The relation of optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in pediatric neurosurgery practice - Part II: Influence of wakefulness, method of ICP measurement, intra-individual ONSD-ICP correlation and changes after therapy

Kerscher, Susanne R.; Schöni, Daniel; Neunhoeffer, Felix; Wolff, Markus; Haas-Lude, Karin; Bevot, Andrea; Schuhmann, Martín U.

doi:10.1007/s00381-019-04336-4

Cited by 36 publications

(35 citation statements)

References 30 publications

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“…Bilateral ONSD was measured in all patients, then calculated mean ONSD which was defined as the average value of the left and right ONSD. The other 6 parameters included the width of the brain and the ventricles in each level were measured as shown in Fig 1. (A: maximum distance between anterior horn, B: minimum bicaudate nuclei distance, D: third ventricle distance, AA, BB, and DD: corresponding brain width, respectively, EE: the square root of summation for AA 2 , BB 2 , and DD 2…”

Section: Measurement Protocol On Ctmentioning

confidence: 99%

“…Therefore, decision was made to use scenario 2 in the further analysis because of fewer explanatory variables. Scenario 1; explanatory variables include ln(age), A, B, D, AA, BB and DD, Scenario 2; explanatory variables include ln (age), A, B, D and EE, n; case number, R; correlation coefficient, R 2 ; coefficient of determination, SE; standard error, A: Maximum distance between anterior horn, B: Minimum bicaudate nuclei distance, D: Third ventricle distance, AA, BB and DD: corresponding brain width to maximum distance between anterior horn, minimum bicaudate nuclei distance, third ventricle distance, respectively, EE: a square root of summation for AA 2 PLOS ONE strongly to ln(age) and the brain width, and fairly to the ventricular width. To the best of our knowledge, this is the first report which revealed a relationship between ONSD and the CT parameters including the width of the brain or the ventricles.…”

Section: Plos Onementioning

confidence: 99%

“…Several studies have found a correlation between ONSD on ultrasound [1,2,16,17], MRI [15], CT [18], and ICP measured through traditional monitoring. In the previous studies which enrolled adult patients with any kind of intracranial pathologies, Robba et al showed that ONSD measured on ultrasound had the strongest correlation in predicting increased ICPs in patients with invasive ICP monitoring [19].…”

Section: Group Comparison Between the Control And The Siicpmentioning

confidence: 99%

“…For the initial diagnosis and follow-up evaluations of many underlying neurosurgical conditions, repeated invasive ICP measurements are desirable; however, it could become a risk for children to repeat sedation, anesthesia, or radiation exposure. Therefore, a reliable and useful clinical technique to non-invasively assess the ICP status in children is admirable [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have indicated the efficacy of various non-invasive methods for predicting elevated ICP [1][2][3][4][5]. In their study, measurements of optic nerve sheath diameter (ONSD) with ultrasound, CT, or MRI could accurately predict increased ICP.…”

Section: Introductionmentioning

confidence: 99%

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Intracranial pressure based decision making: Prediction of suspected increased intracranial pressure with machine learning

2020

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Background Repeated invasive intracranial pressure (ICP) monitoring is desirable because many neurosurgical pathologies are associated with elevated ICP. On the other hand, it could become a risk for children to repeat sedation, anesthesia, or radiation exposure. As a non-invasive method, measurements of optic nerve sheath diameter (ONSD) has been revealed to accurately predict increased ICP. However, no studies have indicated a relationship among age, brain, and ventricular parameters in normal children, nor a prediction of increased ICP with artificial intelligence. Methods and findings This study enrolled 400 normal children for control and 75 children with signs of increased ICP between 2009 and 2019. Measurements of the parameters including ONSD on CT were obtained. A supervised machine learning was applied to predict suspected increased ICP based on CT measurements. A linear correlation was shown between ln(age) and mean ONSD (mONSD) in normal children, revealing mONSD = 0.36ln(age)+2.26 (R 2 = 0.60). This study revealed a linear correlation of mONSD measured on CT with ln(age) and the width of the brain, not the width of the ventricles in 400 normal children based on the univariate analyses. Additionally, the multivariate analyses revealed minimum bicaudate nuclei distance was also associated with mONSD. The results of the group comparison between control and suspected increased ICP revealed a statistical significance in mONSD and the width of the ventricles. The study indicated that supervised machine learning application could be applied to predict suspected increased ICP in children, with an accuracy of 94% for training, 91% for test. Conclusions This study clarified three issues regarding ONSD and ICP. Mean ONSD measured on CT was correlated with ln(age) and the width of the brain, not the width of the ventricles in 400 normal children based on the univariate analyses. The multivariate analyses revealed

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Section: Measurement Protocol On Ctmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Group Comparison Between the Control And The Siicpmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intracranial pressure based decision making: Prediction of suspected increased intracranial pressure with machine learning

2020

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Bedside ocular ultrasonography for diagnosing increased intracranial pressure in patients with leptomeningeal metastases from non‐small‐cell lung cancer

