Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Mar 21;12(3):767.
doi: 10.3390/diagnostics12030767.

Optic Nerve Sheath Diameter Ultrasound: A Non-Invasive Approach to Evaluate Increased Intracranial Pressure in Critically Ill Pediatric Patients

Giulia Cannata  1 , Stefano Pezzato  2 , Susanna Esposito  1 , Andrea Moscatelli  2
Affiliations
Review

Optic Nerve Sheath Diameter Ultrasound: A Non-Invasive Approach to Evaluate Increased Intracranial Pressure in Critically Ill Pediatric Patients

Giulia Cannata et al. Diagnostics (Basel). .

Abstract

Early diagnosis of increased intracranial pressure (ICP) is crucial for prompt diagnosis and treatment of intracranial hypertension in critically ill pediatric patients, preventing secondary brain damage and mortality. Although the placement of an external ventricular drain coupled to an external fluid-filled transducer remains the gold standard for continuous ICP monitoring, other non-invasive approaches are constantly being improved and can provide reliable estimates. The use of point-of-care ultrasound (POCUS) for the assessment of ICP has recently become widespread in pediatric emergency and critical care settings, representing a valuable extension of the physical examination. The aim of this manuscript is to review and discuss the basic principles of ultra-sound measurement of the optic nerve sheath diameter (ONSD) and summarize current evidence on its diagnostic value in pediatric patients with ICP. There is increasing evidence that POCUS measurement of the ONSD correlates with ICP, thus appearing as a useful extension of the physical examination in pediatrics, especially in emergency medicine and critical care settings for the initial non-invasive assessment of patients with suspected raised ICP. Its role could be of value even to assess the response to therapy and in the follow-up of patients with diagnosed intracranial hypertension if invasive ICP monitoring is not available. Further studies on more homogeneous and extensive study populations should be performed to establish ONSD reference ranges in the different pediatric ages and to define cut-off values in predicting elevated ICP compared to invasive ICP measurement.

Keywords: intracranial hypertension; intracranial pressure; optic nerve sheath diameter; pediatric emergency; point-of-care ultrasound.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The Monro–Kellie doctrine.
Figure 2
Figure 2
Cross-section (A) and longitudinal section (B) of the optic nerve.
Figure 3
Figure 3
Axial lateral transbulbar approach ONSD measurement.
See this image and copyright information in PMC

References

    1. Marmarou A., Anderson R.L., Ward J.D., Choi S.C., Young H.F., Eisenberg H.M., Foulkes M.A., Marshall L.F., Jane J.A. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J. Neurosurg. 1991;75:S59–S66. doi: 10.3171/sup.1991.75.1s.0s59. - DOI
    1. Chesnut R.M., Marshall L.F., Klauber M.R., Blunt B.A., Baldwin N., Eisenberg H.M., Jane J.A., Marmarou A., Foulkes M.A. The role of secondary brain injury in determining outcome from severe head injury. J. Trauma. 1993;34:216–222. doi: 10.1097/00005373-199302000-00006. - DOI - PubMed
    1. Juul N., Morris G.F., Marshall S.B., Marshall L.F. Intracranial hypertension and cerebral perfusion pressure: Influence on neurological deterioration and outcome in severe head injury. J. Neurosurg. 2000;92:1–6. doi: 10.3171/jns.2000.92.1.0001. - DOI - PubMed
    1. Balestreri M., Czosnyka M., Hutchinson P., Steiner L.A., Hiler M., Smielewski P., Pickard J.D. Impact of Intracranial Pressure and Cerebral Perfusion Pressure on Severe Disability and Mortality After Head Injury. Neurocritical Care. 2006;4:008–013. doi: 10.1385/NCC:4:1:008. - DOI - PubMed
    1. Myburgh J.A., Cooper D.J., Finfer S.R., Venkatesh B., Jones D., Higgins A., Bishop N., Higlett T. Epidemiology and 12-Month Outcomes from Traumatic Brain Injury in Australia and New Zealand. J. Trauma Acute Care Surg. 2008;64:854–862. doi: 10.1097/TA.0b013e3180340e77. - DOI - PubMed

LinkOut - more resources