Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania.
Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania.
J Pediatr. 2021 Sep;236:54-61.e1. doi: 10.1016/j.jpeds.2021.05.024. Epub 2021 May 15.
To demonstrate that a novel noninvasive index of intracranial pressure (ICP) derived from diffuse optics-based techniques is associated with intracranial hypertension.
We compared noninvasive and invasive ICP measurements in infants with hydrocephalus. Infants born term and preterm were eligible for inclusion if clinically determined to require cerebrospinal fluid (CSF) diversion. Ventricular size was assessed preoperatively via ultrasound measurement of the fronto-occipital (FOR) and frontotemporal (FTHR) horn ratios. Invasive ICP was obtained at the time of surgical intervention with a manometer. Intracranial hypertension was defined as invasive ICP ≥15 mmHg. Diffuse optical measurements of cerebral perfusion, oxygen extraction, and noninvasive ICP were performed preoperatively, intraoperatively, and postoperatively. Optical and ultrasound measures were compared with invasive ICP measurements, and their change in values after CSF diversion were obtained.
We included 39 infants, 23 with intracranial hypertension. No group difference in ventricular size was found by FOR (P = .93) or FTHR (P = .76). Infants with intracranial hypertension had significantly higher noninvasive ICP (P = .02) and oxygen extraction fraction (OEF) (P = .01) compared with infants without intracranial hypertension. Increased cerebral blood flow (P = .005) and improved OEF (P < .001) after CSF diversion were observed only in infants with intracranial hypertension.
Noninvasive diffuse optical measures (including a noninvasive ICP index) were associated with intracranial hypertension. The findings suggest that impaired perfusion from intracranial hypertension was independent of ventricular size. Hemodynamic evidence of the benefits of CSF diversion was seen in infants with intracranial hypertension. Noninvasive optical techniques hold promise for aiding the assessment of CSF diversion timing.
证明一种新的基于扩散光学技术的颅内压（ICP）无创指数与颅内高压有关。
我们比较了脑积水婴儿的无创和有创 ICP 测量。如果临床确定需要脑脊液（CSF）引流，则符合纳入标准的足月和早产儿均有资格入选。术前通过超声测量额枕（FOR）和额颞（FTHR）角比来评估脑室大小。在手术干预时使用压力计获得有创 ICP。术前、术中及术后进行了脑灌注、氧提取和无创 ICP 的扩散光学测量。将光学和超声测量与有创 ICP 测量进行比较，并获得 CSF 引流后其值的变化。
我们共纳入 39 名婴儿，其中 23 名患有颅内高压。通过 FOR（P=0.93）或 FTHR（P=0.76）未发现脑室大小存在组间差异。与无颅内高压的婴儿相比，颅内高压婴儿的无创 ICP（P=0.02）和氧提取分数（OEF）（P=0.01）明显更高。仅在颅内高压婴儿中观察到 CSF 引流后脑血流量（P=0.005）增加和 OEF 改善（P<0.001）。
无创扩散光学测量（包括无创 ICP 指数）与颅内高压有关。这些发现表明，颅内高压引起的灌注受损与脑室大小无关。在颅内高压婴儿中观察到 CSF 引流的血流动力学益处的证据。无创光学技术有望辅助评估 CSF 引流时机。