Jiang

Lin

et al. 2022

Cancer Medicine

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Objectives To explore the diagnostic accuracy of ultrasound measurement of optic nerve sheath diameter (ONSD) and optic disc height (ODH) in detecting intracranial hypertension in non‐small‐cell lung cancer (NSCLC) patients with leptomeningeal metastases (LM). Methods Seventy‐two patients with NSCLC‐LM and 65 patients with NSCLC were enrolled. The ONSD, ODH, eyeball transverse diameter (ETD), and eyeball vertical diameter (EVD) were measured by ultrasound. Subsequently, lumbar puncture was performed in NSCLC‐LM patients to measure cerebrospinal fluid pressure (CSFP), and intrathecal chemotherapy was regularly implemented. Pearson's correlation analysis was used to analyze the relationship between CSFP and ultrasound findings. The diagnostic accuracy of ONSD, ODH, and combined ONSD and ODH was evaluated by receiver operating characteristic (ROC) curve analysis and the corresponding area under the ROC curve (AUC). Results The ONSD, ODH, ONSD/ETD, and ONSD/EVD values were higher in the NSCLC‐LM group (all p < 0.05). The ONSD, ODH, ONSD/ETD, and ONSD/EVD values were all elevated in the abnormally elevated CSFP group (all p < 0.05). ONSD, ODH, ONSD/ETD, and ONSD/EVD were positively correlated with CSFP ( r = 0.531, 0.383, 0.534, and 0.535, all p < 0.0001). The AUCs for ONSD, ODH, ONSD/ETD, and ONSD/EVD to detect CSFP >280 mmH2O were 0.787 (95% CI: 0.64–0.93, sensitivity 68.75%, specificity 91.07%), 0.885 (95% CI: 0.81–0.96, sensitivity 100%, specificity 69.64%), 0.765 (95% CI: 0.64–0.89, sensitivity 81.25%, specificity 64.29%), and 0.788 (95% CI: 0.64–0.93, sensitivity 56.25%, specificity 91.07%), respectively. When ONSD was combined with ODH, the AUC was 0.913 (95% CI: 0.83–0.99, sensitivity 87.85%, specificity 85.70%). Furthermore, intrathecal chemotherapy was associated with a downtrend in CSFP and ultrasound findings. Conclusion There are important advantages of using bedside ultrasonography for detecting elevated CSFP in NSCLC‐LM patients. Further research should be performed to evaluate the clinical significance of an enlarged ONSD and increased ODH in NSCLC‐LM.

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Retrospective longitudinal assessment of optic nerve sheath diameter in patients with malignant glioma

Feucht,

Kerscher,

Ruff

et al. 2023

Cancer Medicine

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IntroductionGlioblastoma (GBM) is a tumor with rapid growth and a possible relationship to elevated intracranial pressure (ICP). High ICP may not always be associated with clinical signs. A non‐invasive technique for assessment of ICP is measuring the optic nerve sheath diameter (ONSD). Identifying patients who need immediate intervention is of importance in neuro‐oncological care. The goal of this study is to assess the available magnetic resonance imaging (MRI) of patients with GBM with respect to pre‐ and postoperative ONSD.Methods and MaterialsRetrospective data analysis was performed on all patients operated for GBM at a tertiary care center between 2010 and 2020. Two pre and one postoperative MRI had to be available. Clinical data and ONSD at multiple time points were analyzed and correlated, as well as preoperative volumetrics.ResultsSixty‐seven patients met the inclusion criteria. Clinical signs of elevated ICP were seen in 25.4% (n = 17), while significant perifocal edema was present in 67.2% (n = 45) of patients. Clinical signs of preoperatively elevated ICP were associated with significantly elevated ONSD at diagnosis (p < 0.001) as well as preoperative tumor volume (p < 0.001). Significant perifocal edema at the time of diagnosis was associated with elevated ONSD (p = 0.029) and higher tumor volume (p = 0.003). In patients with significant edema, ONSD increased significantly between preoperative MRIs (p = 0.003/005). In patients with clinical signs of raised ICP, ONSD also increased, whereas it was stable in asymptomatic patients (yes: 5.01+/−4.17 to 5.83+/−0.55 mm, p = 0.010, no: 5.17+/−0.46 mm to 5.38+/−0.41 mm, p = 0.81). A significant increase of ONSD from diagnosis to preoperative MRI and a significant decrease until 3 months postoperatively were observed (p < 0.001).ConclusionsONSD might help identify high ICP in patients with GBM. In this first‐of‐its kind study, we observed a significant increase of ONSD preoperatively, likely associated with edema. Postoperatively, ONSD decreased significantly until 3 months after surgery and increased again at 12 months. Further prospective data collection is warranted.

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The relation of optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in pediatric neurosurgery practice - Part II: Influence of wakefulness, method of ICP measurement, intra-individual ONSD-ICP correlation and changes after therapy

Cited by 36 publications

References 30 publications

Intracranial pressure based decision making: Prediction of suspected increased intracranial pressure with machine learning

Intracranial pressure based decision making: Prediction of suspected increased intracranial pressure with machine learning

Bedside ocular ultrasonography for diagnosing increased intracranial pressure in patients with leptomeningeal metastases from non‐small‐cell lung cancer

Retrospective longitudinal assessment of optic nerve sheath diameter in patients with malignant glioma

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