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Cerebral blood flow velocity changes after ventricular taps and ventriculoperitoneal shunting
1Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK.
Insights
Transcranial Doppler ultrasonography (TCD) effectively monitors hydrocephalus by tracking cerebrovascular resistance. This non-invasive method helps assess treatment effectiveness after cerebrospinal fluid diversion procedures.
Area of Science:
- Neurology
- Pediatrics
- Medical Imaging
Background:
- Hydrocephalus is a condition characterized by excessive cerebrospinal fluid (CSF) accumulation in the brain.
- Ventriculoperitoneal shunting is a common surgical intervention to manage hydrocephalus.
- Monitoring intracranial pressure (ICP) and cerebral hemodynamics is crucial for managing hydrocephalic patients.
Observation:
- Transcranial Doppler (TCD) ultrasonography was used to assess cerebral blood flow in 14 pediatric hydrocephalus patients.
- TCD measurements, including the resistance index (RI), were taken before and after ventriculoperitoneal shunting.
- Simultaneous ICP measurements and TCD were performed during ventricular taps in 7 patients.
Findings:
- A significant decrease in RI was observed in all patients post-shunting and after ventricular taps.
- The reduction in RI was attributed to a greater increase in end-diastolic flow velocity compared to peak systolic velocity.
- A significant correlation was found between RI and ICP in older infants, children, and individual neonates.
Implications:
- Cerebrospinal fluid diversion effectively reduces ICP and cerebrovascular resistance, improving cerebral perfusion.
- The resistance index (RI) measured by TCD is a reliable tool for serial monitoring of cerebrohemodynamic changes in hydrocephalus.
- TCD offers a non-invasive method for assessing the efficacy of hydrocephalus treatments and guiding patient management.
Abstract:
Transcranial Doppler ultrasonography (TCD) was performed on 14 patients with hydrocephalus (age range 1 day to 12 years old) before and after ventriculoperitoneal shunting. TCD was also performed with simultaneous intracranial pressure (ICP) measurements during ventricular taps through a reservoir in 7 patients. Measurements of the resistance index (RI) = (S-D)/S, peak systolic (S), enddiastolic (D) and time-averaged mean flow velocities were made. After ventricular taps and ventriculoperitoneal shunting there was a significant decrease in RI in all patients. This was due to a greater increase in D compared to S, which suggests a decreased distal cerebrovascular resistance. There was a significant correlation between RI and ICP in the older infants and children and in individual neonates. Successful cerebrospinal fluid diversion reduces ICP and cerebrovascular resistance, thus improving cerebral perfusion. The RI is a reliable index for serial monitoring of cerebrohaemodynamic change in patients with hydrocephalus.