Transcranial Doppler ultrasonography to evaluate need for cerebrospinal fluid drainage in hydrocephalic children.

Abstract

levation of ICP in infants, resulting from hydrocephalus, cerebral edema, and intracranial hemorrhage, may lead to brain damage through diastolic hypoperfusion. 1-5 TCD ultrasonography is an accepted noninvasive method to quantify perfusion of intracranial arteries in adults 6,7 and children. [8][9][10][11][12][13][14][15][16][17] The peak S and end D flow velocities are measured, and the RI is calculated as (S -D)/S. Several authors have described the use of RI to study the relationship between cerebral perfusion pressure and ICP, 1,15-18 to investigate ICP-volume relationships (compliance [19][20][21][22] ), and to examine the effects of treatments aimed at decreasing ICP and improving brain perfusion in infants with the previously mentioned clinical conditions. 1,15,16,18,20,21 These treatments include transfontanellar tapping and shunting procedures for hydrocephalus and subdural fluid collections and hyperventilation, diuretics, and blood pressure manipulations for cerebral edema.The purpose of our study was to prospectively determine whether RI measurements obtained with TCD ultrasonography predict the need for treatment in hydrocephalic children. The aim of this study was to determine whether the resistive index in the anterior cerebral artery, as measured by transcranial Doppler ultrasonography without and with pressure provocation, predicts the need for cerebrospinal fluid drainage in hydrocephalic children. Both without and with pressure provocation, the resistive index was significantly higher (P > 0.05) in patients with raised intracranial pressure compared with control group patients and dropped significantly after drainage. With receiver operating characteristic analysis, the optimal cutoff point between normal and abnormal resistive index values was determined at 0.71 without pressure provocation and at 0.90 with pressure provocation. The addition of the pressure provocation test improved accuracy from 81 to 91%, mainly by improving specificity. In conclusion, transcranial Doppler ultrasonography with pressure provocation accurately identifies hydrocephalic children who require cerebrospinal fluid drainage procedures. KEY WORDS: Doppler ultrasonography; Ultrasonography, infants and children; Skull, surgery; Cerebral blood vessels; Hydrocephalus; Brain, ultrasonography; Brain, blood flow.

Measurement of the blood flow velocity in the pericallosal artery of children with hydrocephalus by transcranial doppler ultrasonography - preliminary results

“…In patients with malfunctioning shunts changes in Doppler curve of cerebral arteries (increase RI due to decrease in EDFV) are present much earlier than progression dilatation of brain ventricles 15 . The introduction of pressure provocation test of anterior fontanelle to examine CSF storage capacity has lead to greater accuracy of TCCD ultrasonography to separate normal from (borderline) abnormal values 16 . Initially, a change in intracranial volume is off set with volume shifts in other components so that ICP remains essentially unchanged.…”

Neuroimaging biomarkers of preterm brain injury: toward developing the preterm connectome

“…The resistive index (RI) increases with significant post-hemorrhagic hydrocephalus and decreases following cerebrospinal fluid (CSF) drainage, suggesting that it might be useful to assess shunt function [122]. Significant change in RI with anterior fontanelle compression is associated with increased intracranial pressure and need of surgical intervention [123].…”

Transcranial Doppler Ultrasonography in the Management of Neonatal Hydrocephalus

“…After the successful drainage procedure, the significant decrease of basal and compressive values of resistive index was found. The borderline value of basal resistive index of anterior cerebral artery was defined as 0,70, for positive anterior compressive test as 0,90 or increase of basal resistive index more than 25% (Westra et al, 1998). Gera et al (2002) were interested in the assessment of Doppler parameters of anterior cerebral artery in newborns and children with hydrocephalus in relationship to the need of drainage procedure.…”

“…The compression of anterior fontanelle by means of ophtalmodynamometer allows exact determination of applied pressure (g/cm2). The Doppler parameters could be measured through transtemporal acoustic window (Taylor et al, 1994;Taylor et al, 1996;Westra et al, 1998). If the value of basal resistive index increased more than 25% or the value of compressive resistive index is more than 0,90, the compressive test is considered to be positive (Westra et al, 1998 …”

“…The reference values of resistive index of Doppler curve in the vertical segment of pericallosal artery before the genu corporis callosi in preterm newborns (Bode, 1988;Westra et al, 1998) (table -authors)…”