Transcranial Doppler (TCD) ultrasound as a noninvasive means of monitoring cerebrohaemodynamic change in hydrocephalus.
Cerebral blood flow velocity (CBFV) measurements by Transcranial Doppler (TCD) ultrasound were performed on 27 patients with hydrocephalus (Group I: neonates, Group II: children). Simultaneous measurements of direct ICP and CBFV were performed during ventricular taps in 16 patients. There was a significant correlation between ICP and Resistance Index (RI = peak systolic-end distolic/peak systolic velocity) overall in Group II patients (p less than 0.02) and in individual neonatal patients (p less than 0.001). After ventricular taps and ventriculo-peritoneal shunting (17 patients) there was a consistent significant decrease in RI due to increased end diastolic velocity in all patients (p less than 0.001). This suggests the RI is a reliable index of cerebrovascular resistance for serial monitoring in individual patients. There was an exponential pattern of decay in RI with CSF volume depletion (volume-flow velocity response) in 50/56 taps which allows calculation of a volume-buffering reserve before perfusion change occurred. Simultaneous ICP/CBFV monitoring during sleep may help to identify patients who are unable to compensate haemodynamically during episodic increase in ICP and are a greater risk of ischaemic insult. TCD is a useful noninvasive technique of monitoring cerebrohaemodynamic change for initial assessment and further management of children with hydrocephalus.
Goh
D
D
Dept. of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, U.K.
Minns
R A
RA
Pye
S D
SD
D000293:Adolescent; D001783:Blood Flow Velocity; D002552:Cerebral Ventricles / Q000098:blood supply / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D004453:Echoencephalography; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure; D014696:Ventriculostomy