Child's Nervous System

, Volume 32, Issue 10, pp 1779–1785 | Cite as

The relationship between transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) and invasively measured ICP in children.

Part II: age-related ONSD cut-off values and patency of the anterior fontanelle
  • Llewellyn C. PadayachyEmail author
  • Vaishali Padayachy
  • Ushma Galal
  • Travis Pollock
  • A. Graham Fieggen
A.J. Raimondi ISPN Award



To analyse the diagnostic accuracy of age-related optic nerve sheath diameter (ONSD) cut-off values in children for detecting raised intracranial pressure (ICP) and to assess the benefit of using patency of the anterior fontanelle in describing a different set of cut-off values.


The ONSD measurement was performed prior to invasive ICP measurement in children under general anesthesia. The diagnostic accuracy of the ONSD measurement was compared to ICP at thresholds of 20, 15, 10, and 5 mmHg. This was further analysed in children above and below the age of 1 year, with a subgroup analysis of age at 4 years, and assessment of the anterior fontanelle (AF) as a reliable physiological marker in part II of this study.


Data from 174 children were analysed. In children ≤1 year old, the ONSD measurement with the best diagnostic accuracy for detecting ICP ≥ 20 mmHg was 5.16 mm, compared to 5.75 mm in children >1 year old (p < 0.001). In addition, patency of the anterior fontanelle (AF) was found to be a useful clinical marker for defining different ONSD cut-off values at ICP thresholds of 20, 15, 10 and 5 mmHg.


Transorbital ultrasound measurement of the ONSD is a reliable non-invasive marker of ICP particularly at higher thresholds of 20 and 15 mmHg. Patency of the AF is a useful clinical marker for defining different ONSD cut-off values in children.


Non-invasive ICP monitoring Optic nerve sheath diameter Ultrasound 


Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Llewellyn C. Padayachy
    • 1
    Email author
  • Vaishali Padayachy
    • 2
  • Ushma Galal
    • 3
  • Travis Pollock
    • 4
  • A. Graham Fieggen
    • 1
  1. 1.Paediatric Neurosurgery Unit, Division of Neurosurgery, Faculty of Health Sciences, Red Cross War Memorial Children’s HospitalUniversity of Cape TownCape TownSouth Africa
  2. 2.Trauma Unit, Red Cross War Memorial Children’s HospitalUniversity of Cape TownCape TownSouth Africa
  3. 3.Department of Statistical SciencesUniversity of Cape TownCape TownSouth Africa
  4. 4.Paediatric Opthalmology Unit, Red Cross War Memorial Children’s HospitalUniversity of Cape TownCape TownSouth Africa

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