Top

Child's Nervous System

Published in:

01-10-2016 | A.J. Raimondi ISPN Award

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

Part I: repeatability, observer variability and general analysis

Authors: Llewellyn C. Padayachy, Vaishali Padayachy, Ushma Galal, Rebecca Gray, A. Graham Fieggen

Published in: Child's Nervous System | Issue 10/2016

Abstract

Purpose

The aim of this study was to investigate the relationship between optic nerve sheath diameter (ONSD) measurement and invasively measured intracranial pressure (ICP) in children.

Methods

ONSD measurement was performed prior to invasive measurement of ICP. The mean binocular ONSD measurement was compared to the ICP reading. Physiological variables including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse rate, temperature, respiratory rate and end tidal carbon dioxide (ETCO2) level were recorded at the time of ONSD measurement. Diagnostic accuracy analysis was performed at various ICP thresholds and repeatability, intra- and inter-observer variability, correlation between measurements in different imaging planes as well the relationship over the entire patient cohort were examined in part I of this study.

Results

Data from 174 patients were analysed. Repeatability and intra-observer variability were excellent (α = 0.97–0.99). Testing for inter-observer variability revealed good correlation (r = 0.89, p < 0.001). Imaging in the sagittal plane demonstrated a slightly better correlation with ICP (r = 0.66, p < 0.001). The ONSD measurement with the best diagnostic accuracy for detecting an ICP ≥ 20 mmHg over the entire patient cohort was 5.5 mm, sensitivity 93.2 %, specificity 74 % and odds ratio (OR) of 39.3.

Conclusion

Transorbital ultrasound measurement of the OSND is a reliable and reproducible technique, demonstrating a good relationship with ICP and high diagnostic accuracy for detecting raised ICP.

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

Hansen HC, Helmke K (1996) The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat 18(4):323–328CrossRefPubMed

Killer HE, Laeng HR, Flammer J, Groscurth P (2003) Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations. Br J Ophthalm 87(6):777–781CrossRef

Hayreh SS (1984) The sheath of the optic nerve. Ophthalmologica 189(1–2):54–63CrossRefPubMed

Geeraerts T, Launey Y, Martin L et al (2007) Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Int Care Med 33(10):1704–1711CrossRef

Kimberly HH, Shah S, Marill K, Noble V (2008) Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 15(2):201–204CrossRefPubMed

Tsung JW, Blaivas M, Cooper A, Levick NR (2005) A rapid noninvasive method of detecting elevated intracranial pressure using bedside ocular ultrasound: application to 3 cases of head trauma in the pediatric emergency department. Ped Emerg Care 21(2):94–99CrossRef

Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B (2011) Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Int Care Med 37(7):1059–1068CrossRef

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):608–613CrossRefPubMed

10.

Singhal A, Yang MM, Sargent MA, Cochrane DD (2013) Does optic nerve sheath diameter on MRI decrease with clinically improved pediatric hydrocephalus? Child Nerv Syst 29(2):269–274CrossRef

11.

Padayachy LC, Kilborn T, Carrara H, Figaji AA, Fieggen GA (2015) Change in optic nerve sheath diameter as a radiological marker of outcome from endoscopic third ventriculostomy in children. Child Nerv Syst 31(5):721–728CrossRef

12.

Watanabe A, Kinouchi H, Horikoshi T, Uchida M, Ishigame K (2008) Effect of intracranial pressure on the diameter of the optic nerve sheath. J Neurosurg 109(2):255–258CrossRefPubMed

13.

Legrand A, Jeanjean P, Delanghe F, Peltier J, Lecat B, Dupont H (2013) Estimation of optic nerve sheath diameter on an initial brain computed tomography scan can contribute prognostic information in traumatic brain injury patients. Crit Care 17(2):R61CrossRefPubMedPubMedCentral

14.

Potgieter DW, Kippin A, Ngu F, McKean C (2011) Can accurate ultrasonographic measurement of the optic nerve sheath diameter (a non-invasive measure of intracranial pressure) be taught to novice operators in a single training session? Anaesth Int Care 39:95–100CrossRef

15.

Bäuerle J, Nedelmann M (2011) Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension. J Neurol 258(11):2014–2019CrossRefPubMed

16.

Bäuerle J, Schuchardt F, Schroeder L, Egger K, Weigel M, Harloff A (2013) Reproducibility and accuracy of optic nerve sheath diameter assessment using ultrasound compared to magnetic resonance imaging. BMC Neurol 13(1):187CrossRefPubMedPubMedCentral

17.

Bäuerle J, Lochner P, Kaps M, Nedelmann M (2012) Intra‐ and inter-observer reliability of sonographic assessment of the optic nerve sheath diameter in healthy adults. J Neuroimaging 22(1):42–45CrossRefPubMed

18.

