Advertisement

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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Non-invasive ICP monitoring Optic nerve sheath diameter Ultrasound 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

References

  1. 1.
    Czosnyka M, Pickard J (2004) Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry 75:813–821CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Wiegand C, Richards P (2007) Measurement of intracranial pressure in children: a critical review of current methods. Develop Med Child Neurol 49:935–941CrossRefPubMedGoogle Scholar
  3. 3.
    Padayachy L, Figaji A, Bullock RS (2010) Intracranial pressure monitoring for traumatic brain injury in the modern era. Childs Nerv Syst 26:441–452CrossRefPubMedGoogle Scholar
  4. 4.
    Bratton SL, Chestnut RM, Ghajar J, Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, et al. (2007) Guidelines for the management of severe traumatic brain injury. VI Indications for intracranial pressure monitoring. J Neurotrauma 24(suppl 1):S37–S44PubMedGoogle Scholar
  5. 5.
    Rosenberg JB, Shiloh AL, Savel RH, Eisen LA (2011) Non-invasive methods of estimating intracranial pressure. Neurocrit Care 15:599–608CrossRefPubMedGoogle Scholar
  6. 6.
    Kristiansson H, Nissborg E, Bartek J Jr, Andresen M, Reinstrup P, Romner B (2013) Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol 25:372–385CrossRefPubMedGoogle Scholar
  7. 7.
    Beau B (2014) Non-invasive assessment of cerebrospinal fluid pressure. J Neuro-ophthalmol 34:288–294CrossRefGoogle Scholar
  8. 8.
    Ballantyne J, Hollman A, Hamilton R, et al. (1999) Transorbital optic nerve sheath ultrasonography in normal children. Clin Radiol 54(11):740–742CrossRefPubMedGoogle Scholar
  9. 9.
    Newman WD, Hollman AS, Dutton GN, Carachi R (2002) Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 86(10):1109–1113CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Moretti R, Pizzi B (2011) Ultrasonography of the optic nerve in neurocritically ill patients. Acta Anaesthesiol Scand 55(6):644–652CrossRefPubMedGoogle Scholar
  11. 11.
    Steinborn M, Friedmann M, Hahn H, et al. (2015) Normal values for transbulbar sonography and magnetic resonance imaging of the optic nerve sheath diameter (ONSD) in children and adolescents. Ultraschall Med 36(1):54–58PubMedGoogle Scholar
  12. 12.
    McAuley D, Paterson A, Sweeney L (2009) Optic nerve sheath ultrasound in the assessment of paediatric hydrocephalus. Child’s Nervous Syst 25(1):87–90CrossRefGoogle Scholar
  13. 13.
    Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. Pediatr Radiol 26(10):701–705CrossRefPubMedGoogle Scholar
  14. 14.
    Malayeri AA, Bavarian S, Mehdizadeh M (2005) Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure. J Ultrasound Med 24(2):143–147PubMedGoogle Scholar
  15. 15.
    Beare NA, Kampondeni S, Glover SJ, et al. (2008) Detection of raised intracranial pressure by ultrasound measurement of optic nerve sheath diameter in African children. Trop Med Int Health 13(11):1400–1404CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Steinborn M, Fiegler J, Kraus V, et al. (2011) High resolution ultrasound and magnetic resonance imaging of the optic nerve and the optic nerve sheath: anatomic correlation and clinical importance. Ultraschall Med 32(6):608–613CrossRefPubMedGoogle Scholar
  17. 17.
    Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M (2007) Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 49(4):508–514CrossRefPubMedGoogle Scholar
  18. 18.
    Geeraerts T, Duranteau J, Benhamou D (2008) Ocular sonography in patients with raised intracranial pressure: the papilloedema revisited. Crit Care 12(3):150CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Moretti R, Pizzi B, Cassini F, Vivaldi N (2009) Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care 11(3):406–410CrossRefPubMedGoogle Scholar
  20. 20.
    Geeraerts T, Newcombe VF, Coles JP, et al. (2008) Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care 12(5):R114CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Hansen HC, Lagreze W, Krueger O, Helmke K (2011) Dependence of the optic nerve sheath diameter on acutely applied subarachnoidal pressure—an experimental ultrasound study. Acta Ophthalm 89(6):e528–e532CrossRefGoogle Scholar
  22. 22.
    Padayachy LC, Brekken R, Fieggen AG, Selbekk T (2015) Pulsatile dynamics of the optic nerve sheath and intracranial pressure: an exploratory in-vivo investigation. Neurosurg. doi: 10.1227/NEU.0000000000001200
  23. 23.
    Morris KP, Forsyth RJ, Parslow RC, et al. (2006) UK Paediatric Traumatic Brain Injury Study Group. Intracranial pressure complicating severe traumatic brain injury in children: monitoring and management. Int Care Med 32(10):1606–1612CrossRefGoogle Scholar
  24. 24.
    Adelson PD, Bratton SL, Carney NA, et al. (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. Pediatr Crit Care Med 4(3 Suppl):S25–S27PubMedGoogle Scholar

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

Personalised recommendations