Ultrasound Nomograms of the Fetal Optic Nerve Sheath Diameter

Abstract Objective To construct prenatal age-specific reference intervals for sonographic measurements of the optic nerve sheath diameter (ONSD) during gestation in normal fetuses. Materials and Methods Prospective cross-sectional study of fetuses assessed in antenatal ultrasound units between 2010 and 2014. The examination was based on a technique for the sonographic assessment of ONSD previously published by our group. The mean values and SDs of the ONSD were modeled as a function of the gestational week by curve estimation analysis based on the highest adjusted R2 coefficient. Repeatability tests were performed to assess intraobserver variability and interobserver agreement. Results During the study period 364 healthy fetuses were enrolled. The mean values for the ONSD varied from 0.6 mm at 15–16 weeks to 2.8 mm at 37–38 weeks. The ONSD grows in a linear fashion throughout gestation, with a quadratic equation providing an optimal fit to the data (adjusted R2 = 0.957). Conclusion Sonographic age-specific references for the fetal ONSD are presented. This data may assist in the decision-making process in fetuses with a suspected increase in intracranial pressure, or anomalies affecting the development of optic stalks, such as optic hypoplasia and septo-optic dysplasia.

Download Full-text

Are ultrasonography measurements of optic nerve sheath diameter an alternative to funduscopy in children with syndromic craniosynostosis?

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.6.peds10547 ◽

2011 ◽

Vol 8 (3) ◽

pp. 329-334 ◽

Cited By ~ 19

Author(s):

Caroline Driessen ◽

Natalja Bannink ◽

Maarten Lequin ◽

Marie-Lise C. van Veelen ◽

Nicole C. Naus ◽

...

Keyword(s):

Optic Nerve ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Predictive Values ◽

Syndromic Craniosynostosis ◽

Nerve Sheath ◽

Age Related ◽

The Mean ◽

A Prospective Study ◽

Ct Measurement

Object Children with syndromic or complex craniosynostosis are evaluated for increased intracranial pressure (ICP) using funduscopy to detect papilledema. However, papilledema is a late sign of increased ICP. Because papilledema might be preceded by an increase in optic nerve sheath (ONS) diameter, the authors conducted a prospective study to establish the validity and applicability of measuring the ONS using ultrasonography. Methods From January 2007 to December 2009, 175 bilateral ultrasonography ONS measurements were performed in 128 patients with syndromic or complex craniosynostosis during the daytime. The measurements were correlated with ONS diameter assessed on CT and simultaneous funduscopy, when available. Furthermore, results were compared by using thresholds for ONS diameters on ultrasonography that are available in the literature. Results The mean ONS diameter on ultrasonography was 3.1 ± 0.5 mm. The CT measurement was significantly correlated with the ultrasonography measurement (r = 0.41, p < 0.001). The mean ONS diameter in 38 eyes with papilledema was 3.3 ± 0.5 mm, compared with 3.1 ± 0.5 mm in the eyes of patients without papilledema (p = 0.039). Relative to the age-related thresholds, the ONS diameter was too large in 11 eyes (3%), particularly in patients with Crouzon syndrome. Compared with funduscopy, ultrasonography sensitivity was 11%, specificity was 97%, and positive and negative predictive values were 40% and 86%, respectively. Conclusions Ultrasonography is a valid and easy way of quantifying the ONS. Although the ONS diameter is larger in children with papilledema, it cannot be used as a daytime screening tool instead of funduscopy. The ONS diameter is possibly a more real-time indicator of ICP.

Download Full-text

Optic Nerve Sheath Diameter in Preterm Infants: Suggested Values

Neonatology ◽

10.1159/000513721 ◽

2021 ◽

Vol 118 (3) ◽

pp. 297-300

Author(s):

Molly Rayner ◽

Tanya Holt ◽

Sibasis Daspal ◽

Prosanta Mondal ◽

Leanne Langford ◽

...

