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Optic nerve sheath diameter articles

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Optic nerve sheath diameter (ONSD) in healthy pregnant women at the anesthesia antenatal visit and in preeclamptic patients on the day of delivery. Evolution over time in the 7 days after delivery. Tenth, 25th, 75th, and 90th percentiles, as well as median values, are represented For this reason, intracranial pressure (ICP) increases are directly transmitted to the optic nerve sheath. Knowing the normal optic nerve sheath diameter (ONSD) range in a healthy population is necessary to interpret this measurement as a sign of intracranial pressure in clinical practice and research In acute large anterior circulation infarct patients with large core volume, we evaluated the role of optic nerve sheath diameter (ONSD) change rates in prediction of malignant progression. We performed a retrospective observational study including patients with anterior circulation acute ischemic stroke with large ischemic cores from January 2010 to October 2017

In recent years, measurement of optic nerve sheath diameter (ONSD) by ultrasonography has been developed and suggested as a possible indicator of intracranial hypertension [ 10 ]. The optic nerve sheath is a membrane covering the optic nerve behind the eye, and is continuous with the dura mater over the brain The subarachnoid space (SAS) around the optic nerve in the orbit can be detected by the fat saturation pulse sequence adapted for T2-weighted imaging. 1,2 The CSF in the SAS around the optic nerve can be differentiated from the surrounding fat tissue and appears as round high-intensity circles on the coronal images. The optic nerve sheath (ONS) diameter can be estimated by measuring the outer.

Ultrasound measured optic nerve sheath diameter is a noninvasive, nonirradiating tool for estimating intracranial hypertension The optic nerve sheath diameter (ONSD) can help predict the neurologic outcomes of patients with post-cardiac arrest (CA) return of spontaneous circulation (ROSC). We aimed to investigate the effect of ONSD changes before and after CA on neurologic outcomes in patients with ROSC after CA using brain computed tomography (CT) Optic nerve sheath diameter (ONSD) has been proposed as an alternative measure for the detection of intracranial hypertension [ 11, 12 ]. The ONSD may be associated with neurological outcomes of SAH patients. However, it has not been reported whether ONSD may facilitate systemic evaluation of neurological outcomes of patients with SAH

Optic Nerve Sheath Diameter on MR Imaging: Establishment of Norms and Comparison of Pediatric Patients with Idiopathic Intracranial Hypertension with Healthy Controls. B. Shofty, L. Ben-Sira, S. Constantini, S. Freedman, A. Kesler. American Journal of Neuroradiology Feb 2012, 33 (2) 366-369; DOI: 10.3174/ajnr.A2779 Optic nerve sheath diameter (ONSD) ultrasound is a noninvasive and repeatable tool to dynamically evaluate intracranial pressure with high diagnostic accuracy; however, data in neonates are scarce. The aim of this study was to determine the reference value of ONSD and potential influencing factors in healthy term neonates Using ultrasound to measure optic nerve sheath diameter (ONSD) is an emerging bedside technique to noninvasively assess intracranial pressure (ICP) in patients with brain injury. This technique is unique among bedside ultrasonography and is often performed by providers who have no formal ultrasound training The optic nerve sheath is continuous with the dura mater, and its contents are continuous with the subarachnoid space. In the anterior part of the optic nerve, the sheath is distensible and can expand in response to raised cerebrospinal fluid pressure, leading to an increase in the optic nerve sheath diameter [9,10]. When eICP is suspected, but. Optic nerve sheath diameter. ICC values showed an excellent agreement between the two researchers (both 0.95 at 3 mm and 6 mm, 95% confidence interval (CI): 0.90-0.98)

Identification of elevated intracranial pressure is important following traumatic brain injury. We assessed the feasibility of educating military trainees on accurately obtaining optic nerve sheath diameter measurements using a brief didactic and hands-on training session. Optic nerve sheath diameter is a noninvasive surrogate marker for elevated intracranial pressure, and may be of value in. Journal Pre-proof Utility of serial optic nerve sheath diameter measurements in patients undergoing cerebral spinal fluid diversion procedures for hydrocephalus Susanth Subramanian, M.Ch, Shalini Nair, MD, IFCCM, Ranjith K. Moorthy, M.Ch, Grace Rebekah, M.Sc; PhD, R. Krishnaprabhu, M.Ch, Baylis Vivek Joseph, M.Ch, Vedantam Rajshekhar, M.Ch PII. Optic nerve sheath diameter (ONSD) is gaining popularity as an easy, bedside, non-invasive ICP estimator The available evidence, summarised in this systematic review and meta-analysis, suggests its potential utility for estimating increased intracranial pressure non-invasively in critically ill patient

