Perioperative near-infrared spectroscopy cerebral oxygen saturation in symptomatic pediatric hydrocephalus patients at risk for intracranial hypertension

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The lack of a continuous, noninvasive modality for monitoring intracranial pressure (ICP) is a major obstacle in the care of pediatric patients with hydrocephalus who are at risk for intracranial hypertension. Intracranial hypertension can lead to cerebral ischemia and brain tissue hypoxia. In this study, the authors evaluated the use of near-infrared spectroscopy (NIRS) to measure regional cerebral oxygen saturation (rSO<jats:sub>2</jats:sub>) in symptomatic pediatric patients with hydrocephalus concerning for elevated ICP.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors evaluated the NIRS rSO<jats:sub>2</jats:sub> trends in pediatric patients presenting with acute hydrocephalus and clinical symptoms of intracranial hypertension. NIRS rSO<jats:sub>2</jats:sub> values were recorded hourly before and after neurosurgical intervention. To test for significance between preoperative and postoperative values, the authors constructed a linear regression model with the rSO<jats:sub>2</jats:sub> values as the outcome and pre- and postsurgery cohorts as the independent variable, adjusted for age and sex, and used the generalized estimating equation method to account for within-subject correlation.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Twenty-two pediatric patients underwent NIRS rSO<jats:sub>2</jats:sub> monitoring before and after CSF diversion surgery. The mean durations of NIRS rSO<jats:sub>2</jats:sub> recording pre- and postoperatively were 13.95 and 26.82 hours, respectively. The mean pre- and postoperative rSO<jats:sub>2</jats:sub> values were 73.84% and 80.65%, respectively, and the adjusted mean difference estimated from the regression model was 5.98% (adjusted p &lt; 0.0001), suggestive of improved cerebral oxygenation after definitive neurosurgical CSF diversion treatment. Postoperatively, all patients returned to baseline neurological status with no clinical symptoms of elevated ICP.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Cerebral oxygenation trends measured by NIRS in symptomatic pediatric hydrocephalus patients with intracranial hypertension generally improve after CSF diversion surgery.</jats:p></jats:sec>

Association between Pediatric Postoperative Delirium and Regional Cerebral Oxygen Saturation: A Prospective Observational Study

“…Utilizing NIRS to assess rSO 2 , our study observed that the mean rSO 2 values in our participant cohort fell within the normal range (preoperative rSO 2 = 62.19, SD = 2.55; postoperative rSO 2 = 64.02, SD = 3.18), as stipulated within the reported range of 60%-70%. 14,15 Furthermore, our investigation identi ed age as the most in uential predictor of both preoperative and postoperative rSO 2 levels. Speci cally, older children displayed higher preoperative rSO 2 , increased preoperative rSO 2min , and elevated postoperative rSO 2 values.…”

Optical Detection of Intracranial Pressure and Perfusion Changes in Neonates With Hydrocephalus

“…Our results expand on previous studies of optical neuromonitoring in this population, which commonly relied on detection of diminished cerebral oxygenation using nearinfrared spectroscopy. [26][27][28][29][30] Whereas cerebral oxygenation has been associated with ventricular dilation 30 and has been demonstrated to improve after CSF diversion, [26][27][28][29] nearinfrared spectroscopy measurements have limited reproducibility and reliability. 31,32 FD-DOS uses a more quantitative measurement of StO 2 that accounts for tissue scattering.…”

Use of near infrared spectroscopy for hemodynamic monitoring in pediatrics

“…There are currently no non-invasive methods to measure intracranial pressure. Lang et al, 34 proposed using ScO 2 determined by NIRS to assess cerebral perfusion in children with hydrocephalus and intracranial hypertension who were scheduled for surgery. They compared ScO 2 before and after cerebrospinal fluid shunt in 22 patients.…”