Optical Detection of Intracranial Pressure and Perfusion Changes in Neonates With Hydrocephalus
| Autor: | Gregory E. Tasian, Arjun G. Yodh, Brian R. White, Wesley B. Baker, Jharna Jahnavi, John Flibotte, Shih-Shan Lang, Gregory G. Heuer, Tracy M. Flanders, Susan T. Sotardi, Phillip B. Storm, Tiffany Ko, Kristen N. Andersen, Jennifer M. Lynch, Benjamin C. Kennedy, Daniel J. Licht |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Intracranial Pressure Hemodynamics Pilot Projects Article 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid 030225 pediatrics Internal medicine Humans Medicine 030212 general & internal medicine Cerebral perfusion pressure Intracranial pressure business.industry Spectrum Analysis Optical Imaging Ultrasound Infant Newborn Reproducibility of Results medicine.disease Cerebrospinal Fluid Shunts Hydrocephalus Cerebral blood flow Cerebrovascular Circulation Pediatrics Perinatology and Child Health Cardiology Feasibility Studies Female Intracranial Hypertension business Perfusion |
| Zdroj: | J Pediatr |
| ISSN: | 0022-3476 |
| DOI: | 10.1016/j.jpeds.2021.05.024 |
| Popis: | OBJECTIVE: To demonstrate that a novel non-invasive index of intracranial pressure (ICP) derived from diffuse optics-based techniques is associated with intracranial hypertension. STUDY DESIGN: We compared non-invasive and invasive ICP measurements in infants with hydrocephalus. Infants born term and preterm were eligible for inclusion if clinically determined to require cerebrospinal fluid (CSF) diversion. Ventricular size was assessed preoperatively via ultrasound measurement of the fronto-occipital (FOR) and fronto-temporal (FTHR) horn ratios. Invasive ICP was obtained at the time of surgical intervention with a manometer. Intracranial hypertension was defined as invasive ICP ≥15 mmHg. Diffuse optical measurements of cerebral perfusion, oxygen extraction, and non-invasive ICP were performed preoperatively, intraoperatively, and postoperatively. Optical and ultrasound measures were compared with invasive ICP measurements, and their change in values after CSF diversion were obtained. RESULTS: We included 39 infants; 23 had intracranial hypertension. No group difference in ventricular size was found by FOR (p=0.93) or FTHR (p=0.76). Infants with intracranial hypertension had significantly higher non-invasive ICP (p=0.02) and oxygen extraction fraction (p=0.01) compared with infants without intracranial hypertension. Increased cerebral blood flow (p=0.005) and improved oxygen extraction fraction (P < .001) after CSF diversion were only observed in infants with intracranial hypertension. CONCLUSIONS: Non-invasive diffuse optical measures (including a non-invasive ICP index) were associated with intracranial hypertension. The findings suggest impaired perfusion from intracranial hypertension was independent of ventricular size. Hemodynamic evidence of the benefits of CSF diversion was seen in infants with intracranial hypertension. Non-invasive optical techniques hold promise for aiding the assessment of CSF diversion timing. |
| Databáze: | OpenAIRE |
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