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The current study aimed to identify whether ultrasonographic measurements of optic nerve sheath diameter (ONSD) could dynamically and sensitively evaluate real-time intracranial pressure (ICP). ONSD measurements were performed approximately 5 min prior to and after a lumbar puncture (LP). A total of 84 patients (mean±SD age, 43.5±14.7 years; 41 (49%) men; 18 patients with elevated ICP) were. CAS Article Google Scholar 4. De Bernardo M, Vitiello L, Rosa N. Optic nerve sheath diameter ultrasound: optic nerve growth curve and its application to detect intracranial hypertension in children. Am J Ophthalmol. 2019;208:438. Article Google Scholar 5. Bala R, Kumar R, Sharma J Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is known to be an accurate monitor of elevated intracranial pressure (ICP). However, it is yet unknown whether fluctuations in ICP result in direct changes in ONSD

Purpose To evaluate the diagnostic accuracy of ultrasonography of optic nerve sheath diameter (ONSD) for assessment of intracranial hypertension. Methods Systematic review without language restriction based on electronic databases, with manual review of literature and conference proceedings until July 2010. Studies were eligible if they compared ultrasonography of ONSD with intracranial. Optic nerve sheath diameter measured using ocular sonography is raised in patients with eclampsia Renu Bala 1, Arnab Banerjee 2, Susheela Taxak 1, Rajesh Kumar 1 1 Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India 2 Department of Anaesthesiology and Critical Care, All India Institute of Medical Science, New Delhi, Indi

Optic nerve sheath diameter (ONSD) measurement by ultrasonography is a promising method to detect elevated intracranial pressure (ICP) [1, 2] and is gaining popularity as a beside assessment of ICP in critically ill patients [].This may be of particular benefit to undifferentiated patients presenting to the emergency department with concerns for elevated ICP and where Point-of-care ultrasound. Optic nerve sheath diameter increased from 0.79 cm to 0.86 cm as illustrated by the white arrow. In both ultrasound images the lens was bypassed in order to obtain the most accurate display of the posterior structures of the eye. Further both images are made by using a zoom box of 2 cm size Examination revealed papilloedema. The patient's optic nerve sheath diameter was measured 3 mm posterior to the globe and found to be 7.5 mm. The patient subsequently had computed tomography scan of her brain that showed an optic nerve sheath diameter of 7.56 mm as measured 3 mm posterior to the globe

Ultrasound measurement of optic nerve diameter and optic nerve sheath diameter in healthy Chinese adults. BMC Neurol. 2015; 15:106 doi: 10.1186/s12883-015-0361-x [Europe PMC free article] [Google Scholar Recently, measuring the optic nerve sheath diameter (ONSD) via ultrasonography has become a popular approach for detecting elevated ICP. 8-11 Previously, we confirmed that this noninvasive technique could be used to qualitatively and effectively identify elevations in ICP. 12 However, whether ultrasonographic ONSD measurements can be used to. Among 51 pregnant women, when the diameter of the optic nerve sheath was >5.8 mm, this threshold diameter was associated with 95% sensitivity and 100% specificity to detect increased ICP in preeclampsia [ 22 ]. In another study of 24 emergency rooms patients, an optic nerve sheath diameter of >5 mm had 100% sensitivity and 75% specificity [ 23 ] Ultrasound measurement of optic nerve sheath diameter (ONSD) appears to be a promising, rapid, non-invasive bedside tool for identification of elevated intra-cranial pressure. With improvements in ultrasound technology, machines are becoming smaller; however, it is unclear if these ultra-portable handheld units have the resolution to make these measurements precisely

