale prospective studies are needed to establish standardized intervention thresholds and improve long-term patient outcomes.
Keywords: Epiduroscopy, Intracranial pressure (ICP), non-invasive monitoring, Ocular Ultrasonography (OUS), Optic nerve sheath diameter (ONSD), Spinal procedures
Received: 31 Mar 2025; Accepted: 31 Jan 2026.
Copyright: © 2026 coven, tire, mermer, celep and Coven. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: ilker coven
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