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  • 1
    Electronic Resource
    Electronic Resource
    Relationship between anterior fontanelle pressure measurements and clinical signs in infantile hydrocephalus (1996)
    Springer
    Child's nervous system 12 (1996), S. 200-209 
    Details
    ISSN: 1433-0350
    Keywords: Hydrocephalus ; Intracranial pressure ; Anterior fontanelle pressure ; Waveform analysis ; Clinical signs ; Infant
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The treatment of choice in progressive hydrocephalus is drainage of cerebrospinal fluid in order to reduce elevated intracranial pressure (ICP). Defining the right moment for surgical intervention, however, in a hydrocephalic infant on the basis of clinical signs alone can be a difficult task. Clinical signs of raised ICP are known to be unreliable and sometimes even misleading. In the present study, the relationship between long-term anterior fontanelle pressure (AFP) measurements and clinical signs was investigated in 37 infants with hydrocephalus. The decision as to whether to operate or not was based on clinical signs alone; AFP values were not taken into account. There was an overall difference between the non-operated group and the preoperative measurements in the operated group, and also between the preoperative and the postoperative measurements in the latter, in regard to both AFP measurements and clinical signs. Almost all preoperative AFP values were increased. The direct correlation (ϕ) between most individual clinical signs and AFP levels, however, was low (ϕ=0.15–0.41). The clinical sign “tense fontanelle” showed the best correlation with the AFP levels (ϕ=0.75). Furthermore, using logistic regression analysis, no combination of clinical signs could be found which reliably predicted the AFP. The relationship between the AFP pressure variables and clinical signs was also examined. The pathological A-waves occurred only in the presence of raised (baseline) AFP, a situation in which considerably more frequent B-waves were observed as well. It was concluded that clinical signs of raised ICP in infantile hydrocephalus are not very reliable and AFP monitoring can therefore provide valuable information on intracranial dynamics in patients with dubious neurological manifestations of progressive hydrocephalus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00301251
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  • 2
    Electronic Resource
    Electronic Resource
    Value of transcranial Doppler indices in predicting raised ICP in infantile hydrocephalus (1995)
    Springer
    Child's nervous system 11 (1995), S. 595-603 
    Details
    ISSN: 1433-0350
    Keywords: Hydrocephalus ; Transcranial Doppler ; Pulsatility index ; Resistance index ; Intracranial pressure ; Anterior fontanel pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cerebral hemodynamic changes in infants with progressive hydrocephalus have been studied with the transcranial Doppler (TCD) technique. Several authors have referred to the correlation between the hemodynamic changes and increased intracranial pressure (ICP). Despite conflicting conclusions on the value of pulsatility index (PI) measurements for monitoring infantile hydrocephalus, these pulsatility indices are the most commonly used for this purpose. Although clinical signs of raised ICP are highly variable and unreliable in infants, assumptions have been made in most of the studies about the presence of elevated ICP on the basis of the patient's clinical state. Few studies have reported on actual ICP values, however, and a direct relationship between ICP and TCD changes has never been adequately demonstrated. In the present study, this relationship was investigated in long-term simultaneous TCD/ICP measurements, in an attempt to develop a noninvasive method of monitoring the effect of ICP on intracranial hemodynamics. Two groups of data sets were established. Group I consisted of pre- and postoperative (shunt implantation) TCD/ICP measurements. Group II were long-term simultaneous TCD/ICP recordings showing significant ICP variations. In most of the postoperative measurements there was a decrease in the average PI and RI values. The correlation between PI or RI and ICP in the long-term simultaneous recordings, however, was generally poor. The risk of obtaining false positive or false negative PI or RI values in short-term measurements was also demonstrated. It can be concluded from our results, besides the wide range of reference values for the Doppler indices and extracranial influences upon them, that the present Doppler indices are inadequate for monitoring the complex intracranial dynamic responses in patients with raised ICP.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00300999
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  • 3
    Electronic Resource
    Electronic Resource
    The contribution of prenatal diagnosis to the understanding of malformative intracranial cysts: state of the art (2000)
    Springer
    Child's nervous system 16 (2000), S. 618-626 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Intracranial cyst ; Prenatal ; Fetus ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This review evaluates the contribution of prenatal diagnosis to the understanding of intracranial cysts. We describe the outcome of 54 fetuses in which prenatal investigations indicated the presence of such lesions. The cysts were diagnosed between 20 and 30 weeks of gestation. Most (63%) were supratentorial and interhemispheric. There was only a single sylvian cyst. In the infratentorial compartment, median retrocerebellar cysts were predominant. Incisural cysts accounted for 14.8% of the series. Nine pregnancies were interrupted because of the presence of associated brain disorders. Forty-five children are alive. Thirty-four had neuropsychological tests. Cysts rarely progressed, most frequently stabilized and often regressed postnatally. Hydrocephalus was rare. In two cases delivery was precipitated at 36 weeks to allow urgent treatment of rapidly evolving cysts. Thirteen children (28.2%) were treated postnatally, in general for developing cysts. The median follow-up for the whole series exceeds 4 years. Behavior, neurological development, and intelligence are normal in 88% of the cases, and 91% have a normal neurological status. Prognosis at the time of the prenatal consultation was correct in 89% of the cases. We emphasize the value of prenatal magnetic resonance imaging and karyotype studies to limit risks of incorrect prognosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810000316
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  • 4
    Electronic Resource
    Electronic Resource
    Non-invasive ICP monitoring in infants: the Rotterdam Teletransducer revisited (1995)
    Springer
    Child's nervous system 11 (1995), S. 207-213 
    Details
    ISSN: 1433-0350
    Keywords: Intracranial pressure ; Ventricular fluid pressure ; Fontanelle pressure ; ICP monitoring ; Fontanometry ; Hydrocephalus ; Infant
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Measurement of intracranial pressure (ICP) is important in patients at risk of raised ICP, as in hydrocephalus. Ideally, it should be non-invasive, thus avoiding the risk of infection and other complications. Such is provided by measurement of ICP through the anterior fontanelle. There are several methods of measuring anterior fontanelle pressure (AFP); those most frequently used are based on the applanation principle. An evaluation of AFP measurement devices resulted in the choice of the Rotterdam Teletransducer (RTT) to be used in our study of children with hydrocephalus. The literature contains little information on the accuracy or validation of the AFP measurements using the RTT. Therefore, the physical qualities of the RTT were reassessed, using a specially developed calibration device. The results of this study demonstrate that membrane temperature does not have any effect on the measured pressure. The thermal stabilization time of the RTT was found to be 3 h after switching on . Insufficient thermal stabilization results in a pressure underestimation of up to 3 mmHg. Furthermore, a maximum inaccuracy of 2.6 mmHg, after calibration and readjustment of the transducer, was calculated. Validation of the equipment was achieved by simultaneous AFP/ICP measurements in hydrocephalic patients showing high correlations (r=0.96–0.98). The discusion suggests a measurement protocol as a means of increasing the reliability of RTT measurements.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00277655
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    Paper (German National Licenses)
    Fulltext
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