Du J, Deng Y, Li H et al (2020) Ratio of optic nerve sheath diameter to eyeball transverse diameter by ultrasound can predict intracranial hypertension in traumatic brain injury patients: a prospective study. Neurocrit Care 32(2):478-485. Article Google Scholar 17 Optic nerve sheath diameter showed a pooled sensitivity of 0.88 (95% confidence interval, 0.79-0.94), a pooled specificity of 0.86 (95% confidence interval, 0.70-0.95), and an area under the hierarchical summary receiver operating characteristics curve of 0.93 (95% confidence interval, 0.91-0.95) for the diagnosis of raised intracranial. First, regardless of the validity of their results, it is unclear that they are actually measuring the optic nerve sheath diameter. As noted by Copetti and Cattarossi, 2 the anatomy of the eye is such that it would be unlikely for the optic nerve and sheath to be aligned in such a way as to produce the sonographic images studied

Optic nerve sheath diameter Radiology Reference Article

Optic nerve sheath diameter was 4.5 ± 0.4 mm in Group 1 and 4.4 ± 0.5 mm in Group 2 in 0th hour, and no statistical difference was found between the groups (p = 0.162). In Group 1, optic nerve sheath diameter increased 0.6 ± 0.4 mm after the treatment. Of the patients in Group 1, 22 (44%) patients with diabetic ketoacidosis or hyperosmolar. Background: to study the association between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in patients with moderate-to-severe brain injury.Patients and Methods: A retrospective cohort study of traumatic brain injury (TBI) patients was conducted between 2010 and 2014. Data were analyzed and compared according to the ICP monitoring cutoff values

Optic nerve sheath diameter Dilatation of the optic nerve sheath has been shown to be a much earlier manifestation of ICP rise 1) 2). For Liu et al. ONSD measured via head CT correlates with ICP and can predict the requirement for surgery in patients with TBI following admission to the emergency department 3). In a study of Agrawal et al. optic nerve sheath diameter demonstrated a modest. Aim: To evaluate the utility of measuring the optic nerve sheath diameter in children with shunted hydrocephalus, suspected of having raised intracranial pressure. Methods: 23 children with shunted hydrocephalus were examined, six had well controlled ICP, 17 however manifested symptoms suggestive of intracranial hypertension. A clinical history was taken from all patients and their parents or. Optic Nerve Sheath Diameter Measurement Using Magnetic Resonance Imaging High-resolution magnetic resonance imaging (MRI) can be used to precisely measure the diameter of the optic nerve and its surrounding sheath by using a fat-suppressed T2-weighted sequence. 27-31 ONSD can easily be measured using a T2-weighted sequence 3mm behind the.

Optic nerve sheath diameter assessment by neurosonology: A

  1. Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) isc emerging as an effective non-invasive technique to assess ICP. 12, 13 The optic nerve sheath (ONS) is a continuation of the brain's dura mater, whereas the subarachnoid space around the optic nerve is continuous with the intracranial subarachnoid space. Characteristics of the ONS, as well as blood flow to the eye, are.
  2. CAS PubMed Article Google Scholar 3. Kim MS, Bai SJ, Lee JR, Choi YD, Kim YJ, Choi SH. Increase in intracranial pressure during carbon dioxide pneumoperitoneum with steep trendelenburg positioning proven by ultrasonographic measurement of optic nerve sheath diameter. J Endourol. 2014;28(7):801-6
  3. Optic nerve sheath diameter (ONSD) assessment has been shown in multiple studies to have good correlation with intracranial pressure (ICP) [1-6]. It is one of the few modalities for non-invasive assessment of ICP. The optic nerve is surrounded by cerebrospinal fluid and ensheathed by all three meningeal layers (dura, arachnoid, and pia mater.
  4. Optic nerve sheath diameter (ONSD) measured 3 mm (A), 4 mm (B), and 5 mm (C) behind the eye globe at supine (0°) baseline (black squares) and after 4.5 h head-down tilt (HDT; gray squares) during various degrees of HDT and with additional interventions during −12° HDT. Data are presented as means ± SE
  5. In this letter to the Editor, we would like to comment on the article by Betcher et al., concerning the possibility of teaching military trainees to obtain accurate optic nerve sheath diameter measurements, using a brief didactic and a hands-on training session. In particular, this letter notes the importance of the measurement of optic nerve sheath diameter in detecting the eventual elevated.
  6. e intracranial pressure, considering that the brain subarachnoid space is continuous with the optic nerve sheath and the pressure should be transmitted. 1-4 However, the way to measure the diameter has yet to be deter

