Neonatal Hydrocephalus - International Hydrocephalus Imaging ...

Idiopathic Intracranial HypertensionAge 20Dr G Bateman

Achondroplasia♦ Children withhydrocephalus andachondroplasia orcraniostenosis havevenous outflow stenosisShulman K, Ransohoff: Sagittal sinuspressure in hydrocephalus. JNeurosurg 23:169-173, 1965Dr G Bateman

JNS 1965JNS 2007Dr G Bateman

♦ Case Courtesy of Dr Anders Von Heijne MD♦ Dept Diagnostic Radiology, Danderyd Hospital, Karolinska InstituteDr G Bateman

Neonatal hydrocephalus: what do we know?Pediatric Research (2004) 55, 872–876; doi:10.1203/01.PDR.0000119370.21770.ACCSF Removal in Infantile PosthemorrhagicHydrocephalus Results in SignificantImprovement in Cerebral HemodynamicsJanet S Soul 1 , Eric Eichenwald 2 , Gene Walter 1 , Joseph J Volpe 1 and AdréJ Du Plessis 11Department of Neurology, Children's Hospital, Boston, Massachusetts02115, U.S.A.2Department of Newborn Medicine, Brigham and Women's Hospital andHarvard Medical School, Boston, Massachusetts 02115, U.S.A.Correspondence: Adré J. du Plessis, M.D., Children's Hospital,Department of Neurology, Fegan 11, 300 Longwood Avenue, Boston, MA02115, U.S.A.; e-mail: adre.duplessis@childrens.harvard.eduDr G Bateman

Neonatal hydrocephalus: Where's the blockage?The CBF increased by 100% post shunt in infantile hydrocephalusfrom 25 mls/100gm/min to 50 ml/100gm/minDr G Bateman

Are the arterioles constricting ?Dr G Bateman

Flow through collapsible tubesDr G Bateman

The Study:♦ Retrospective review of all neonates whohad an MRV and susceptibility weightingon the 3 T scanner at a Teaching hospital♦ Two groups: 10 neonates with no evidenceof raised intracranial pressure and 3 withhydrocephalus.Dr G Bateman

Normal neonateDr G Bateman

ResultsBirthweightgmsAgedaysVentriclesize%Vein sizemmSinus sizemmNormaln=10 2900 14± 10 31±3 0.7±0.2 6±1.4Hydrocephalus 2300 12± 10n=354±7 2.0 ±0.7 2.7±0.4P value .08 0.7 0.001 0.0001 0.001Dr G Bateman

Case 118 week antenatal ultrasound In-utero MRIDr G Bateman

Case 1Immediate 3 days post birthDr G Bateman

Case 1Immediate post birthDr G Bateman

Case 1BirthFollow-up 6 months oldDr G Bateman

Case 1Follow-up 6 monthsDr G Bateman

Case 24 days Post birth Seven days later after shunt insertionDr G Bateman

Case 2BirthSeven days later post shuntDr G Bateman

Cerebral Perfusion PressureCPP= MAP – ICP or CVP(which ever is higher)Dr G Bateman

Mean Blood pressureMean blood pressure vs birth weight in KgDr G Bateman

The CSF PressureWelch K. The intracranial pressure in infants. J Neurosurg 52:693-699,19801.36 cm H 2 O= 1 mmHgAvery RA et al. Reference Range for Cerebrospinal Fluid OpeningPressure in Children N ENGL J MED 2010; 363:891-893Dr G Bateman

Sagittal Sinus PressureGrady MS et al. Changes in superior saggital sinus pressure in childrenwith head elevation, jugular venous compression and PEEP. J Neurosurg65:199-202, 1986Iwabuchi T et al. Dural sinus pressure: various aspects in humanbrain surgery in children and adults. Am J Physiol. 1986 Mar;250(3 Pt 2):H389-96.Dr G Bateman

Starling Forces at work2222 5 1740 17 0 1713Dr G Bateman

Conclusions♦ Hydrocephalus in neonates reversiblyreduces cerebral blood flow making somepatients oligaemic/ischemic.♦ The reversible stenosis is in the venousoutflow at the level of the sinuses♦ Even mildly elevated venous pressure inneonates significantly alters the StarlingforcesDr G Bateman