Keyword(s):

Optic Nerve ◽

Linear Regression ◽

Preterm Infants ◽

Gestational Age ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Mean Values ◽

Nerve Sheath ◽

Neurologic Sequelae ◽

Highly Correlated

Objective: Timely detection of elevated intracranial pressure (ICP) in highrisk preterm infants may be critical to avoid permanent neurologic sequelae. Size of optic nerve sheath diameter (ONSD) is highly correlated with changes in ICP. Normal ultrasonographic ONSD values for preterm infants have been published. This study sought to compare these data with MRI measured OSND and to propose suggested ultrasonographic ONSD values. Methods: The ONSD in preterm MRIs were retrospectively measured and related to pre-existing ultrasonographic ONSD. Data were stratified for corrected gestational age. Simple linear regression between ONSD mean values and age was modeled for both eyes, and R2 was calculated. Suggested values for ultrasonographic ONSD were ascertained through linear regression and calculated prediction intervals. Results: ONSD measurements demonstrated R2 values of 0.95 (right ONSD MRI), 0.95 (left ONSD MRI), 0.96 (right ONSD ultrasound), and 0.93 (left ONSD ultrasound). Suggested ONSD values were incremental with corrected gestational age. Conclusion: ONSD measurements with MRI and ultrasound are similar. The proposed suggested ONSD values may be helpful in clinical situations where ICPs are suspected or known.

Download Full-text

The relationship between computed tomography measurement of the optic nerve sheath diameter and elevated intracranial pressure in non-trauma patients

South African Journal of Radiology ◽

10.4102/sajr.v20i1.1060 ◽

2016 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Daniël Luyt ◽

Delmé Hurter ◽

Gina Joubert

Keyword(s):

Computed Tomography ◽

Optic Nerve ◽

Intracranial Pressure ◽

Digital Images ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Trauma Patients ◽

Cross Sectional ◽

Nerve Sheath ◽

The Brain

Background: The early detection and treatment of raised intracranial pressure (ICP) is critical in the prevention of mortality and morbidity as a result of secondary ischemic brain injury. Measuring the optic nerve sheath diameter (ONSD) on computed tomography (CT) to predict raised ICP may be useful in cases where routine CT investigations of the brain are indicated and invasive ICP monitoring is not available, or a lumbar puncture (LP) is contraindicated.Objective: The purpose of this study was to determine if the ONSD can be measured on digital images obtained by routine CT investigations of the brain, to identify patients with non-traumatic causes of elevated ICP, and to provide the observer with a non-invasive, objective measurement to predict elevated ICP.Method: We conducted a cross-sectional, retrospective analysis of anonymised patient data, comparing the ONSD on CT imaging with the opening pressure manometry during LP on patients who presented with focal neurology or with a Glasgow coma scale score of less than 15. The study sample consisted of 67 patients, ≥18 years of age, treated at the emergency department of the Kimberly Hospital Complex from 01 March 2013 to 31 December 2014.Results: An ONSD measurement of ≥4.8 mm identified patients with an elevated ICP with a sensitivity of 92.9% and a specificity of 97.6%, using a 95% confidence interval. Raising the ONSD cut-off value to ≥5.0 mm decreased the sensitivity to 85.7% but increased the specificity to 100%, eliminating all patients with a normal ICP.Conclusion: The ONSD can be measured on digital images obtained by routine CT investigations of the brain to predict elevated ICP in non-trauma patients, ≥18 years of age, with acceptable sensitivity and specificity.

Download Full-text

Study of Optic Nerve Sheath Diameter in Normal Nepalese Adults Using Ultrasound

Birat Journal of Health Sciences ◽

10.3126/bjhs.v3i1.19758 ◽

2018 ◽

Vol 3 (1) ◽

pp. 357-360 ◽

Cited By ~ 1

Author(s):

Bidur KC ◽

Amit Thapa

Keyword(s):