The idiopathic intracranial hypertension is a disease that is represented by high intracranial pressure of unknown reason. The visual disturbance presents the main medical problem of this syndrome. This study was conducted to assess the diagnostic value of the optic nerve sheath diameter (ONSD) measured using MRI 3D DRIVE in the diagnosis of idiopathic intracranial hypertension Background To report on the optic nerve sheath diameter (ONSD) in patients with normal-tension glaucoma (NTG) compared with controls without known optic nerve (ON) or intracranial disease. Methods In 18 patients with NTG (mean age 64.9±8.9 years; 7 women and 11 men), CT of the orbit was performed. 17 age- and gender-matched patients without ON or intracranial disease, who underwent CT of the.

Assessment of Optic Nerve Sheath Diameter in Patients

  1. Optic nerve sheath diameter ultrasonography at admission as a predictor of intracranial hypertension in traumatic brain injured patients: a prospective observational study Chiara Robba MD, PhD 1, 2, Joseph Donnelly MD, PhD 3, 4, Danilo Cardim.
  2. ation revealed papilloedema. The patient's optic nerve sheath diameter was measured 3 mm posterior to the globe and found to be 7.5 mm
  3. An ONSD > 5 mm suggests elevated intracranial pressure. The optic nerve sheath contains fluid in which sits the optic nerve. The sheath attaches to the posterior aspect of the globe and is contiguous with the subarachnoid space. Accordingly, the ONSD can act as a surrogate for intracranial pressure
  4. Relationship between the ratio of optic nerve sheath diameter to eyeball transverse diameter and morphological characteristics of dogs Adrien Dupanloup DVM and Stephanie Osinchuk DVM, MSc Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
  5. Keywords: Eclampsia, optic nerve sheath diameter, severe preeclampsia, ultrasonography. How to cite this article: Singh SK, Bhatia K. Ultrasonographic optic nerve sheath diameter as a surrogate measure of raised intracranial pressure in severe pregnancy-induced hypertension patients. Anesth Essays Res 2018;12:42-
  6. Background Ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD) has been proposed as a non-invasive, bedside method to detect raised intracranial pressure (ICP) in various clinical settings. We aimed to correlate the ONSD obtained from ultrasonography with the gold standard, intraventricular ICP, and to find out the cut-off point which predicts ICP accurately at different.

Among 51 pregnant women, when the diameter of the optic nerve sheath was >5.8 mm, this threshold diameter was associated with 95% sensitivity and 100% specificity to detect increased ICP in preeclampsia . In another study of 24 emergency rooms patients, an optic nerve sheath diameter of >5 mm had 100% sensitivity and 75% specificity Optic nerve sheath diameter measurements were made within 4 hours of arrival and after 18 to 23 hours at 4300 m, or earlier if the subject became too ill before the 18-hour time point. Subjects filled out Lake Louise Score (LLS) questionnaires at baseline, on arrival to 4300 m, and after 18 hours at high altitude or earlier if the subject.

An optic nerve sheath diameter of >0.63 cm suggests a cerebrospinal fluid pressure of greater than 20 cm of water. How to cite this article: Gupta S, Pachisia A. Ultrasound-measured optic nerve sheath diameter correlates well with cerebrospinal fluid pressure Articles. Article 1: Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intraranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011 Jul;37(7):1059-68 ANSWER KEY. Article 2: Ohle R, McIsaac SM, Woo MY, Perry JJ. Sonography of the Optic Nerve.

