Optical Detection of Intracranial Pressure and Perfusion Changes in Neonates With Hydrocephalus.
Optical Detection of Intracranial Pressure and Perfusion Changes in Neonates With Hydrocephalus.
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DOI：
10.1016/j.jpeds.2021.05.024
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Baker WB
中科院分区：
文献类型：
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作者：
Flanders TM;Lang SS;Ko TS;Andersen KN;Jahnavi J;Flibotte JJ;Licht DJ;Tasian GE;Sotardi ST;Yodh AG;Lynch JM;Kennedy BC;Storm PB;White BR;Heuer GG;Baker WB
证明基于漫射光学技术的一种新的无创颅内压（ICP）指数与颅内高压相关。我们比较了无创和有创颅内压测量婴儿脑积水。如果临床确定需要脑脊液（CSF）分流，则足月和早产婴儿有资格入选。术前通过超声测量额枕（FOR）和额颞（FTHR）角比率评估心室大小。在手术干预时用压力计获得侵入性ICP。颅内高压定义为颅内压≥15 mmHg。在术前、术中和术后进行脑灌注、氧提取和无创ICP的弥散光学测量。将光学和超声测量与有创ICP测量进行比较，并获得CSF分流后其值的变化。我们纳入了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）未发现心室大小的组间差异。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（p=0.01）显著更高。仅在颅内高压的婴儿中观察到CSF分流术后脑血流量增加（p=0.005）和氧摄取分数改善（P <0.001）。非侵入性弥散光学测量（包括非侵入性ICP指数）与颅内高压相关。结果表明，颅内高压导致的灌注受损与心室大小无关。在颅内高压的婴儿中观察到了CSF分流术益处的血流动力学证据。无创光学技术有望帮助评估CSF分流时机。
To demonstrate that a novel non-invasive index of intracranial pressure (ICP) derived from diffuse optics-based techniques is associated with intracranial hypertension. We compared non-invasive 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 fronto-temporal (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 non-invasive 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 had intracranial hypertension. No group difference in ventricular size was found by FOR (p=0.93) or FTHR (p=0.76). Infants with intracranial hypertension had significantly higher non-invasive ICP (p=0.02) and oxygen extraction fraction (p=0.01) compared with infants without intracranial hypertension. Increased cerebral blood flow (p=0.005) and improved oxygen extraction fraction (P < .001) after CSF diversion were only observed in infants with intracranial hypertension. Non-invasive diffuse optical measures (including a non-invasive ICP index) were associated with intracranial hypertension. The findings suggest 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. Non-invasive optical techniques hold promise for aiding the assessment of CSF diversion timing.