Optic Nerve ◽

Optic Nerve Sheath Diameter ◽

Cross Sectional Study ◽

Optic Nerve Sheath ◽

P Value ◽

Cross Sectional ◽

Non Invasive ◽

Normal Limits ◽

Nerve Sheath ◽

Significant Difference

Introduction: Though invasive intracranial devices are gold standard to calculate intracranial pressure (ICP); these are not without any complications. Non-invasive measurement of ICP by Ultrasonography could be a safe and portable technique.Objectives: The objective of the study was to measure and compare values of optic nerve sheath diameter of both eyes in healthy Nepalese adults.Methodology: A prospective cross-sectional study of healthy adult Nepalese volunteers was performed using a 7.5 MHz linear Ultrasound probe on the closed eyelids; optic nerve sheath diameter (ONSD) was measured 3 mm behind the globe in each eye.Results: Optic nerve sheath diameter (ONSD) of both eyes was measured in 100 healthy volunteers of age ranged from 15 to 75 years with a mean of 30.21 ± 14.05 years. There were 18 (18%) male and 82 (82%) female. ONSD for right eye ranged from 3.20 to 4.90 mm with mean of 4.10 ± 0.50 mm and left eye from 3.20 to 4.80 mm with mean of 4.22 ± 0.49 mm. P value for right and left eye ONSD (P = 0.06) and male and female (P = 0.12 and 0.85 for right and left ONSD respectively) were within normal limits. ONSD has no correlation with age (P = 0.27 and 0.27 for right and left ONSD respectively).Conclusion Mean of optic nerve sheath diameter (ONSD) is 4.10mm and 4.22 mm for right and left eye respectively. There is no statistical significant difference in mean of ONSD between right and left eye. BJHS 2018;3(1)5 : 357-360

Download Full-text

How accurate is ultrasound of the optic nerve sheath diameter performed by inexperienced operators to exclude raised intracranial pressure?

South African Journal of Radiology ◽

10.4102/sajr.v19i1.745 ◽

2015 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

G. J. Du Toit ◽

D. Hurter ◽

M. Nel

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Lumbar Puncture ◽

Predictive Value ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Ultrasound Measurement ◽

Raised Intracranial Pressure ◽

Cross Sectional ◽

Nerve Sheath

Background: It has been well documented that ultrasound measurement of the optic nerve sheath diameter performed by an experienced operator shows good correlation with raised intracranial pressure, irrespective of the cause. Objective: To establish the accuracy of this technique performed by inexperienced operators.Method: A prospective analytical cross-sectional study was conducted. All patients ≥18 years of age who presented at our medical casualty and emergency departments with suspected meningitis were enrolled in the study. All patients were evaluated with the use of optic nerve sheath diameter ultrasound with or without computed tomography brain scan prior to lumbar puncture. Lumbar puncture opening pressure measurements were compared with the ultrasound measurements.Results: A total of 73 patients were enrolled in the study, of whom 14 had raised intracranial pressure. The study had a sensitivity of 50% (95% confidence interval (CI) 26.8%–73.2%) and specificity of 89.8% (95% CI 79.5%–95.3%) with a positive predictive value of 54.8% (95% CI 29.1%–76.8%) and negative predictive value of 88.3% (95% CI 77.8%–94.2%). The likelihood ratio of a positive test was 4.92 (95% CI 1.95–11.89) and that of a negative test 0.56 (95% CI 0.29–0.83). Cohen’s kappa value was 0.41 which indicates a moderate agreement. The receiver operating characteristic (ROC) curve had an area under the curve (AUC) of 0.73 (95% CI 0.51–0.95). Conclusion: Ultrasound measurement of the optic nerve sheath diameter can be used to exclude raised intracranial pressure, even in the hands of inexperienced operators.

