title: New transcranial Doppler index in infants with hydrocephalus: transsystolic time in clinical practice.
abstract: Raised intracranial pressure (ICP) in infants with hydrocephalus may cause (ir)reversible damage to the brain parenchyma but can be present without clinical signs and/or symptoms. Therefore, new, favorably noninvasive, detection methods are needed to distinguish between compensated hydrocephalus with normal intracranial pressure and slowly progressive hydrocephalus with increased intracranial pressure. Because early ischemic changes in the brain parenchyma are associated with increased intracranial pressure, transcranial Doppler (TCD) indices may be useful to detect increased intracranial pressure in infants with hydrocephalus. Twenty-four infants with hydrocephalus underwent noninvasive ICP measurement, magnetic resonance imaging and TCD before and after cerebrospinal fluid (CSF) diversion. The TCD indices were paired to the anterior fontanelle pressure findings and compared for correlation. After CSF diversion, ICP decreased significantly from 21.8 cm H(2)O to 7.7 cm H(2)O (p<0.005). The transsystolic time (TST) as measured with TCD increased significantly from 176 to 221 ms (p<0.005), whereas the pulsatility index (PI) decreased significantly from 1.3 to 1.0 (p<0.05). The resistance index (RI) decreased significantly from 0.73 to 0.63 (p<0.05). Mean bloodflow velocity through the middle cerebral artery increased significantly from 55.5 to 75.8 cm/s (p<0.005). TST has a strong correlation with the ICP (p<0.005). Measuring TST with TCD can be helpful in the decision-making process about whether to perform CSF diversion in infants with hydrocephalus. Because TST is related solely to the relative changes in the flow velocity caused by intracranial physical properties, it has a closer relation to ICP than the PI and the RI.
authors.affiliation: Department of Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. p.h.leliefeld@umcutrecht.nl
authors.forename: Paul H
authors.initials: PH
authors.lastname: Leliefeld
authors.forename: Rob H J M
authors.initials: RH
authors.lastname: Gooskens
authors.forename: Rob J M
authors.initials: RJ
authors.lastname: Peters
authors.forename: Cees A F
authors.initials: CA
authors.lastname: Tulleken
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: K Sen
authors.initials: KS
authors.lastname: Han
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hanlo
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D002557:Cerebrospinal Fluid Shunts; D003937:Diagnosis, Differential; D018450:Disease Progression; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure / Q000502:physiology; D011184:Postoperative Period; D011379:Prognosis; D013599:Systole / Q000502:physiology; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods