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The relation of optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in pediatric neurosurgery practice - Part I: Correlations, age-dependency and cut-off values

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Abstract

Purpose

It is assumed that the width of the optic nerve sheath diameter (ONSD) is dependent on intracranial pressure (ICP) and pulsatility and thus constitutes a non-invasively accessible “window” for qualitative assessment of ICP. Data on the correlation to invasively measured ICP in children are scarce and have often been obtained from sedated patients in intensive care unit (ICU) or intraoperatively. We report on a mixed cohort of pediatric neurosurgical patients, ICP and ONSD measurements were available from both sedated and awake children, only a minority from ICU patients.

Methods

Seventy-two children were investigated. Ultrasound ONSD determination was performed immediately prior to invasive ICP measurement and the mean binocular ONSD was compared with ICP. The investigations were performed in children awake, sedated, or under general anesthesia.

Results

In the entire patient cohort, the correlation between ONSD and ICP was good (r = 0.52, p < 0.01). Children > 1 year revealed a better correlation (r = 0.63; p < 0.01) and those ≤ 1 year did worse (r = 0.21). Infants with open fontanelle had no correlation. In the entire cohort, the best ONSD cut-off value for detecting ICP ≥ 15 and ≥ 20 mmHg was 5.28 and 5.57 mm (OR 22.5 and 7.2, AUC 0.782 and 0.733).

Conclusion

Transorbital ultrasound measurement of ONSD is a reliable non-invasive technique to assess increased ICP in children in every clinical situation; however, the impact of age and fontanelle status needs to be considered. ONSD thresholds enable qualitative first orientation regarding ICP categories with a very satisfying diagnostic accuracy.

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Acknowledgements

We are deeply indebted to Juergen Beck, MD PhD, University of Bern and Freiburg, who inspired our interest in ultrasound determination of ONSD and to Llewellyn Padayachy, MD PhD, University of Cape Town and Pretoria, for many fruitful discussions over the years.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany

    Susanne R. Kerscher & Martin U. Schuhmann

  2. Department of Neurosurgery, University Hospital of Tuebingen, 72076, Tuebingen, Germany

    Susanne R. Kerscher, Daniel Schöni, Helene Hurth & Martin U. Schuhmann

  3. Department of Neurosurgery, University Hospital of Bern, 3010, Bern, Switzerland

    Daniel Schöni

  4. Pediatric Intensive Care Unit, Children’s Hospital, University of Tuebingen, 72076, Tuebingen, Germany

    Felix Neunhoeffer

  5. Department of Pediatric Neurology and Developmental Medicine, Children’s Hospital, University of Tuebingen, 72076, Tuebingen, Germany

    Karin Haas-Lude & Markus Wolff

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  1. Susanne R. Kerscher
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Correspondence to Susanne R. Kerscher.

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Kerscher, S.R., Schöni, D., Hurth, H. et al. The relation of optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in pediatric neurosurgery practice - Part I: Correlations, age-dependency and cut-off values. Childs Nerv Syst 36, 99–106 (2020). https://doi.org/10.1007/s00381-019-04266-1

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