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Cranial Doppler ultrasonography correlates with criteria for ventriculoperitoneal shunting
W M Chadduck1, J J Seibert, J Adametz
1Department of Neurosurgery, Arkansas Children's Hosptial, University of Arkansas for Medical Sciences, Little Rock, 72202.
Insights
Pulsed Doppler ultrasound
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Medical Imaging
Background:
- Ventriculomegaly and hydrocephalus are common in infants.
- Accurate assessment is crucial for timely intervention.
- Ventriculoperitoneal shunting is a common treatment.
Purpose of the Study:
- To evaluate the utility of Resistive Index (RI) in predicting the need for ventriculoperitoneal shunting in infants with ventriculomegaly.
- To assess the effectiveness of shunting by monitoring RI changes.
- To explore RI's role in evaluating shunt function.
Main Methods:
- Pulsed Doppler ultrasound was used to measure RI in 46 infants with ventriculomegaly.
- RI was calculated using peak systolic and end diastolic frequencies.
- Criteria for shunting included ventriculomegaly severity, head circumference changes, and clinical symptoms.
Main Results:
- Patients requiring shunts had a pre-shunting RI of 84 +/- 13%.
- Post-shunting RI significantly decreased to 72 +/- 11% (p < 0.001).
- Post-shunting RI values were comparable to normal newborns and patients not requiring shunts.
Conclusions:
- Resistive Index is a valuable non-invasive tool for assessing the need for ventriculoperitoneal shunting in infants.
- RI monitoring can help evaluate shunt function and detect malfunctions.
- Combining RI with clinical assessment improves hydrocephalus management.
Abstract:
Using pulsed Doppler ultrasound through the sonic window of the anterior fontanelle in infants, 46 children with ventriculomegaly had sequential evaluations of Resistive Index for comparison with the need for ventriculoperitoneal shunting. Hydrocephalus was associated with myelomeningocele in 17 patients and posthemorrhagic, postmeningitic, or congenital hydrocephalus accounted for the rest. The Resistive Index was obtained by dividing the difference between the peak systolic and end diastolic frequencies by the systolic frequency. Criteria for shunting included massive ventriculomegaly, increasing ventriculomegaly with an abnormal increase in head circumference, and clinical evidence of symptomatic hydrocephalus. Those patients requiring shunts had a Resistive Index of 84 +/- 13% prior to shunting. The Resistive Index fell to 72 +/- 11% postshunting with the difference being statistically significant at p less than 0.001. Moreover, the postshunting values compared favorably to data on 29 normal newborns, having Resistive Indices of 71 +/- 7% and to the Resistive Indices of three patients never shunted who had values of 74%, 66%, and 71%. Variations included primarily low Resistive Indices in myelomeningocele patients whose ventricles were decompressed by the leaking spinal lesions. Resistive Index used in conjunction with clinical observations may be extremely helpful not only in predicting the need for ventriculoperitoneal shunt, but also in evaluating children suspected of shunt malfunctions.