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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

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Abstract

Purpose

Previous studies correlating ultrasound (US)-based optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in children were performed under general anesthesia. To apply ONSD in daily clinical routine, it is necessary to investigate patients awake. It is furthermore essential for ICP-assessment with ONSD to know if ONSD-ICP correlation varies within individuals. In this study, we report on the influence of wakefulness, method of ICP measurement, intraindividual correlations, and dynamic changes of ONSD and ICP after ICP decreasing therapy.

Methods

The overall study included 72 children with a median age of 5.2 years. US ONSD determination was performed immediately prior to invasive ICP measurement, and the mean binocular ONSD was compared to ICP. In 10 children, a minimum of 3 ONSD/ICP measurements were performed to investigate a correlation within subjects. In 30 children, measurements were performed before and after therapy.

Results

Twenty-eight children were investigated awake with an excellent correlation of ONSD and ICP (r = 0.802, p < 0.01). In 10 children, at least three simultaneous ONSD and ICP measurements were performed. The intraindividual correlations were excellent (r = 0.795–1.0) however with strongly differing individual regression curves. The overall correlation within subjects was strong (r = 0.78, p < 0.01). After ICP decreasing therapy, all ONSD values decreased significantly (p < 0.01); however, there was no correlation between ∆ICP and ∆ONSD.

Conclusion

Awake investigation does not impair the correlation between ONSD and ICP. Even if there is a good overall ONSD-ICP correlation, every individual has its own distinctive and precise correlation line. The relationship between ONSD and ICP is furthermore not uniform between individuals. Strong ICP decreases can lead to smaller ONSD changes and vice versa. This should be kept in mind when using this technique in the clinical daily routine.

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Acknowledgments

We are deeply indebted to Juergen Beck, MD PhD, University of Bern and Freiburg, who inspired our interest in ultrasound determination of ONSD and to Llewellyn Padayachy, MD PhD, University of CapeTown and Pretoria, for many fruitful discussions over the years.

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Authors and Affiliations

  1. Department of Neurosurgery, Pediatric Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany

    Susanne R. Kerscher & Martin U. Schuhmann

  2. Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany

    Susanne R. Kerscher, Daniel Schöni & Martin U. Schuhmann

  3. Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland

    Daniel Schöni

  4. Pediatric Intensive Care Unit, Childrens’ Hospital, University Hospital of Tuebingen, Tuebingen, Germany

    Felix Neunhoeffer

  5. Department of Pediatric Neurology and Developmental Medicine, Childrens’ Hospital, University Hospital of Tuebingen, Tuebingen, Germany

    Markus Wolff, Karin Haas-Lude & Andrea Bevot

Authors
  1. Susanne R. Kerscher
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  2. Daniel Schöni
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  3. Felix Neunhoeffer
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  7. Martin U. Schuhmann
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Correspondence to Susanne R. Kerscher.

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The study was approved by the institutional ethics committee (project number: 180/2018B02).

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Kerscher, S.R., Schöni, D., Neunhoeffer, F. et al. 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. Childs Nerv Syst 36, 107–115 (2020). https://doi.org/10.1007/s00381-019-04336-4

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