Does cerebral perfusion improve following CSF diversion in pediatric hydrocephalus? A prospective study using 99mTc ECD single photon emission computed tomography.
OBJECTIVE
To study regional cerebral perfusion before and after ventriculoperitoneal shunt placement in children with hydrocephalus, using (99m)Tc ECD single photon emission computed tomography (SPECT).


METHODS
17 consecutive children (less than 16 years) with hydrocephalus due to various causes, who were planned for ventriculoperitoneal shunt, were included in this prospective study. Brain SPECT using (99m)Tc ECD was performed pre- and postoperatively and changes in cerebral perfusion were compared with the change in ventricular size (assessed using Evan's ratio).


METHODS
There were 11 males and 6 females with a median age of 24 months. Nine children were up to 2 years of age and the mean duration of symptoms was 6 months. The cause of hydrocephalus was congenital in 10, secondary to tumor in 5 and as sequelae of infection in 2 children. Fourteen children (82%) showed improvement in cerebral perfusion following shunting. Of these, 12 also had a concomitant decrease in ventricular size postoperatively.


RESULTS
On logistic regression analysis, none of the factors analyzed, i.e. age, duration of symptoms, etiology of hydrocephalus and decrease in ventricular size, were found to predict improvement of cerebral perfusion following shunting.


CONCLUSIONS
Cerebral perfusion improves in the majority of the children following CSF diversionary procedures, and contrary to the common belief, duration of hydrocephalus and decreased ventricular size do not influence this improvement in cerebral perfusion. SPECT can therefore prove to be a valuable tool for objective assessment of improvement in cerebral perfusion in children with hydrocephalus secondary to various etiologies following surgical or medical interventions.
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 11029, India.
Pralay Kumar
PK
Nayak
Deepak
D
Agrawal
Naveen K
NK
Gowda
C S
CS
Bal
A K
AK
Mahapatra
D001921:Brain / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D002675:Child, Preschool; D003545:Cysteine / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery*; D007223:Infant; D016015:Logistic Models; D008297:Male; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon; D017287:Ventriculoperitoneal Shunt
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine