Compensated or progressive hydrocephalus?

Abstract

OBJECTIVE: 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 nor with the clinical signs or symptoms. In this study we investigated whether cerebral blood flow (CBF) can be measured by quantitative magnetic resonance angiography (MRA) in infants with progressive hydrocephalus. In addition, we investigated the relation between CBF and ICP, before and after cerebrospinal fluid (CSF) diversion. METHODS: Fifteen infants with progressive hydrocephalus (aged between 1 day and 7 months) were investigated. All patients underwent anterior fontanelle pressure (AFP) measurement, MRA and mean arterial blood pressure (MABP) measurement before and after CSF diversion. Brain volume was measured to compensate for the physiological increase of CBF during brain maturation in infants. RESULTS: The mean pre-operative ICP was 19.1 cm H20 (SD 8.4). The mean post-operative ICP was 6.7 cm H20 (SD 4.0) (p