Tracy M Flanders1, Shih-Shan Lang2, Tiffany S Ko3, Kristen N Andersen3, Jharna Jahnavi3, John J Flibotte4, Daniel J Licht3, Gregory E Tasian5, Susan T Sotardi6, Arjun G Yodh7, Jennifer M Lynch8, Benjamin C Kennedy2, Phillip B Storm2, Brian R White9, Gregory G Heuer2, Wesley B Baker10. 1. Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania. 2. Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania. 3. Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania. 4. Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA. 5. Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Division of Urology, Children's Hospital of Philadelphia. 6. Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania. 7. Department of Physics and Astronomy, University of Pennsylvania. 8. Department of Anesthesiology and Critical Care Medicine. 9. Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 10. Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania. Electronic address: bakerw@chop.edu.
Abstract
OBJECTIVE: To demonstrate that a novel noninvasive index of intracranial pressure (ICP) derived from diffuse optics-based techniques is associated with intracranial hypertension. STUDY DESIGN: 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. RESULTS: 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 < .001) after CSF diversion were observed only in infants with intracranial hypertension. CONCLUSIONS: Noninvasive diffuse optical measures (including a noninvasive ICP index) were associated with intracranial hypertension. The findings suggest that 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. Noninvasive optical techniques hold promise for aiding the assessment of CSF diversion timing.
OBJECTIVE: To demonstrate that a novel noninvasive index of intracranial pressure (ICP) derived from diffuse optics-based techniques is associated with intracranial hypertension. STUDY DESIGN: 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. RESULTS: 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 < .001) after CSF diversion were observed only in infants with intracranial hypertension. CONCLUSIONS: Noninvasive diffuse optical measures (including a noninvasive ICP index) were associated with intracranial hypertension. The findings suggest that 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. Noninvasive optical techniques hold promise for aiding the assessment of CSF diversion timing.
Authors: Wesley B Baker; Ashwin B Parthasarathy; Kimberly P Gannon; Venkaiah C Kavuri; David R Busch; Kenneth Abramson; Lian He; Rickson C Mesquita; Michael T Mullen; John A Detre; Joel H Greenberg; Daniel J Licht; Ramani Balu; W Andrew Kofke; Arjun G Yodh Journal: J Cereb Blood Flow Metab Date: 2017-05-25 Impact factor: 6.200
Authors: Tiffany S Ko; Constantine D Mavroudis; Wesley B Baker; Vincent C Morano; Kobina Mensah-Brown; Timothy W Boorady; Alexander L Schmidt; Jennifer M Lynch; David R Busch; Javier Gentile; George Bratinov; Yuxi Lin; Sejin Jeong; Richard W Melchior; Tami M Rosenthal; Brandon C Shade; Kellie L Schiavo; Rui Xiao; J William Gaynor; Arjun G Yodh; Todd J Kilbaugh; Daniel J Licht Journal: J Cereb Blood Flow Metab Date: 2018-10-30 Impact factor: 6.200
Authors: Hasan Ayaz; Wesley B Baker; Giles Blaney; David A Boas; Heather Bortfeld; Kenneth Brady; Joshua Brake; Sabrina Brigadoi; Erin M Buckley; Stefan A Carp; Robert J Cooper; Kyle R Cowdrick; Joseph P Culver; Ippeita Dan; Hamid Dehghani; Anna Devor; Turgut Durduran; Adam T Eggebrecht; Lauren L Emberson; Qianqian Fang; Sergio Fantini; Maria Angela Franceschini; Jonas B Fischer; Judit Gervain; Joy Hirsch; Keum-Shik Hong; Roarke Horstmeyer; Jana M Kainerstorfer; Tiffany S Ko; Daniel J Licht; Adam Liebert; Robert Luke; Jennifer M Lynch; Jaume Mesquida; Rickson C Mesquita; Noman Naseer; Sergio L Novi; Felipe Orihuela-Espina; Thomas D O'Sullivan; Darcy S Peterka; Antonio Pifferi; Luca Pollonini; Angelo Sassaroli; João Ricardo Sato; Felix Scholkmann; Lorenzo Spinelli; Vivek J Srinivasan; Keith St Lawrence; Ilias Tachtsidis; Yunjie Tong; Alessandro Torricelli; Tara Urner; Heidrun Wabnitz; Martin Wolf; Ursula Wolf; Shiqi Xu; Changhuei Yang; Arjun G Yodh; Meryem A Yücel; Wenjun Zhou Journal: Neurophotonics Date: 2022-08-30 Impact factor: 4.212
Authors: Ena Suppan; Gerhard Pichler; Corinna Binder-Heschl; Bernhard Schwaberger; Berndt Urlesberger Journal: Front Pediatr Date: 2022-06-13 Impact factor: 3.569
Authors: Alec Lafontant; Elizabeth Mahanna Gabrielli; Karla Bergonzi; Rodrigo M Forti; Tiffany S Ko; Ronak M Shah; Jeffrey S Arkles; Daniel J Licht; Arjun G Yodh; W Andrew Kofke; Brian R White; Wesley B Baker Journal: Neurophotonics Date: 2022-08-25 Impact factor: 4.212