Leliefeld Paul H, Gooskens Rob H J M, Vincken Koen L, Ramos Lino M P, van der Grond Jeroen, Tulleken Cees A F, Kappelle L Jaap, Hanlo Patrick W
Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
J Neurosurg Pediatr. 2008 Sep;2(3):163-70. doi: 10.3171/PED/2008/2/9/163.
Raised intracranial pressure (ICP) that is associated with hydrocephalus may lead to alterations in cerebral hemodynamics and ischemic changes in the brain. In infants with hydrocephalus, defining the right moment for surgical intervention based on clinical signs alone can sometimes be a difficult task. Clinical signs of raised ICP are known to be unreliable and sometimes even misleading. Furthermore, when sutures are closed, ICP does not always correlate with the size of the ventricles or with the clinical signs or symptoms. In this study the authors investigated whether cerebral blood flow (CBF) can be measured by using quantitative MR angiography in infants with progressive hydrocephalus. In addition, the authors investigated the relationship between CBF and ICP, before and after cerebrospinal fluid (CSF) diversion.
Fifteen infants with progressive hydrocephalus (age range 1 day-7 months) were examined. All patients underwent anterior fontanel pressure measurement, MR angiography, and mean arterial blood pressure measurements before and after CSF diversion. Brain volume was measured to compensate for the physiological increase in CBF during brain maturation in infants.
The mean preoperative ICP was 19.1 +/- 8.4 cm H(2)O (+/- standard deviation). The mean postoperative ICP was 6.7 +/- 4.0 cm H(2)O (p < 0.005). The mean preoperative CBF was 25.7 +/- 11.3 ml/100 cm(3) brain/min. After CSF diversion, CBF increased to 50.1 +/- 12.1 ml/100 cm(3) brain/min (p < 0.005). The mean arterial blood pressure did not change after surgical intervention.
Magnetic resonance imaging can be used to measure CBF in infants with hydrocephalus. Raised ICP was related to a decrease in CBF. After CSF diversion, CBF and ICP improved to values within the normal range.
与脑积水相关的颅内压（ICP）升高可能导致脑血流动力学改变及脑部缺血性变化。在脑积水婴儿中，仅根据临床体征来确定手术干预的最佳时机有时是一项艰巨的任务。已知ICP升高的临床体征不可靠，有时甚至会产生误导。此外，当颅骨缝闭合时，ICP并不总是与脑室大小、临床体征或症状相关。在本研究中，作者调查了在进行性脑积水婴儿中是否可以通过定量磁共振血管造影来测量脑血流量（CBF）。此外，作者还研究了脑脊液（CSF）引流前后CBF与ICP之间的关系。
对15例进行性脑积水婴儿（年龄范围1天至7个月）进行了检查。所有患者在CSF引流前后均接受了前囟压力测量、磁共振血管造影和平均动脉血压测量。测量脑体积以补偿婴儿脑成熟过程中CBF的生理性增加。
术前平均ICP为19.1±8.4 cm H₂O（±标准差）。术后平均ICP为6.7±4.0 cm H₂O（p<0.005）。术前平均CBF为25.7±11.3 ml/100 cm³脑/分钟。CSF引流后，CBF增加至50.1±12.1 ml/100 cm³脑/分钟（p<0.005）。手术干预后平均动脉血压未发生变化。
磁共振成像可用于测量脑积水婴儿的CBF。ICP升高与CBF降低有关。CSF引流后，CBF和ICP改善至正常范围内的值。
