MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension

Rohr, Axel; Jensen, Ulf; Riedel, Christian; Baalen, Andreas van; Fruehauf, M.-C.; Bartsch, Thorsten; Hedderich, J.; Doerner, Lutz; Jansen, Olav

doi:10.3174/ajnr.a2120

Cited by 49 publications

(23 citation statements)

References 17 publications

(22 reference statements)

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“…Due to the invasive nature of testing CSFP, noninvasive measures are desirable. Other techniques that have been explored include IOP measurement, 19 optic nerve sheath width measurement by ultrasonography 20 or MRI, 21,22 and an approach using transcranial Doppler technology. 23 Unfortunately, limitations exist for each of these techniques as well as the technical approach that is being used to estimate CSFP.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Cerebrospinal Fluid Pressure Estimation Using Formulae Derived From Clinical Data

Fleischman

Bicket

Stinnett

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To evaluate a frequently used regression model and a new, modified regression model to estimate cerebrospinal fluid pressure (CSFP). METHODS. Datasets from the Beijing iCOP study from Tongren Hospital, Beijing, China, and the Mayo Clinic, Rochester, Minnesota, were tested in this retrospective, case-control study. An often-used regression model derived from the Beijing iCOP dataset, but without radiographic data, was used to predict CSFP by using demographic and physiologic data. A regression model was created using the Mayo Clinic dataset and tested against a validation group. The Mayo Clinic-derived formula was also tested against the Beijing Eye Study population. Intraclass correlation was used to assess predicted versus actual CSFP. RESULTS. The Beijing-derived regression equation was reported to have an intraclass correlation coefficient (ICC) of 0.71, indicating strong correlation between predicted and actual CSFP in the study population. The Beijing iCOP regression model poorly predicted CSFP in the Mayo Clinic population with an ICC of 0.14. The Mayo Clinic-derived regression model similarly did not predict CSFP in its Mayo Clinic validation group (ICC 0.28 6 0.04) nor in the Beijing Eye Study population (ICC 0.06). CONCLUSIONS. Formulae used to predict CSFP derived from clinical data fared poorly against a large retrospective dataset. This may be related to differences in lumbar puncture technique, in the populations tested, or the timing of collection of physiologic variables in the Mayo Clinic dataset. Caution should be used when interpreting results based on formulaic derivation of CSFP.

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Section: Discussionmentioning

confidence: 99%

Analysis of Cerebrospinal Fluid Pressure Estimation Using Formulae Derived From Clinical Data

Fleischman

Bicket

Stinnett

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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“…Most interesting, further support for this theory is suggested in studies showing a similar correlation in the opposite direction (ie, a small ONSD value in the setting of decreased intracranial pressure). 14,15 In the pediatric population, Le et al 16 tested bedside sonographic assessment of the ONSD in children admitted to an intensive care unit. In their study, ONSD values of 4.0 mm (for children younger than 1 year of age) and 4.5 mm (for older children) were established as the upper limits of the normal diameter.…”

Section: Discussionmentioning

confidence: 99%

Optic Nerve Sheath Diameter on MR Imaging: Establishment of Norms and Comparison of Pediatric Patients with Idiopathic Intracranial Hypertension with Healthy Controls

Shofty¹,

Ben-Sira²,

Constantini³

et al. 2011

AJNR Am J Neuroradiol

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“…

We read with interest the recent article entitled "MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension" by Rohr et al 1 In patients with craniospinal hypotension, apart from engorged venous sinuses, enlarged pituitary gland, subdural effusions, and sagging of the brain, the authors have observed a partially or fully collapsed intersheath space of the optic nerves. Such a demonstration is particularly clear in their Fig 3. We would like to draw more attention to changes in the pituitary gland.

…”

mentioning

confidence: 97%

Enlargement of the Inferior Intercavernous Sinus: A New Sign for the Diagnosis of Craniospinal Hypotension

Bonneville¹,

Cattin²,

Bonneville³

2011

AJNR Am J Neuroradiol

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We read with interest the recent article entitled "MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension" by Rohr et al. 1 In patients with craniospinal hypotension, apart from engorged venous sinuses, enlarged pituitary gland, subdural effusions, and sagging of the brain, the authors have observed a partially or fully collapsed intersheath space of the optic nerves. Such a demonstration is particularly clear in their Fig 3. We would like to draw more attention to changes in the pituitary gland. As shown in Fig 3C (arrow), enlargement of the sellar content is also due partially to dilation of the inferior intercavernous sinus (IICS), which has collapsed after treatment. Such a dilation is not mentioned in the legend. In our experience, the IICS, which is visible in roughly 30% of children on MR imaging, is never quite visible in the healthy adult.In a personal series of 12 adult patients with intracranial hypotension syndrome studied by MR imaging, the IICS was visualized in 11 cases 2 : The IICS was very thin in 2 cases, prominent in 6 cases, and very thick (Ͼ3 mm) in 3 cases (Fig 1). The differential diagnosis includes a pituitary gland with increased height on one hand, corresponding to physiologic (hyperplasia, pregnancy, small sella) or pathologic conditions (a holosellar pituitary adenoma, hypophysitis, and so forth), and focal intrasellar lesions such as pituitary microadenoma on the other hand. Recognition of the presence of the IICS allows exclusion of these pituitary abnormalities. In 3 of 12 cases of our series, MR imaging follow-up after blood patch or spontaneous resolution of intracranial hypotension demonstrated a significant decrease in the height of the IICS (Fig 2). In our experience, dilation of the IICS constitutes a useful adjunctive sign for the diagnosis of intracranial hypotension. Moreover, enlargement of the IICS should be added to the other causes of enlargement of the sellar content.

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MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension

Abstract: BACKGROUND AND PURPOSE:Craniospinal hyper-or hypotension leads to morphologic changes in certain intracranial structures. We tested the hypothesis that the amount of CSF in the ONS visible in MR imaging is reduced in patients with CSH.

Cited by 49 publications

References 17 publications

Analysis of Cerebrospinal Fluid Pressure Estimation Using Formulae Derived From Clinical Data

Analysis of Cerebrospinal Fluid Pressure Estimation Using Formulae Derived From Clinical Data

Optic Nerve Sheath Diameter on MR Imaging: Establishment of Norms and Comparison of Pediatric Patients with Idiopathic Intracranial Hypertension with Healthy Controls

Enlargement of the Inferior Intercavernous Sinus: A New Sign for the Diagnosis of Craniospinal Hypotension

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