Shih-Shan Lang1,2,3, Omaditya Khanna4, Natalie J Atkin5,6, Judy E Palma3, Ian Yuan5,6, Phillip B Storm1,2,3, Gregory G Heuer1,2,3, Benjamin Kennedy1,2,3, Angela J Waanders3,7, Yimei Li8,9,10, Jimmy W Huh5,6. 1. 1Division of Neurosurgery, Children's Hospital of Philadelphia. 2. 2Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania. 3. 6Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia. 4. 3Department of Neurological Surgery, Thomas Jefferson University Hospital. 5. 4Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia. 6. 5Department of Anesthesia, Perelman School of Medicine, University of Pennsylvania. 7. 10Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 8. 7Department of Oncology, Children's Hospital of Philadelphia. 9. 8Department of Oncology, Perelman School of Medicine, University of Pennsylvania. 10. 9Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
Abstract
OBJECTIVE: The lack of a continuous, noninvasive modality for monitoring intracranial pressure (ICP) is a major obstacle in the care of pediatric patients with hydrocephalus who are at risk for intracranial hypertension. Intracranial hypertension can lead to cerebral ischemia and brain tissue hypoxia. In this study, the authors evaluated the use of near-infrared spectroscopy (NIRS) to measure regional cerebral oxygen saturation (rSO2) in symptomatic pediatric patients with hydrocephalus concerning for elevated ICP. METHODS: The authors evaluated the NIRS rSO2 trends in pediatric patients presenting with acute hydrocephalus and clinical symptoms of intracranial hypertension. NIRS rSO2 values were recorded hourly before and after neurosurgical intervention. To test for significance between preoperative and postoperative values, the authors constructed a linear regression model with the rSO2 values as the outcome and pre- and postsurgery cohorts as the independent variable, adjusted for age and sex, and used the generalized estimating equation method to account for within-subject correlation. RESULTS: Twenty-two pediatric patients underwent NIRS rSO2 monitoring before and after CSF diversion surgery. The mean durations of NIRS rSO2 recording pre- and postoperatively were 13.95 and 26.82 hours, respectively. The mean pre- and postoperative rSO2 values were 73.84% and 80.65%, respectively, and the adjusted mean difference estimated from the regression model was 5.98% (adjusted p < 0.0001), suggestive of improved cerebral oxygenation after definitive neurosurgical CSF diversion treatment. Postoperatively, all patients returned to baseline neurological status with no clinical symptoms of elevated ICP. CONCLUSIONS: Cerebral oxygenation trends measured by NIRS in symptomatic pediatric hydrocephalus patients with intracranial hypertension generally improve after CSF diversion surgery.
OBJECTIVE: The lack of a continuous, noninvasive modality for monitoring intracranial pressure (ICP) is a major obstacle in the care of pediatric patients with hydrocephalus who are at risk for intracranial hypertension. Intracranial hypertension can lead to cerebral ischemia and brain tissue hypoxia. In this study, the authors evaluated the use of near-infrared spectroscopy (NIRS) to measure regional cerebral oxygen saturation (rSO2) in symptomatic pediatric patients with hydrocephalus concerning for elevated ICP. METHODS: The authors evaluated the NIRS rSO2 trends in pediatric patients presenting with acute hydrocephalus and clinical symptoms of intracranial hypertension. NIRS rSO2 values were recorded hourly before and after neurosurgical intervention. To test for significance between preoperative and postoperative values, the authors constructed a linear regression model with the rSO2 values as the outcome and pre- and postsurgery cohorts as the independent variable, adjusted for age and sex, and used the generalized estimating equation method to account for within-subject correlation. RESULTS: Twenty-two pediatric patients underwent NIRS rSO2 monitoring before and after CSF diversion surgery. The mean durations of NIRS rSO2 recording pre- and postoperatively were 13.95 and 26.82 hours, respectively. The mean pre- and postoperative rSO2 values were 73.84% and 80.65%, respectively, and the adjusted mean difference estimated from the regression model was 5.98% (adjusted p < 0.0001), suggestive of improved cerebral oxygenation after definitive neurosurgical CSF diversion treatment. Postoperatively, all patients returned to baseline neurological status with no clinical symptoms of elevated ICP. CONCLUSIONS: Cerebral oxygenation trends measured by NIRS in symptomatic pediatric hydrocephaluspatients with intracranial hypertension generally improve after CSF diversion surgery.
Authors: Tracy M Flanders; Shih-Shan Lang; Tiffany S Ko; Kristen N Andersen; Jharna Jahnavi; John J Flibotte; Daniel J Licht; Gregory E Tasian; Susan T Sotardi; Arjun G Yodh; Jennifer M Lynch; Benjamin C Kennedy; Phillip B Storm; Brian R White; Gregory G Heuer; Wesley B Baker Journal: J Pediatr Date: 2021-05-15 Impact factor: 6.314