Download Full-text

PERBEDAAN OPTIC NERVE SHEATH DIAMETER (ONSD) PADA RESPONDEN NORMAL DAN NYERI KEPALA

Biomedika ◽

10.23917/biomedika.v11i2.8466 ◽

2019 ◽

Vol 11 (2) ◽

pp. 96-104

Author(s):

Sulistyani Sulistyani ◽

Rivan Danuaji

Keyword(s):

Optic Nerve ◽

Normal Volunteer ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Cross Sectional ◽

Average Value ◽

Normal People ◽

Nerve Sheath ◽

Significant Difference ◽

Transorbital Sonography

Nyeri kepala merupakan penanda adanya gangguan intrakranial. Nervus optikus merupakan saraf kranialis yang mudah dipengaruhi langsung adanya gangguan intrakranial. Kalimatnya Jumping. Kelainan nervus optikus dapat diketahui dengan adanya pelebaran optic nerve sheath diameter (ONSD). ONSD dapat diukur dengan transorbital sonografi yang bersifat nonimvasif. Penelitian ini bertujuan membedakan diameter ONSD pada orang yang nyeri kepala dan orang normal. Penelitian ini menggunakan pendekatan observasional analitik dengan metode cross sectional. Responden diambil dari pasien rawat inap dan responden normal. Hasil penelitian didapatkan rata – rata nilai ONSD pada pasien nyeri kepala adalah 0,52 ± 0,86 dan pada responden normal adalah 0,40 ± 0,57 (p < 0,05). Terdapat perbedaan signifikan nilai ONSD pada pasien normal dan nyeri kepala. Penelitian ini membuktikan bahwa terdapat gangguan intrakranial pada orang dengan nyeri kepala dan dapat digunakan sebagai deteksi dini.Kata Kunci: Optic Nerve Sheath Diameter (ONSD), Responden Normal, Nyeri KepalaHeadache is a sign of intracranial disorders. The optic nerve is a cranial nerve that is easily affected directly by intracranial disorders. The sentence is Jumping. Optic nerve abnormalities can be identified by the widening of the optic nerve sheath diameter (ONSD). ONSD can be measured by transorbital sonography which is nonimvasive. This study aims to distinguish the ONSD diameter in people with headaches and normal people. This research uses an analytic observational approach with cross sectional method. Respondents were taken from inpatients and normal respondents. The results showed that the average value of ONSD in headache patients was 0.52 ± 0.86 and in normal respondents was 0.40 ± 0.57 (p <0.05). There is a significant difference in the value of ONSD in normal patients and headaches. This research proves that there are intracranial disorders in people with headaches and can be used as early detection.Keyword: Optic nerve sheath diameter , headache , normal volunteer

Download Full-text

Propofol Affects Optic Nerve Sheath Diameter less than Sevoflurane during Robotic Surgery in the Steep Trendelenburg Position

BioMed Research International ◽

10.1155/2019/5617815 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Yanghyun Kim ◽

Seomun Choi ◽

Sungwoo Kang ◽

Boram Park

Keyword(s):

Optic Nerve ◽

Demographic Data ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Ischemic Optic Neuropathy ◽

Trendelenburg Position ◽

Nerve Sheath ◽

Steep Trendelenburg Position ◽

The Mean ◽

End Tidal

Background. Robot-assisted laparoscopic radical prostatectomy (RLRP) can increase intracranial pressure (ICP) related to a change in position. Increasing ICP may result in various ocular complications, which are rare but serious, such as a corneal abrasion and ischemic optic neuropathy. We performed a prospective observational trial using ultrasonographic measurements to compare optic nerve sheath diameter (ONSD) related to ICP between patients who received either propofol or sevoflurane and underwent RLRP. Methods. Thirty-two male patients scheduled to undergo RLRP were assigned into groups according to the anesthetic agent used (group P: propofol, n = 16; group S: sevoflurane, n = 16). ONSD, end-tidal partial pressure of CO2, and blood pressure were measured 10 min after induction of anesthesia (T0), 30 min (T1), 60 min (T2), and 90 min after changing to the steep Trendelenburg position and introducing a pneumoperitoneum (T3) and 10 min after returning the patient’s position to supine (T4) during surgery. Results. No significant differences were observed in the demographic data of the patients, surgery time, or intraoperative variables, including hemodynamic and respiratory variables, at any of the time points. The mean right ONSDs in the propofol and sevoflurane groups were 37.3 and 40.1 mm at 30 min (p=0.003), respectively. The mean left ONSDs were 38.4 and 40.8 mm at 30 min (p=0.021) after changing to the Trendelenburg position. The ONSDs between the two groups were significantly different during surgery. Conclusions. ONSD increased more in the sevoflurane group than in the propofol group during RLRP. Intravenous anesthetics could alleviate the increase in ICP during RLRP.

