Assessment of childhood intracranial pressure: a comparative study of transcranial Doppler ultrasound indices and findings at ventriculoperitoneal shunt
Purpose This study compares transcranial Doppler (TCD) Pulsatility Index (PI) and Resistivity Index (RI) with intra-operative CSF opening pressure measured by manometric technique during ventriculoperitoneal (V-P) shunt in children with hydrocephalus. Methods It was a prospective, hospital-based stu...
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| Published in: | Child's nervous system Vol. 40; no. 9; pp. 2915 - 2920 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Berlin/Heidelberg
Springer Berlin Heidelberg
01-09-2024
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Purpose
This study compares transcranial Doppler (TCD) Pulsatility Index (PI) and Resistivity Index (RI) with intra-operative CSF opening pressure measured by manometric technique during ventriculoperitoneal (V-P) shunt in children with hydrocephalus.
Methods
It was a prospective, hospital-based study performed among patients diagnosed with hydrocephalus. Patients had TCD ultrasonography before V-P shunt. The TCD sonography was repeated within 1 week post-op, and at 1 month post-op. The PI and RI were retrieved after insonating the middle cerebral artery. Ventricular CSF opening pressure was measured. Associations between TCD indices and CSF pressure were determined using the
t
-test and the Wilcoxon rank /Mann–Whitney tests where the normality test failed. A
p
-value of < 0.05 was considered significant for associations.
Results
Fifty-two patients were enrolled with a mean age of 9.9 ± 11.5 months. Of these, 41 (78.8%) were aged ≤ 12 months. The mean CSF opening pressure was 21.4 ± 9.0. When raised, ICP was defined as opening pressure > 15 cm of H
2
O, high PI (≥ 1.19), and high RI (> 0.8) diagnosed it with a sensitivity of 55% and 50%, respectively. The mean pre-operative PI (1.17 ± 0.56) reduced to 0.96 (
Z
= − 2.032,
p
= 0.042), while that of RI (0.66 ± 0.17) also decreased to 0.58 (
t
= 2.906,
p
= 0.044) after V-P shunt surgery. A strong positive correlation exists between a reduction in PI and RI after V-P shunt (
r
= 0.743,
p
= 0.014).
Conclusion
Both PI and RI significantly decrease following V-P shunt, but a single reading has a poor sensitivity in predicting ICP. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0256-7040 1433-0350 1433-0350 |
| DOI: | 10.1007/s00381-024-06496-4 |