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

• Published in: The Journal of pediatrics 2021-09, Vol.236, p.54-61.e1
• Main Authors: Flanders, Tracy M., Lang, Shih-Shan, Ko, Tiffany S., Andersen, Kristen N., Jahnavi, Jharna, Flibotte, John J., Licht, Daniel J., Tasian, Gregory E., Sotardi, Susan T., Yodh, Arjun G., Lynch, Jennifer M., Kennedy, Benjamin C., Storm, Phillip B., White, Brian R., Heuer, Gregory G., Baker, Wesley B.
• Format: Article
• Language: English
• Subjects: Cerebrospinal Fluid Shunts; Cerebrovascular Circulation - physiology; diffuse correlation spectroscopy; Feasibility Studies; Female; Humans; Hydrocephalus - diagnostic imaging; Hydrocephalus - physiopathology; Hydrocephalus - surgery; Infant, Newborn; Intracranial Hypertension - diagnosis; Intracranial Hypertension - etiology; Intracranial Hypertension - physiopathology; Intracranial Pressure - physiology; Male; near-infrared spectroscopy; Optical Imaging; Pilot Projects; Reproducibility of Results; shunt; Spectrum Analysis
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2021.05.024

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