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Transorbital optic nerve sheath ultrasonography in normal children
J Ballantyne1, A S Hollman, R Hamilton
1Department of Radiology, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
Insights
Ultrasound measurement of optic nerve sheath diameter (ONSD) can help diagnose increased intracranial pressure (ICP). This study establishes normal ONSD ranges in children, identifying abnormal values for early diagnosis and treatment.
Area of Science:
- Pediatric imaging
- Neurology
- Critical care medicine
Background:
- Early diagnosis of acute intracranial hypertension is crucial for timely treatment.
- Optic nerve sheath diameter (ONSD) increases with intracranial pressure (ICP).
- Ultrasound offers a non-invasive, portable, and cost-effective method for ONSD measurement.
Purpose of the Study:
- To establish normal ONSD values in infants and children up to 15 years of age.
- To provide reference ranges for diagnosing elevated ICP in pediatric patients.
Main Methods:
- Prospective study involving 102 children.
- Optic nerve sheath diameter (ONSD) measured using a 7 MHz sector probe, 3 mm behind the optic nerve head.
- Three measurements taken per eye.
Main Results:
- Normal ONSD range: 2.1-4.3 mm, with a mean of 3.08 mm (SD 0.36).
- No significant differences found between sexes or between right and left eyes.
- A correlation was observed between increasing age and increasing ONSD, particularly in the first two months of life.
Conclusions:
- Suggests abnormal ONSD is >4 mm in infants (<1 year) and >45 mm in older children.
- Provides ultrasound-based diagnostic criteria for elevated ICP in pediatric populations.
- Highlights the utility of ONSD ultrasound for non-invasive ICP monitoring in children.
Aim:
Early diagnosis of acute intracranial hypertension is essential to enable prompt, optimal treatment. The optic nerve sheath diameter (ONSD) is increased in raised ICP and there has been recent interest in the use of ultrasound to diagnose and indirectly monitor raised ICP by ONSD measurement. The advantages of the technique include its non-invasiveness, wide availability, portability, low cost and the absence of ionizing radiation. This prospective study was designed to establish the range of normal values for ONSD in infants and children up to 15 years of age.
Patients And Methods:
One hundred and two children attending the hospital for other reasons were recruited to the study. Three measurements of the ONSD were taken for each eye, 3 mm behind the optic nerve head using a 7 MHz sector probe.
Results:
The range for ONSD was 2.1-4.3 mm, mean 3.08 (SD 0.36). There were no significant differences on ONSD measurement between boys and girls (P = 0.59) or between right and left eyes (P=0.66). When the data were grouped and analysed, a correlation between increasing age and increasing ONSD was seen (r2=0.48), with the greatest increase occurring in the first 2 months of life.
Conclusion:
Using the technique described here, our results suggest that an ONSD of greater than 4 mm in infants less than 1 year, and 45 mm or greater in older children, should be regarded as abnormal.
