Technical University Munich, Department of Pediatrics, Pediatric Neurology, Kölner Platz 1, 80804, Munich, Germany; Technical University Munich, Department of Pediatrics, Chair of Social Pediatrics, Heiglhofstraße 65, 81377, Munich, Germany; Community Hospital Munich, Department of Pediatrics, Kölner Platz 1, 80804 Munich, Germany.
Technical University Munich, Department of Pediatrics, Pediatric Neurology, Kölner Platz 1, 80804, Munich, Germany; Community Hospital Munich, Department of Pediatrics, Kölner Platz 1, 80804 Munich, Germany.
Eur J Paediatr Neurol. 2023 May;44:9-17. doi: 10.1016/j.ejpn.2023.01.010. Epub 2023 Jan 19.
Determination of optic nerve sheath diameter (ONSD) with transbulbar sonography has become an easily accessible and time-effective tool in the assessment of increased intracranial pressure. The aim of our study was to evaluate the usefulness of transbulbar sonography in the initial diagnosis and in follow-up examinations of children and adolescents with the diagnosis of pseudotumor cerebri syndrome (PTCS). We retrospectively reviewed imaging results of 24 patients aged 0.75-17 years with PTCS. Serial transbulbar sonography examinations were performed between 2011 and 2021. Sonographic evaluation included the ONSD, papilledema and subarachnoid space. 240 sonographic measurements taken at 108 time points in 17 patients met the inclusion criteria. All patients underwent serial lumbar punctures and routine fundoscopy in close relation to transbulbar sonography. We found that ONSD values remained high in all patients. The longest follow-up period was dated 2498 days (6.84 years) after initial diagnosis. Papilledema resolved in close correlation to fundoscopy normalization. In 16/17 patients the subarachnoid space remained cystic in appearance. These findings were independent of clinical symptoms and lumbar puncture opening pressure. We conclude that transbulbar sonography is a useful diagnostic tool in the initial diagnostic workup of children with PTCS. On follow-up however ONSD values and the cystic transformation of the subarachnoid space remained pathologic in the majority of cases while papilledema resolved parallel to fundoscopy findings. Serial measurements of ONSD are therefore of limited value in the follow-up of patients with PTCS and cannot be considered a reliable tool in subsequent therapeutic decisions.
经眶超声测量视神经鞘直径（ONSD）在评估颅内压增高方面已成为一种易于获取且省时的工具。本研究旨在评估经眶超声在儿童和青少年假性脑瘤综合征（PTCS）的初始诊断和随访检查中的作用。我们回顾性分析了 2011 年至 2021 年间 24 例诊断为 PTCS 的 0.75-17 岁患者的影像学结果。对这些患者进行了连续的经眶超声检查。超声评估包括 ONSD、视乳头水肿和蛛网膜下腔。在 17 例患者的 108 个时间点共进行了 240 次超声测量，符合纳入标准。所有患者均接受了连续腰椎穿刺和常规眼底检查，与经眶超声密切相关。我们发现所有患者的 ONSD 值均持续升高。初始诊断后最长随访时间为 2498 天（6.84 年）。视乳头水肿与眼底镜检查正常化密切相关。16/17 例患者蛛网膜下腔仍呈囊性外观。这些发现与临床症状和腰椎穿刺开放压无关。我们得出结论，经眶超声是儿童 PTCS 初始诊断的有用诊断工具。然而，在随访中，大多数情况下 ONSD 值和蛛网膜下腔的囊性改变仍然是病理性的，而视乳头水肿与眼底镜检查结果平行缓解。因此，PTCS 患者的随访中，ONSD 连续测量的价值有限，不能作为后续治疗决策的可靠工具。
