Artikel
Ultrasound-based measurement of the optic nerve sheath diameter (ONSD) as a clinical guide to assess increased intracranial pressure (ICP) in the daily routine in pediatric neurosurgery
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Autoren
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Susanne R. Kerscher
- Universitätsklinik Tübingen, Tübingen, Deutschland
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Felix Neunhoeffer
- Universitätsklinik Tübingen, Tübingen, Deutschland
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Konstantin Hockel
- Universitätsklinik Tübingen, Tübingen, Deutschland
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Martin U. Schuhmann
- Universitätsklinik Tübingen, Tübingen, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Regarding detection of ICP increase, ultrasound-based measurement of the optic nerve sheath diameter (ONSD) has been proven to be a reliable method to assess increased ICP in children of any age group. This study aims to investigate the relationship between ONSD and invasively measured ICP and if ONSD values may indicate a clinical situation with potentially increased ICP in pediatric neurosurgical patients.
Methods: 104 patients aged newborn to 18 years (median age 6 years) were investigated. Diagnoses included hydrocephalus (n=50), tumor (n=18), craniosynostosis (n=15) and other intracranial pathologies (n=21). Dependent on diagnosis, the investigation was performed in children awake or sedated, pre- and post-operatively, or longitudinally over a period of time, respectively. In 33 patients the mean binocular ONSD was compared to invasively measured ICP.
Results: 33 patients underwent ultrasonography of the ONSD during invasive measurement of ICP. ONSD revealed dynamic changes that were directly proportional to the ICP. The correlation between ONSD and ICP was good (r= 0.6, p< 0.01).
46 patients with clear symptoms of increased ICP underwent surgery to decrease ICP. All patients showed increased ONSD values before surgery (mean 5.89 ± 0.82mm) and decreased ONSD values after surgery (mean 5.14 ± 0.8 mm) (p<0.001). In 25 patients with moderate clinical signs of raised ICP, normal ONSD values (mean 4.78 ± 0.38 mm) were found. In those a wait-and-see strategy was applied and none needed a therapeutic intervention during follow-up. In 16 patients with mild symptoms of raised ICP, higher ONSD values were found (mean 5.4 ± 0.29 mm). In those invasive ICP measurement was recommended.
The ONSD cut-off value with the highest diagnostic value for detecting clinically relevant situations of increased ICP was 5.3 mm, with a sensitivity of 83%, specificity of 94%, an odds ratio (OR) of 47.5 and an AUROC of 0.901.
Conclusion: Transorbital ultrasound measurement of ONSD seems to be a reliable technique to assess increased ICP in every clinical situation, including the impact of age and fontanelle status. ONSD thresholds enable qualitative orientation regarding ICP categories with good diagnostic accuracy. ONSD is an ideal non-invasive and quickly available screening tool to rule out or indicate elevated ICP in pediatric neurosurgery.