Download Full-text

Repeatability of ultrasound examination of the optic nerve sheath diameter in the adult cat: comparison between healthy cats and cats suffering from presumed intracranial hypertension

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x19898006 ◽

2020 ◽

Vol 22 (10) ◽

pp. 959-965 ◽

Cited By ~ 1

Author(s):

Maria Antonietta Evangelisti ◽

Giovanni Carta ◽

Giovanni P Burrai ◽

Maria Luisa Pinna Parpaglia ◽

Francesca Cubeddu ◽

...

Keyword(s):

Optic Nerve ◽

Intracranial Hypertension ◽

Linear Regression Analysis ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Nerve Sheath ◽

Group A ◽

The Mean ◽

Group B ◽

The Right

Objectives The objectives of this study were to test: (1) the repeatability of ultrasonographic examination of the optic nerve sheath diameter (ONSD) in the cat; (2) the association between the ONSD and age, sex and body weight in healthy cats; and (3) the difference in the ONSD between healthy cats and those suffering from presumed intracranial hypertension (ICH). Methods This study had a prospective, blinded, observational cross-sectional study design. Two groups of animals were considered: healthy cats (group A) and cats with a diagnosis of presumed ICH (group B). The ONSD was evaluated, measured and compared between the two groups via an ultrasonographic transpalpebral approach. Repeatability of the procedure was evaluated through the intraclass correlation coefficient (ICC). Data were statistically compared using the Student’s t-test and linear regression analysis. Results A strong inter- and intraobserver ICC indicating good repeatability was observed. The interobserver ICC was 0.965 ( P <0.05) for the right eye and 0.956 ( P <0.05) for the left eye. The intraobserver ICC was 0.988 ( P <0.05) and 0.984 ( P <0.05) for the right and left eyes, respectively. In healthy cats the mean ± SD ONSD was 1.23 ± 0.11 mm (range 1–1.47 mm) and 1.23 ± 0.10 (range 1–1.4 mm) for right and left eyes, respectively. The ONSD was not related to sex or weight; a weak relationship was observed with age. In group B, the mean ONSD was 1.68 ± 0.13 mm (range 1.5–1.9 mm) and 1.61 ± 0.15 mm (range 1.4–1.9 mm) for the right and left eyes, respectively. In group B, the ONSD was statistically significantly larger than in group A, the healthy cats ( P <0.001). Conclusions and relevance The transpalpebral ultrasonographic technique is a non-invasive, feasible and reproducible method to measure ONSD both in healthy cats and in cats suffering from suspected ICH.

Download Full-text

Evaluation of the Relationship Between NIRS (Near-Infrared Spectroscopy) and Optic Nerve Sheath Diameter Measurement in Children with Increased Intracranial Pressure: A Pilot Study

10.21203/rs.3.rs-95069/v1 ◽

2020 ◽

Author(s):

Didar Arslan ◽

Dinçer Yildizdas ◽

Özden ÖZGÜR HOROZ ◽

Nagehan Aslan ◽

Faruk İNCECİK

Keyword(s):

