Infantile hydrocephalus: brain sonography as an effective tool for diagnosis and follow-up

Machado, Hélio Rubens; Martelli, Nelson; Ja, Assirati Júnior; Bo, Colli

doi:10.1007/bf00249396

Cited by 14 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although not radiation based, MR imaging requires sedation and its costs are considerable; additionally, it is not always available in busy neurosurgical centers. 18 The addition of TCD technology to ultrasonographic examination made it possible to conduct studies in children after fontanelle closure, by applying the transducer to the temporal region. 20,25,28,36 The use of TCD allows one to obtain real-time measurements of arterial or venous blood flow velocity directly from insonation of vessels coded in color or by methodically searching the vessels and analyzing changes in sound frequencies.…”

Section: Discussionmentioning

confidence: 99%

Transcranial color-coded Doppler ultrasonography for evaluation of children with hydrocephalus

Oliveira¹,

Machado²

2003

FOC

View full text Add to dashboard Cite

Object Hydrocephalus is a common disease process. Transcranial color-coded Doppler (TCCD) ultrasonography is an accepted noninvasive method with which to quantify intracranial blood flow in adults and children. The authors studied the applications of TCCD ultrasonography and the alterations of the flow velocity of the cerebral arteries in children with hydrocephalus. Methods One hundred thirty-five children were divided into three groups: Group 1 comprised 40 infants with asymptomatic hydrocephalus who had well-functioning ventriculoperitoneal (VP) shunts; Group 2 comprised 10 children with symptomatic hydrocephalus who had malfunctioning shunts that were replaced; and Group 3 was a control group of 85 healthy infants. All patients underwent sequential measurements of cerebral blood flow (CBF) velocities (systolic and diastolic velocities) and resistivity index (RI). One group of patients underwent functional tests (compression of the anterior fontanelle and CO2 vasoreactivity) to determine hemodynamic changes in cerebral circulation. A significant statistical change in RI measurements, end diastolic CBF velocity, and percentage of change in RI was shown in patients with malfunctioning shunts, and in infants with a well-functioning VP shunt vasomotor reactivity was severely reduced. Conclusions Transcranial color-coded Doppler ultrasonography can be used to perform follow-up assessments of normal and malfunctioning shunts in children with hydrocephalus; the functional tests are a noninvasive tool for evaluating the cerebral compliance and the cerebral autoregulation in infants with hydrocephalus. The autoregulatory capacity may partly or completely be lost in cases of long-term shunt-treated hydrocephalus, and loss of cerebral vasoreactivity may be responsible for long-term deficits commonly observed in children, which help explain some of symptoms related to slit ventricles.

show abstract

Section: Discussionmentioning

confidence: 99%

Transcranial color-coded Doppler ultrasonography for evaluation of children with hydrocephalus

Oliveira¹,

Machado²

2003

FOC

View full text Add to dashboard Cite

show abstract

“…Pediatric hydrocephalus most often affects neonates and infants, where ultrasound is often used [5,[14][15][16]. Threedimensional US [17], where ventricular volumes could be calculated, is still largely a research tool and not yet widely adapted to the central nervous system.…”

Section: Discussionmentioning

confidence: 99%

Frontal and Occipital Horn Ratio: A Linear Estimate of Ventricular Size for Multiple Imaging Modalities in Pediatric Hydrocephalus

O'Hayon¹,

Drake²,

Ossip³

et al. 1998

Pediatr Neurosurg

278

164

View full text Add to dashboard Cite

Objective: Measurement of ventricular size is important in pediatric patients with hydrocephalus, especially those who are being followed with cerebrospinal fluid (CSF) shunts. While volumetric techniques are a more accurate estimate of true ventricular volume, they are often impracticable when multiple modalities including ultrasound are used. Volumetric area and linear measurements were compared to find the most reasonable measurement method. Methods: Sixty-four computed tomography (CT), magnetic reasonance imaging (MRI), and ultrasound (US) scans from 25 children aged 0–17 years with hydrocephalus, before and after treatment, were measured. Measurements included ventricular volume, a ventricular/brain ratio, and four standard linear measures (Evans’ ratio, Huckman’s measurement, minimal lateral ventricular width, and lateral ventricular span at the body). We also included a new ratio, which accounts for often disproportionate occipital horn expansion in pediatric patients, called the frontal and occipital horn ratio. Volume and linear measurements were compared using the Spearman’s correlation coefficients and correlations were further differentiated using a Z test statistic. The frontal and occipital horn ratio was also measured on CT, MRI, and US scans from 44 normal children aged 0–17 years to identify normal values. The effect of age was determined by linear regression. Results: The best linear correlation with ventricular size was the frontal + occipital horn ratio (r = 0.852) and was equivalent to the ventricular/brain ratio (r = 0.891), previously shown to have the highest correlation with ventricular volume. Evans’ ratio correlates less well (r = 0.423). The normal frontal and occipital horn ratio is 0.37 and is independent of age. Conclusions: The frontal and occipital horn ratio is a simple method of evaluating ventricular size in pediatric hydrocephalus patients with CSF shunts.

