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[Usefulness of Doppler method for evaluating intracranial hemodynamics in infantile hydrocephalus]
1Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka.
Insights
Pulsatility index (PI) in infant hydrocephalus reflects cerebral vascular resistance. Changes in PI correlate with intracranial pressure, aiding shunt placement and effectiveness evaluation.
Area of Science:
- Pediatric Neurology
- Cerebrovascular Physiology
- Neurosurgery
Background:
- Infantile hydrocephalus presents challenges in monitoring intracranial pressure and cerebral hemodynamics.
- Pulsatility index (PI) is a non-invasive Doppler ultrasound parameter reflecting vascular resistance.
Purpose of the Study:
- To investigate the changes in pulsatility index (PI) of the anterior cerebral artery (ACA) and basilar artery (BA) in infants with hydrocephalus.
- To assess the utility of PI in evaluating cerebral vascular resistance and guiding shunt management.
Main Methods:
- Longitudinal monitoring of PI in the ACA and BA of 8 infants with hydrocephalus.
- Measurement of PI before and after ventriculoperitoneal (V-P) shunt placement.
- Correlation analysis between PI, anterior fontanel pressure, and ventricular size.
Main Results:
- PI increased with hydrocephalus progression in both ACA and BA.
- A significant decrease in PI was observed 6 hours post-V-P shunt placement, followed by stabilization.
- PI changes correlated well between ACA and BA, and with anterior fontanel pressure, but not consistently with ventricular size post-shunt.
Conclusions:
- Pulsatility index (PI) serves as an objective measure of cerebral vascular resistance in infantile hydrocephalus.
- PI changes are directly influenced by intracranial pressure, suggesting its potential role in shunt placement criteria and effectiveness assessment.
- Integrating PI assessment with other diagnostic methods is crucial for comprehensive management of infantile hydrocephalus.
Abstract:
The changes of pulsatility index (PI) were followed for anterior cerebral artery (ACA) and basilar artery (BA) in 8 hydrocephalic infants. PI increased with the progression of hydrocephalus in both ACA and BA, from an average of 0.69 to 0.80 and from 0.73 to 0.81, respectively. The index made a sharp dip in 6 hours 0.65 for ACA and 0.70 for BA after placing a V-P shunt. It eventually stabilized within mean +/- SE. (ACA:0.69 +/- 0.0042, BA:0.71 +/- 0.0036). The index enabled us to observe objectively cerebral vascular resistance of the illness in numerical values. It may become a useful tool for setting criteria for placing a shunt (about 0.80) as well as for judging the shunt effectiveness. Throughout the entire observation, changes in PI of both ACA and BA were well correlated. Anterior fontanel pressure was also correlated with PI in the period, except PI of BA before the shunt operation. However, the pre-shunt correlation of PI to lateral ventricle enlargement was lost after the shunt operation. And the ventricle size reduced only slightly when PI rapidly decreased in 6 hours after the V-P shunt. These facts indicated that the changes in PI was affected directly by the intracranial pressure rather than the enlarged ventricle. The findings of this study indicated the necessity of evaluating of the intracranial hemodynamics with other diagnostic approaches in managing infantile hydrocephalus.