Infrared Spectroscopy ◽

Optic Nerve ◽

Intracranial Pressure ◽

Near Infrared ◽

Optic Nerve Sheath Diameter ◽

Increased Intracranial Pressure ◽

Mean Values ◽

Nerve Sheath ◽

The Mean ◽

Increased Icp

Abstract Background: The increased intracranial pressure (ICP) syndrome may emerge depending on many different neurological factors and the early diagnosis and treatment are important for the prevention of neurologic damage and related mortality. In recent years, the follow-up of increased ICP with non-invasive methods has been increasing. In this study, our objective was to determine the significance of ONSD (Optic Nerve Sheath Diameter) and NIRS (Near-Infrared Spectroscopy) in children with increased ICP and any possible correlation between ONSD and NIRS. Methods: Patients who were hospitalized in our pediatric ICU at Çukurova University Medical Faculty between June 2018 and June 2019 due to the suspicion of increased ICP were included in this study. The demographic characteristics of patients, diagnosis at admission, results of the cranial CT and MRI examinations, and results of the simultaneous ONSD and NIRS measurements were recorded. Results: A total of 36 patients were included in our study. With respect to the diagnosis, non-traumatic causes were at the forefront in 30 patients (83.3%), and the most common causes were meningoencephalitis (n=9; 25%) and non-traumatic bleeding (n=7; 19.4%). Six of the patients were under the age of one year (16.7%), and the mean values of ONSD and NIRS were 4.8±0.7 mm and 71.1±12.4% respectively in this group. Fourteen patients were in the one to ten year age group and the mean values of ONSD and NIRS were 6.1±0.6 mm and 72.7±9.3% respectively. Sixteen patients were over ten years of age (44.4%), and the mean values of ONSD and NIRS were 5.6±0.7 mm and 74.2±16% respectively. There was no correlation between the ONSD and NIRS values (r:0.3; p=0.07).Conclusion: Our study showed that ONSD measurements were helpful in children with increased ICP and reflected the increase in ICP. However, our study also demonstrated that ONSD was not in correlation with the NIRS monitoring. We believe that there is a need for further studies focused on the use of ONSD and NIRS in the monitoring of increased ICP.

Download Full-text

Evaluation of the relationship between NIRS (near-infrared spectroscopy) and optic nerve sheath diameter measurement in children with increased intracranial pressure: a pilot study

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01035-2 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Didar Arslan ◽

Dinçer Yıldızdaş ◽

Özden Özgür Horoz ◽

Nagehan Aslan ◽

Faruk İncecik

Keyword(s):

Infrared Spectroscopy ◽

Optic Nerve ◽

Intracranial Pressure ◽

Near Infrared ◽

Optic Nerve Sheath Diameter ◽

Increased Intracranial Pressure ◽

Mean Values ◽

Nerve Sheath ◽

The Mean ◽

Increased Icp

Abstract Background The increased intracranial pressure (ICP) syndrome may emerge depending on many different neurological factors and the early diagnosis and treatment are important for the prevention of neurologic damage and related mortality. In recent years, the follow-up of increased ICP with non-invasive methods has been rising. In this study, our objective was to determine the significance and any possible correlation between Optic Nerve Sheath Diameter (ONSD) and Near Infrared Spectroscopy (NIRS) in children with increased ICP. Methods Patients who were hospitalized in our pediatric ICU at Çukurova University Medical Faculty between June 2018 and June 2019 due to the suspicion of increased ICP were included in this study. The demographic characteristics of patients, diagnosis at admission, results of the cranial CT and MRI examinations, and results of the simultaneous ONSD and NIRS measurements were recorded. Results A total of 36 patients were included in our study. With respect to the diagnosis, non-traumatic causes were at the forefront in 30 patients (83.3%), and the most common causes were meningoencephalitis (n = 9; 25%) and non-traumatic bleeding (n = 7; 19.4%). Six of the patients were under the age of one year (16.7%), and the mean values of ONSD and NIRS were 4.8 ± 0.7 mm and 71.1 ± 12.4% respectively in this group. Fourteen patients were in the one to ten year age group and the mean values of ONSD and NIRS were 6.1 ± 0.6 mm and 72.7 ± 9.3% respectively. Sixteen patients were over ten years of age (44.4%), and the mean values of ONSD and NIRS were 5.6 ± 0.7 mm and 74.2 ± 16% respectively. There was no correlation between the ONSD and NIRS values (r:0.307; p = 0.068). Conclusion Our study showed that ONSD measurements were helpful in children with increased ICP and reflected the increase in ICP. However, our study also demonstrated that ONSD was not in correlation with the NIRS monitoring. We believe that there is a need for further studies focused on the use of ONSD and NIRS in the monitoring of increased ICP.

Download Full-text