Driessen Caroline, Bannink Natalja, Lequin Maarten, van Veelen Marie-Lise C, Naus Nicole C, Joosten Koen F M, Mathijssen Irene M J
Department of Plastic and Reconstructive Surgery, Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
J Neurosurg Pediatr. 2011 Sep;8(3):329-34. doi: 10.3171/2011.6.PEDS10547.
Children with syndromic or complex craniosynostosis are evaluated for increased intracranial pressure (ICP) using funduscopy to detect papilledema. However, papilledema is a late sign of increased ICP. Because papilledema might be preceded by an increase in optic nerve sheath (ONS) diameter, the authors conducted a prospective study to establish the validity and applicability of measuring the ONS using ultrasonography.
From January 2007 to December 2009, 175 bilateral ultrasonography ONS measurements were performed in 128 patients with syndromic or complex craniosynostosis during the daytime. The measurements were correlated with ONS diameter assessed on CT and simultaneous funduscopy, when available. Furthermore, results were compared by using thresholds for ONS diameters on ultrasonography that are available in the literature.
The mean ONS diameter on ultrasonography was 3.1 ± 0.5 mm. The CT measurement was significantly correlated with the ultrasonography measurement (r = 0.41, p < 0.001). The mean ONS diameter in 38 eyes with papilledema was 3.3 ± 0.5 mm, compared with 3.1 ± 0.5 mm in the eyes of patients without papilledema (p = 0.039). Relative to the age-related thresholds, the ONS diameter was too large in 11 eyes (3%), particularly in patients with Crouzon syndrome. Compared with funduscopy, ultrasonography sensitivity was 11%, specificity was 97%, and positive and negative predictive values were 40% and 86%, respectively.
Ultrasonography is a valid and easy way of quantifying the ONS. Although the ONS diameter is larger in children with papilledema, it cannot be used as a daytime screening tool instead of funduscopy. The ONS diameter is possibly a more real-time indicator of ICP.
对于患有综合征性或复杂性颅缝早闭的儿童，通过眼底镜检查来检测视乳头水肿，以评估颅内压（ICP）升高情况。然而，视乳头水肿是ICP升高的晚期体征。由于视乳头水肿之前可能会出现视神经鞘（ONS）直径增加，作者进行了一项前瞻性研究，以确定使用超声测量ONS的有效性和适用性。
2007年1月至2009年12月期间，在白天对128例患有综合征性或复杂性颅缝早闭的患者进行了175次双侧超声ONS测量。这些测量结果与CT评估的ONS直径以及同时进行的眼底镜检查结果（若有）进行了相关性分析。此外，还使用文献中可用的超声ONS直径阈值对结果进行了比较。
超声测量的平均ONS直径为3.1±0.5mm。CT测量结果与超声测量结果显著相关（r = 0.41，p < 0.001）。38例有视乳头水肿的眼睛的平均ONS直径为3.3±0.5mm，而无视乳头水肿患者眼睛的平均ONS直径为3.1±0.5mm（p = 0.039）。相对于年龄相关阈值，11只眼睛（3%）的ONS直径过大，尤其是在克鲁宗综合征患者中。与眼底镜检查相比，超声检查的敏感性为11%，特异性为97%，阳性预测值和阴性预测值分别为40%和86%。
超声是一种有效且简便的量化ONS的方法。尽管有视乳头水肿的儿童的ONS直径较大，但它不能替代眼底镜检查作为白天的筛查工具。ONS直径可能是ICP更实时的指标。
