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Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition
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Does optic nerve sheath diameter on MRI decrease with clinically improved pediatric hydrocephalus?

Ash Singhal1, Michael M H Yang, Michael A Sargent

  • 1Department of Surgery, Division of Pediatric Neurosurgery, University of British Columbia and BC Children's Hospital, Vancouver, BC V6H 3V4, Canada. ash.singhal@cw.bc.ca

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|October 30, 2012
PubMed
Summary
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Optic nerve sheath diameter (ONSD) and optic disk bulging effectively indicate hydrocephalus control in children after neurosurgery. These measurements offer a more reliable assessment than ventricular size alone for treatment success.

Area of Science:

  • Pediatric Neurosurgery
  • Ophthalmology
  • Radiology

Background:

  • Hydrocephalus in children often requires neurosurgical intervention.
  • Assessing treatment efficacy typically relies on ventricular size, which can be an imperfect indicator.
  • Novel radiographic markers are needed to better evaluate hydrocephalus management outcomes.

Observation:

  • Optic nerve sheath diameter (ONSD), optic disk bulging, and optic nerve tortuosity were assessed in 16 children post-endoscopic third ventriculostomy (ETV) or posterior fossa tumor resection.
  • Magnetic resonance imaging (MRI) was used to measure ONSD and evaluate optic disk and nerve changes.
  • Ventricular size was quantified using the frontal and occipital horn ratio (FOR).

Findings:

  • A significant reduction in ONSD was observed post-intervention (p = 0.0017).

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  • Optic disk bulging decreased by 88% (p = 0.011), while tortuosity showed a 60% reduction (p = 0.23).
  • FOR normalized in the tumor resection group, and all patients improved clinically.

    • Implications:

    • Serial ONSD measurements and optic disk bulging assessment can serve as valuable indicators of successful hydrocephalus treatment in pediatric neurosurgery.
    • These findings suggest that ocular parameters may provide more sensitive monitoring of hydrocephalus control than ventricular size alone.
    • Further research can validate these ocular metrics for routine clinical use in managing pediatric hydrocephalus.