Increased intracranial pressure is suspected in the pathogenesis of acute mountain sickness (AMS), but no studies have correlated it with the presence or severity of AMS. We sought to determine whe.. Objective: To investigate the association of optic nerve sheath diameter (ONSD), as a correlate of intracranial pressure (ICP), with acute mountain sickness (AMS). Design: Longitudinal cohort study of mountaineers from sea level to 6400 m. Setting: Mount Everest (North side). Participants: 13 mountaineers (10 men, 3 women; aged 23-52 years) on a British expedition to climb Mount Everest

Optic Nerve Sheath Diameter Used as Ultrasonographic

  1. Optic Nerve Sheath Diameter Ultrasound Evaluation in Intensive Care Unit: Possible Role and Clinical Aspects in Neurological Critical Patients' Daily Monitoring. BioMed Research International, Vol. 2017, Issue. , p. 1
  2. Background: Evaluation of optic nerve sheath diameter (ONSD) is a suggested correlate of intracranial pressure (ICP) and potential predictor of outcome after neurological injury. Studies have evaluated sonographic measurement of ONSD, yet clinical limitations to this approach persist. Evaluation of ONSD measurements via routine brain computed tomography (CT) imaging is less studied but offers.
  3. Background: Estimation of intracranial pressure (ICP) may be helpful in the management of neurological critically ill patients. It has been shown that ultrasonography of the optic nerve sheath diameter (ONSD) is a reliable tool for non-invasive estimation of increased intracranial pressure (ICP) at hospital admission or in intensive care

The Measurement of Elderly Volunteers' Optic Nerve Sheath

The optic nerve is anatomically part of the central nervous system. It is surrounded by dura mater, subarachnoid space, and cerebrospinal fluid. Therefore, any change in the ICP also changes the diameter of the optic nerve sheath [4,5,6]. Article Optic nerve sheath diameter ultrasound measurement to evaluate cerebral edema in children with diabetic ketoacidosis was published on 26 Nov 2019 in the journal Journal of Pediatric Endocrinology and Metabolism (Volume 32, Issue 11)

Optic nerve sheath diameter change in prediction of

Ultrasound measurement of optic nerve diameter and optic

  1. e the accuracy of ONSD sonography for increased ICP diagnosis. Methods and analyses We will include published and unpublished randomised.
  2. Optic nerve sheath diameter on sonography in idiopathic intracranial hypertension versus normal Figure 1:Distribution of ONSD in normal age related controls. Figure 2:Distribution of ONSD in patients with IIH. Journal of the College of Physicians and Surgeons Pakistan 2016, Vol. 26 (9): 758-760 759
  3. optic nerve sheath diameter in patients with sepsis: a prospective. observational study. Crit Care. 2020;24(1):235. 2. Walker AE, Adamkiewicz JJ. Pseudotumor cerebri associated with prolonged
  4. degree of bias in optic nerve sheath diameter measures provided by trainees was very small: d=−0.004 for the right eye and d=−0.007 for the left eye. Conclusion: This study demonstrates that optic nerve sheath diameter measurement can be accurately performed by novice ultrasonographers after a brief training session
  5. Figure 5: The optic nerve sheath diameter should be measured 3 mm behind the retina. Scanning Procedure. To measure the ONSD: Place the patient in the supine position. Apply sufficient amount of sterile (preferably) gel on the closed eyelid

Decreased Diameter of the Optic Nerve Sheath Associated

The optic nerve sheath diameter (ONSD), measured at a fixed distance behind the retina has been evaluated to diagnose and measure intracranial hypertension in traumatic brain injury and intracranial hemorrhage 3) 4). The optic nerve sheath is fairly easy to visualize by ultrasonography by insonation across the orbit in the axial plane BACKGROUND: There is considerable evidence that prolonged use of cervical collars potentially cause detrimental effects including increase in optic nerve sheath diameter (ONSD) among healthy volunteers. Different types of cervical collars immobilize cervical spine variably well and may presumably differently influence the venous compression and hence the intracranial pressure. We therefore. The optic nerve sheath is also called the myelin layer around the optic nerve. Myelin is described as the white matter of the brain. It acts as a protector and insulator for the nerves. This particular sheath is responsible for insulating the optic nerve, which is the primary structure that connects the eye to the brain Intra- and interobserver reliability of transorbital sonographic assessment of the optic nerve sheath diameter and optic nerve diameter in healthy adults. J Ultrasound. 2016; 19 : 41-45 View in Article The optic nerve sheath diameter (ONSD) is an indirect marker of the intracranial pressure, but the normal range of ONSD as measured using magnetic resonance imaging (MRI) and its associations with clinical parameters and the eyeball transverse diameter (ETD) remain unclear

