Asymmetric growth of the lateral cerebral ventricle in infants with posthemorrhagic ventricular dilation
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1Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque 87131.
Insights
Linear ventricular measurements are inaccurate for tracking hydrocephalus in preterm infants. Sequential volume measurements offer a more reliable method for monitoring ventricular size changes in these vulnerable patients.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Neuroimaging
Background:
- Intraventricular hemorrhage (IVH) is a common complication in preterm infants.
- Posthemorrhagic hydrocephalus (PHH) can develop following IVH, necessitating monitoring of ventricular size.
- Traditional linear measurements like the ventricular index (VI) are often used to assess ventricular volume.
Purpose of the Study:
- To evaluate the correlation between lateral cerebral ventricular volume and linear index measurements in preterm infants.
- To investigate the accuracy of linear measurements in serial assessment of ventricular size in infants with PHH.
- To determine the most reliable method for monitoring ventricular enlargement in PHH.
Main Methods:
- Longitudinal measurement of lateral cerebral ventricular volume in 36 preterm infants.
- Comparison of volumetric measurements with traditional linear index (VI) and lateral ventricular ratio (LVR).
- Segmental volume analysis to assess regional ventricular growth patterns in PHH.
Main Results:
- A poor correlation (r² = 0.67) was found between ventricular volume and linear index measurements.
- The occipital region of the lateral ventricle showed significantly faster enlargement (1.904 ml/day) in infants with PHH compared to anterior (0.546 ml/day) and middle (-0.209 ml/day) regions.
- Asymmetric ventricular growth in PHH renders linear indexes inaccurate for serial assessment.
Conclusions:
- Linear indexes (VI, LVR) are unreliable for accurate serial estimation of ventricular size in PHH due to asymmetric ventricular growth.
- Sequential volumetric measurements provide a more accurate and useful method for monitoring ventricular size in infants with PHH.
- This study highlights the limitations of traditional methods and advocates for advanced volumetric analysis in managing PHH.
Abstract:
Lateral cerebral ventricular volume in 36 preterm infants with or without an intraventricular hemorrhage, and with or without posthemorrhagic hydrocephalus, was measured longitudinally and compared with the ventricular index measurements of the same ventricles. A poor correlation was found (r2 = 0.67). To determine a reason for this poor relationship, we analyzed the volumes of the regions of the ventricles by a segmental volume analysis. The occipital region of the lateral cerebral ventricle enlarged at a much faster rate (1.904 +/- 0.477 ml/day) than either the anterior region (0.546 +/- 0.253 ml/day; p less than 0.01) or the middle region (-0.209 +/- 0.334 ml/day; p less than 0.01) in infants with posthemorrhagic hydrocephalus. The rate of growth of the middle region of the lateral cerebral ventricles was the same for all infants. Linear indexes, such as the ventricular index and the lateral ventricular ratio, do not allow for accurate serial estimates of ventricular size in posthemorrhagic hydrocephalus because of asymmetric growth of the lateral cerebral ventricle. We conclude that sequential volume measurements are more useful than ventricular index measurements to follow ventricular size sequentially in infants with posthemorrhagic hydrocephalus.