Shah S, Kimberly H, Marill K, Noble VE (2009) Ultrasound techniques to measure the optic nerve sheath: is a specialized probe necessary? Med Sci Monitor 15(5):MT63–MT68

19.

Ballantyne SA, O’Neill G, Hamilton R, Hollman AS (2002) Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound 15(3):145–149CrossRefPubMed

20.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) Strobe Initiative The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med 45(4):247–251CrossRef

21.

Vandenbroucke JP, Von Elm E et al (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Int Med 147(8):W-163CrossRef

22.

Lizzi FL, Mortimer AJ (1988) Bioeffects considerations for the safety of diagnostic ultrasound–preface. J Ultrasound Med 7(9):S1–S38

23.

Nelson TR, Fowlkes JB, Abramowicz JS, Church CC (2009) Ultrasound biosafety considerations for the practising sonographer and sonologist. J Ultrasound Med 28:139–150PubMed

24.

European Federation for Societies of Ultrasound in Medicine and Biology (EFSUMB) (1998) Clinical safety statement for diagnostic ultrasound safety. Tours, France. 1998. Eur J Ultrasound 8:67–68CrossRef

25.

Ballantyne J, Hollman A, Hamilton R et al (1999) Transorbital optic nerve sheath ultrasonography in normal children. Clin Rad 54(11):740–742CrossRef

26.

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 Ophthalm 86(10):1109–1113CrossRef

27.

Moretti R, Pizzi B (2011) Ultrasonography of the optic nerve in neurocritically ill patients. Acta Anaesth Scand 55(6):644–652CrossRefPubMed

28.

Malayeri AA, Bavarian S, Mehdizadeh M (2005) Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure. J Ultrasound Med 24(2):143–147PubMed

29.

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):1400–1404CrossRefPubMedPubMedCentral

30.

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):54–58PubMed

31.

Driessen C, Eveleens J, Bleyen I, Van Veelen ML, Joosten K, Mathiijssen I (2014) Optical coherence tomography: a quantitative tool to screen for papilledema in craniosynostosis. Childs Nerv Syst 30:1067–1073PubMed

32.

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):406–410CrossRefPubMed

33.

Geeraerts T, Duranteau J, Benhamou D (2008) Ocular sonography in patients with raised intracranial pressure: the papilloedema revisited. Crit Care 12(3):150CrossRefPubMedPubMedCentral

34.

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):34–40CrossRefPubMed

35.

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 27(3):407–411PubMed

36.

Geeraerts T, Bergès O, Merceron S et al (2009) Reply to Copetti and Cattarossi. Int Care Med 35(8):1490–1491CrossRef

37.

McAuley D, Paterson A, Sweeney L (2009) Optic nerve sheath ultrasound in the assessment of paediatric hydrocephalus. Child Nerv Syst 25(1):87–90CrossRef

38.

Hayreh SS (1964) Pathogenesis of oedema of the optic disc (papilloedema): a preliminary report. Br J Ophthalm 48(10):522CrossRef

39.

Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL (2011) Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 15(3):506–515CrossRefPubMed

40.

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):508–514CrossRefPubMed

41.

Strumwasser A, Kwan RO, Yeung L et al (2011) Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma. J Surg Res 170(2):265–271CrossRefPubMed

42.

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–e532CrossRef

43.

Padayachy LC, Fieggen AG (2015) Optic nerve sheath diameter as criteria for endoscopic third ventriculostomy failure in children. Child Nerv Syst 31(8):1219CrossRef

44.

Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A (2008) Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care 12(3):R67CrossRefPubMedPubMedCentral

45.

Wang L, Feng L, Yao Y et al (2015) Optimal optic nerve sheath diameter threshold for the identification of elevated opening pressure on lumbar puncture in a Chinese population. PLoS One 10(2):e0117939CrossRefPubMedPubMedCentral

Title: The relationship between transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) and invasively measured ICP in children
Part I: repeatability, observer variability and general analysis
Authors: Llewellyn C. Padayachy
Vaishali Padayachy
Ushma Galal
Rebecca Gray
A. Graham Fieggen
Publication date: 01-10-2016
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 10/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-016-3067-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Part I: repeatability, observer variability and general analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2016

Conventional chemotherapy and perspectives for molecular-based oncological treatment in pediatric hemispheric low-grade gliomas

44th Annual Meeting of International Society for Pediatric Neurosurgery, Kobe, Japan, Oct 23-27, 2016

PET and SPECT studies in children with hemispheric low-grade gliomas

Presidential address (ISPN 2015, Izmir)

Neurosurgical tools to extend tumor resection in pediatric hemispheric low-grade gliomas: iMRI

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