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Updated: Aug 17, 2026
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Does cerebral perfusion improve following CSF diversion in pediatric hydrocephalus? A prospective study using 99mTc
Pralay Kumar Nayak1, Deepak Agrawal, Naveen K Gowda
1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 11029, India.
Insights
Cerebral perfusion significantly improves in most children after hydrocephalus treatment with ventriculoperitoneal shunts. The duration of hydrocephalus and ventricular size do not predict this perfusion improvement.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Neurosurgery
Background:
- Hydrocephalus in children can lead to altered regional cerebral perfusion.
- Ventriculoperitoneal shunt placement is a common treatment for pediatric hydrocephalus.
Purpose of the Study:
- To assess changes in regional cerebral perfusion in children with hydrocephalus before and after ventriculoperitoneal shunt placement.
- To evaluate the utility of technetium-99m ethyl cysteinate dimer (99mTc ECD) single photon emission computed tomography (SPECT) in measuring these changes.
Main Methods:
- A prospective study included 17 children under 16 years with hydrocephalus undergoing shunt placement.
- Brain SPECT imaging with 99mTc ECD was performed pre- and postoperatively.
- Changes in cerebral perfusion were correlated with changes in ventricular size using Evan's ratio.
Main Results:
- 82% of children demonstrated improved cerebral perfusion after shunt placement.
- In most cases with improved perfusion, a decrease in ventricular size was also observed.
- Logistic regression analysis indicated that age, symptom duration, hydrocephalus etiology, and ventricular size reduction did not predict perfusion improvement.
Conclusions:
- Ventriculoperitoneal shunting generally leads to improved cerebral perfusion in pediatric hydrocephalus patients.
- Contrary to common assumptions, the duration of hydrocephalus and the degree of ventricular size reduction do not appear to influence the improvement in cerebral perfusion.
- SPECT imaging with 99mTc ECD is a valuable tool for objectively assessing cerebral perfusion improvements following interventions for hydrocephalus in children.
Aims And Objectives:
To study regional cerebral perfusion before and after ventriculoperitoneal shunt placement in children with hydrocephalus, using (99m)Tc ECD single photon emission computed tomography (SPECT).
Materials And Methods:
17 consecutive children (less than 16 years) with hydrocephalus due to various causes, who were planned for ventriculoperitoneal shunt, were included in this prospective study. Brain SPECT using (99m)Tc ECD was performed pre- and postoperatively and changes in cerebral perfusion were compared with the change in ventricular size (assessed using Evan's ratio).
Observations:
There were 11 males and 6 females with a median age of 24 months. Nine children were up to 2 years of age and the mean duration of symptoms was 6 months. The cause of hydrocephalus was congenital in 10, secondary to tumor in 5 and as sequelae of infection in 2 children. Fourteen children (82%) showed improvement in cerebral perfusion following shunting. Of these, 12 also had a concomitant decrease in ventricular size postoperatively.
Results:
On logistic regression analysis, none of the factors analyzed, i.e. age, duration of symptoms, etiology of hydrocephalus and decrease in ventricular size, were found to predict improvement of cerebral perfusion following shunting.
Conclusions:
Cerebral perfusion improves in the majority of the children following CSF diversionary procedures, and contrary to the common belief, duration of hydrocephalus and decreased ventricular size do not influence this improvement in cerebral perfusion. SPECT can therefore prove to be a valuable tool for objective assessment of improvement in cerebral perfusion in children with hydrocephalus secondary to various etiologies following surgical or medical interventions.
