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视神经外直径的变化和儿童脑室静脉冲失效

Adrienne L Davis¹, Mark Tessaro¹, Suzanne Schuh^1,2

¹Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.

JAMA network open

|May 16, 2025

概括

眼部护理点超声波 (POCUS) 可以通过测量视神经外直径 (ONSD) 变化来检测水头症儿童的分流失败. 低于0.4毫米的ONSD变化表明分流器故障的风险很低.

科学领域:

儿科神经外科儿科神经外科
医疗成像医学成像
眼科医生眼科眼科

背景情况:

水脑是儿童中常见的疾病,需要脑脊液 (CSF) 短路.
旁路功能障碍是常见的并发症,需要及时诊断和干预.
眼部点诊超声波 (POCUS) 是一种非侵入性方法,可以间接评估内压力.

研究的目的:

评估视觉神经外直径 (ONSD) 变化与儿科水脑病患者的分流失败之间的关联.
为了确定POCUS是否可以在急诊室设置中可靠地检测掉线功能障碍.

主要方法:

未来的观察队列研究涉及儿童 (≤18岁) 患有CSF短路.
在无症状访问期间进行的基线眼球POCUS;如果症状呈现给ED,则进行第二次POCUS.
从基线到症状呈现的ONSD变化是主要暴露;分流失败是主要结果.

主要成果:

18%的ED病例 (14/76) 与手术内确诊的分流失败有关.
与没有 (0.16毫米) 的患者相比,与分流失败 (0.89毫米) 的患者相比,平均ONSD变化显著更大.
每增加0.1毫米的ONSD与1.4倍更高的分流失败概率相关;一个ONSD变化<0.4毫米有一个0.98负的分流失败预测值.

结论:

通过眼球POCUS测量ONSD的变化与水头症儿童的分流失败有关.
低于0.4毫米的ONSD变化有效地识别了处置器失效风险较低的患者.
需要进一步的研究来验证ONSD值,并对神经成像中低风险患者进行风险分层.

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