Ultrasonographic Optic Nerve Sheath Diameter Measurement

the optic nerve sheath diameter (ONSD). It is based on the principle that the optic nerve sheath is a continuation of the subarachnoid space, and cerebrospinal fluid freely flows through the subarachnoid space between the cranium and orbit [7]. When the ICP is elevated, the increased ICP will be transmitted to the flui Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med. 2014 Sep;40(9):1267-74. doi: 10.1007/s00134-014-3392-7 The sample size estimation was performed in accordance with the effect size (0.5) of a study comparing the optic nerve sheath diameter by magnetic resonance imaging before and after the shunt operation 4.This yielded a sample size of 34 subjects with α = 0.05, β = 0.8

Predictive Utility of Changes in Optic Nerve Sheath

Ultrasonography studies have shown that optic nerve sheath diameter (ONSD) correlates with intracranial pressure (ICP) in critical care patients, and recent studies report elevated ONSD values at high altitude. The aim of this review was to elucidate whether 1. measurement of ONSD could shed light on the pathophysiology of AMS, and 2. The measurement of the optic nerve sheath diameter (ONSD) via optic nerve ultrasound has been shown to noninvasively and reliably detect elevations in ICP in a diverse cohort of neurocritical care patients in multiple studies. 4-6 A cutoff > 0.48 cm has been associated with ICP values > 20 mm Hg. 4 However, the use of this technique has never. Correlation between intracranial pressure change and optic nerve sheath diameter [ Time Frame: Baseline to 10-15 minutes after lumbar puncture ] Before and after lumbar puncture, optic nerve sheath diameter measured with optic ultrasonography. The correlation of these measurements with cerebrospinal fluid opening and closing pressures was. Objective: Previous studies have shown that measuring the optic nerve sheath diameter (ONSD) can be a useful indicator in cases with ICP rising. The present study was designed to determine the agreement rate between performing Ultrasound (US) compared to Brain Computed Tomography (CT) scanning in the diagnosis of ICP rising through measuring. Intracranial pressure and optic nerve sheath diameter as cephalic venous pressure increases in swine. Aviat Space Environ Med 2013; 84:946-51. Background: Nontraumatic, nonhydrocephalic increases in intracranial pressure (ICP) are often difficult to diagnose and may underlie spaceflight-related visual changes. This study looked at the utility.

Emergency Department Sonographic Measurement of OpticBedside Sonographic Measurement of Optic Nerve Sheath

Background To assess if ultrasound measurement of the optic nerve sheath diameter (ONSD) can accurately predict the presence of raised intracranial pressure (ICP) and acute pathology in patients in the emergency department. Methods This 3-month prospective observational study used ultrasound to measure the ONSD in adult patients who required CT from the emergency department sheath (and the resulting enlargement of the optic nerve diameter) is a more dynamic process (4). The retrobulbar optic nerve sheath diameter (ONSD) can be measured at a position 3 mm posterior to the globe, where ultrasound contrast is greatest with more reproducible results, and anatomically, the anterior aspect of the nerve is most. The measurement of ocular nerve sheath diameter (ONSD) via ocular ultrasound scanning is a recent non-invasive method for intracranial pressure (ICP) assessment. Few clinical studies have assessed ONSD variations during osmotherapy for the treatment of sustained increased ICP episodes Background: Measuring optic nerve sheath diameter (ONSD), a relatively re-cent technique, allows an indirect and non-invasive diagnosis of intracranial hypertension. The ONSD ratio to eyeball transverse diameter (ETD) increases this reliability of the technique. The objective of this study was to determine the normal ONSD and its ratio with ETD in black African adults in Benin Key words: Intra-abdominal pressure, optic nerve sheath diameter, laparoscopic surgery. Similar Articles. The anatomical, electrophysiological and histological observations of muscle contraction units in rabbits: a new perspective on nerve injury and regeneration. Xu TM, Chen B, Jin ZX, Yin XF, Zhang PX, Jiang B

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