show abstract

“…21 Computed tomography shows disproportionate hydrocephalus and can be used for screening of patients. However, cysts usually have a density similar to that of CSF, and their walls are usually transparent, making it usually difficult to visualize the cyst wall accurately.…”

Section: Imaging Findingsmentioning

confidence: 99%

Endoscopic cyst fenestration in the treatment of uniloculated hydrocephalus in children

El-Ghandour¹

2013

PED

View full text Add to dashboard Cite

Object The treatment of uniloculated hydrocephalus is a difficult problem in pediatric neurosurgery. Definitive treatment is surgical, yet the approach remains controversial. This study evaluates the role of endoscopic cyst fenestration (ECF) in the management of this disease. Methods Thirty-one pediatric patients with uniloculated hydrocephalus who underwent endoscopic surgery, performed by the author, between May 1999 and December 2010 constitute the patient group for this study. The patients included 17 boys and 14 girls, with ages ranging from 5 months to 5 years (mean 22.9 months). Patients with multiloculated hydrocephalus were not included. The patients' charts were reviewed for demographic data, radiological findings, information regarding morbidity, improvement of hydrocephalus, incidence of recurrence, shunt dependency, and the need for shunt revision. Results Neuroepithelial cysts were the most common cause (17 cases), followed by postoperative gliosis due to previous shunt infection (9 cases), intraventricular hemorrhage (3 cases), and meningitis (2 cases). Multiplanar MRI was reliable in making the diagnosis and is indicated if CT shows disproportionate hydrocephalus. Surgical treatment included ECF (31 cases), endoscopic revision of malfunctioning preexisting shunts (9 cases), endoscopic third ventriculostomy (4 cases), and placement of a new shunt (3 cases). Endoscopic cyst fenestration was easily performed in all the cases, with devascularization of the cyst wall by coagulation to prevent recurrence. Improvement of hydrocephalus was observed in 26 cases (83.9%). Among the group of patients without prior shunts (22 cases), 3 patients (13.6%) required repeat ECF and 3 patients (13.6%) required placement of a shunt (new shunt placement). In the 9 patients with preexisting shunts, endoscopy reduced the mean rate of shunt revision from 2.7 revisions per year before fenestration to 0.25 per year after fenestration. Four of these 9 patients had multiple shunts, which could be converted to a single shunt; however, repeat ECF was necessary in all 9 patients. With a mean follow-up duration of 4.3 years, none of the patients with a prior shunt was able to become shunt-independent, whereas 86.4% of patients without a prior shunt were able to avoid shunt placement. Endoscopic complications were reversible (unilateral subdural effusion in 5 cases, minor arterial bleeding in 2 cases, CSF leakage in 1 case), and there was no death (0%). Conclusions Endoscopic cyst fenestration is recommended in the treatment of uniloculated hydrocephalus because it is effective, simple, minimally invasive, and associated with low morbidity and mortality rates. The fact that all previously shunt-treated patients needed repeat ECF and that none of these patients was able to become shunt-independent makes it clear that uniloculated hydrocephalus due to postoperative gliosis induced by previous shunt infection carries the worst prognosis.

show abstract

Infantile hydrocephalus: brain sonography as an effective tool for diagnosis and follow-up

Cited by 14 publications

References 15 publications

Transcranial color-coded Doppler ultrasonography for evaluation of children with hydrocephalus

Transcranial color-coded Doppler ultrasonography for evaluation of children with hydrocephalus

Frontal and Occipital Horn Ratio: A Linear Estimate of Ventricular Size for Multiple Imaging Modalities in Pediatric Hydrocephalus

Endoscopic cyst fenestration in the treatment of uniloculated hydrocephalus in children

Contact Info

Product

Resources

About