经眶超声视神经鞘直径与脑积水婴儿术中测量的颅内压的相关性。

Correlation of the transorbital ultrasonographic optic nerve sheath diameter with intracranial pressure measured intraoperatively in infants with hydrocephalus.

机构信息

1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

2Department of Radiation Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; and.

出版信息

J Neurosurg Pediatr. 2024 Jan 12;33(4):334-342. doi: 10.3171/2023.12.PEDS23273. Print 2024 Apr 1.

DOI:10.3171/2023.12.PEDS23273

PMID:38215445

Abstract

OBJECTIVE

Hydrocephalus is a highly significant global public health concern. In infants, it may be associated with a potentially deleterious increase in intracranial pressure (ICP). Currently, the gold standard for accurate monitoring of ICP is an intraventricular ICP monitor, but this method is invasive and expensive. Transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) may provide a noninvasive and cost-effective alternative method for monitoring ICP. The goal of the study was to determine the extent of the correlation between ultrasonographic ONSD and ICP in infants.

METHODS

A prospective observational study of 47 children with hydrocephalus aged ≤ 18 months was performed. The ONSD was measured with a transorbital ultrasound scan, while the intraventricular CSF opening pressure was assessed using a manometer during ventriculoperitoneal shunt insertion. Data were analyzed using SPSS software. The ONSD and ICP measurements were correlated, the receiver operating characteristic (ROC) curve was evaluated, and a sensitivity analysis was performed. Inferences were made using the 0.05 alpha level of significance.

RESULTS

The mean age of the study cohort was 4.8 ± 4.3 months, and 93.6% of patients were infants. The mean ONSD was 4.5 ± 0.7 mm (range 2.9-6.0 mm), and the mean ICP was 19.9 ± 6.5 mm Hg (range 5.2-32.4 mm Hg). Both ONSD and ICP increased with increasing age. The Pearson correlation coefficient revealed a strong positive correlation between ONSD and ICP (r = 0.77, p < 0.001). The ONSD cutoff points were 3.2 mm, 4.0 mm, and 4.6 mm for patients with ICPs of 10 mm Hg, 15 mm Hg, and ≥ 20 mm Hg, respectively. The sensitivity of ONSD was 97.7% (area under the ROC curve 0.99), and for every 14.3-mm Hg increase in ICP, the ONSD increased by 1.0 mm holding age constant.

CONCLUSIONS

ONSD has a strong positive correlation with ICP. Correspondingly, ONSD is highly sensitive in estimating ICP.

摘要

目的

脑积水是一个具有重大全球公共卫生意义的问题。在婴儿中，它可能与颅内压（ICP）的潜在有害增加有关。目前，ICP 准确监测的金标准是脑室内 ICP 监测器，但这种方法具有侵入性且昂贵。经眶超声视神经鞘直径（ONSD）测量可能为 ICP 监测提供一种非侵入性且具有成本效益的替代方法。本研究的目的是确定超声 ONSD 与婴儿 ICP 之间的相关性程度。

方法

对 47 名年龄≤18 个月的脑积水患儿进行前瞻性观察研究。使用经眶超声扫描测量 ONSD，同时在脑室-腹腔分流术插入期间使用压力计评估脑室内 CSF 开口压力。使用 SPSS 软件分析数据。对 ONSD 和 ICP 测量值进行相关性分析，评估受试者工作特征（ROC）曲线，并进行敏感性分析。使用 0.05 的 alpha 水平进行推断。

结果

研究队列的平均年龄为 4.8±4.3 个月，93.6%的患者为婴儿。平均 ONSD 为 4.5±0.7mm（范围 2.9-6.0mm），平均 ICP 为 19.9±6.5mmHg（范围 5.2-32.4mmHg）。ONSD 和 ICP 均随年龄增长而增加。Pearson 相关系数显示 ONSD 与 ICP 之间存在强正相关（r=0.77，p<0.001）。当 ICP 分别为 10mmHg、15mmHg 和≥20mmHg 时，ONSD 的截断值分别为 3.2mm、4.0mm 和 4.6mm。ONSD 的灵敏度为 97.7%（ROC 曲线下面积为 0.99），在保持年龄不变的情况下，ICP 每增加 14.3mmHg，ONSD 增加 1.0mm。