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Child's Nervous System

Published in:

01-12-2013 | Original Paper

Bedside optic nerve sheath diameter ultrasound for the evaluation of suspected pediatric ventriculoperitoneal shunt failure in the emergency department

Authors: M. Kennedy Hall, David M. Spiro, Alfredo Sabbaj, Christopher L. Moore, Katharine L. Hopkins, Garth D. Meckler

Published in: Child's Nervous System | Issue 12/2013

Abstract

Objective

To determine the feasibility and test characteristics of optic nerve sheath diameter (ONSD) measured by ocular ultrasound as a screening tool for ventriculoperitoneal shunt (VPS) failure.

Methods

Prospective observational study using a convenience sample of children 6 months to 18 years of age, presenting to an academic pediatric emergency department for evaluation of possible VPS failure between September 2008 and March 2009. ONSD was measured by anterior transbulbar and lateral transbulbar techniques. Mean ONSD was compared between subjects with and without shunt failure, as determined by neurosurgical decision to operate.

Results

A total of 39 encounters were completed, including 20 VPS failures. The mean ONSD was 4.5 ± 0.9 and 5.0 ± 0.6 mm among encounters with and without shunt failure (p = 0.03), respectively. The mean ONSD was not statistically different when obtained by the anterior transbulbar vs. the lateral transbulbar approach (4.8 ± 1.0 vs. 4.7 ± 0.8 mm, p = 0.12). ONSD ultrasound had a sensitivity of 61.1 % (95 % CI 35.7–82.7) and specificity of 22.2 % (95 % CI 6.4–47.6 %) for detecting shunt failure in this sample.

Conclusions

ONSD ultrasound does not appear to be a useful primary screening tool in emergency department evaluation of VPS failure. There was no difference between the anterior transbulbar approach and the lateral transbulbar approach. Children with VPS in our sample have larger ONSD measurements than in previously reported studies.

Ballantyne J, Hollman AS, Hamilton R, Bradnam MS, Carachi R, Young DG, Dutton GN (1999) Transorbital optic nerve sheath ultrasonography in normal children. Clin Radiol 54(11):740–742PubMedCrossRef

Blehar DJ, Gaspari RJ, Montoya A, Calderon R (2008) Correlation of visual axis and coronal axis measurements of the optic nerve sheath diameter. J Ultrasound Med: Off J Am Inst Ultrasound Med 27(3):407–411

Byrne SF (1986) Standardized echography of the eye and orbit. Neuroradiology 28(5–6):618–640PubMedCrossRef

Copetti R, Cattarossi L (2009) Optic nerve ultrasound: artifacts and real images. Intensive Care Med 35(8):1488–1489. doi:10.1007/s00134-009-1494-4, author reply 1490–1481PubMedCrossRef

Geeraerts T, Launey Y, Martin L, Pottecher J, Vigue B, Duranteau J, Benhamou D (2007) Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 33(10):1704–1711. doi:10.1007/s00134-007-0797-6 PubMedCrossRef

Hansen HC, Helmke K (1997) Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg 87(1):34–40. doi:10.3171/jns.1997.87.1.0034 PubMedCrossRef

Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. experimental study. Pediatr Radiol 26(10):701–705PubMedCrossRef

Iskandar BJ, Sansone JM, Medow J, Rowley HA (2004) The use of quick-brain magnetic resonance imaging in the evaluation of shunt-treated hydrocephalus. J Neurosurg 101(2 Suppl):147–151. doi:10.3171/ped.2004.101.2.0147 PubMed

Kast J, Duong D, Nowzari F, Chadduck WM, Schiff SJ (1994) Time-related patterns of ventricular shunt failure. Childs Nerv Syst : ChNS : Off j Int Soc Pediatr Neurosurg 10(8):524–528CrossRef

10.

Kim TY, Stewart G, Voth M, Moynihan JA, Brown L (2006) Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department. Pediatr Emerg Care 22(1):28–34PubMedCrossRef

11.

Le A, Hoehn ME, Smith ME, Spentzas T, Schlappy D, Pershad J (2009) Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children. Ann Emerg Med 53(6):785–791. doi:10.1016/j.annemergmed.2008.11.025 PubMedCrossRef

12.

McAuley D, Paterson A, Sweeney L (2009) Optic nerve sheath ultrasound in the assessment of pediatric hydrocephalus. Childs Nerv Syst 25(1):87–90. doi:10.1007/s00381-008-0713-6 PubMedCrossRef

13.

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):1109–1113PubMedCrossRef

14.

Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Sir Craft AW, Parker L, BerringtondeGonzalez A (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukemia and brain tumors: a retrospective cohort study. Lancet 380(9840):499–505. doi:10.1016/S0140-6736(12)60815-0S0140-6736(12)60815-0 PubMedCrossRef

15.

Pitetti R (2007) Emergency department evaluation of ventricular shunt malfunction: is the shunt series really necessary? Pediatr Emerg Care 23(3):137–141. doi:10.1097/PEC.0b013e3180328c77 PubMedCrossRef

16.

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):508–514. doi:10.1016/j.annemergmed.2006.06.040 PubMedCrossRef

Title: Bedside optic nerve sheath diameter ultrasound for the evaluation of suspected pediatric ventriculoperitoneal shunt failure in the emergency department
Authors: M. Kennedy Hall
David M. Spiro
Alfredo Sabbaj
Christopher L. Moore
Katharine L. Hopkins
Garth D. Meckler
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 12/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-013-2172-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bedside optic nerve sheath diameter ultrasound for the evaluation of suspected pediatric ventriculoperitoneal shunt failure in the emergency department

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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