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Estimation of elevated intracranial pressure in infants with hydroce-phalus by using transcranial Doppler velocimetry

Teiko Yoshizuka1, Masahiro Kinoshita1, Sachiko Iwata2

  • 1Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan.

Scientific Reports
|August 9, 2018
PubMed

Insights

Resistive index (RI) with fontanel compression effectively distinguishes intracranial pressure (ICP) levels in infants. This non-invasive method aids in managing progressive hydrocephalus by optimizing invasive procedures.

Area of Science:

  • Pediatric Neurology
  • Neurosurgery
  • Medical Imaging

Background:

  • Infants with acute progressive hydrocephalus require cerebrospinal fluid (CSF) drainage until ventriculo-peritoneal shunt insertion.
  • Accurate assessment of intracranial pressure (ICP) is crucial for timely intervention.
  • Non-invasive surrogate markers for ICP monitoring are needed to optimize management.

Purpose of the Study:

  • To evaluate the utility of resistive index (RI) with and without fontanel compression in differentiating normal, mild, and moderate ICP elevation in infants.
  • To determine if RI can serve as a reliable non-invasive surrogate marker for ICP.

Main Methods:

  • Assessed 74 ICP measurements and 148 Doppler-derived RI values of the middle cerebral artery in infants.
  • Measured RI with and without gentle fontanel compression.
  • Correlated RI values with invasive ICP measurements (normal <5, mild 5-11, moderate >11 cmH2O).

Main Results:

  • Higher RI was significantly associated with fontanel compression, elevated ICP, and their interaction (p < 0.001).
  • RI without compression differentiated normal from moderate ICP (p < 0.001) and mild from moderate ICP (p = 0.033).
  • RI with compression significantly improved discrimination across all ICP levels (p < 0.001) and enhanced predictive accuracy (AUCs improved to 0.806 and 0.814 for mild and moderate ICP).

Conclusions:

  • Resistive index (RI) measured with fontanel compression is a valuable, non-invasive tool for discriminating between normal, mild, and moderate intracranial pressure elevations in infants.
  • This method can aid clinicians in optimizing the timing of invasive procedures for infants with hydrocephalus.

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