The incidence of significant venous sinus stenosis and cerebral hyperemia in childhood hydrocephalus: prognostic value with regards to differentiating active from compensated disease
Open Access
- 29 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Fluids and Barriers of the CNS
- Vol. 17 (1), 1-12
- https://doi.org/10.1186/s12987-020-00194-4
Abstract
Symptomatic or active hydrocephalus in children is linked to an elevation in intracranial pressure (ICP), which is likely to be multifactorial in origin. The CSF outflow resistance, venous sinus resistance and total cerebral blood flow are likely factors in the ICP elevation. The purpose of this paper is to define the incidence, site and significance of venous sinus stenosis and/or cerebral hyperemia in a cohort of children diagnosed with hydrocephalus at a tertiary referral hospital. The imaging database was reviewed over a 10 year period and the index MRI of all children between the ages of 4 months and 15 years, who were diagnosed with treatment naive hydrocephalus of any type (excluding secondary to tumor) and had magnetic resonance venography (MRV) and flow quantification were selected. Patients were compared with children undergoing an MRI with MRV and flow quantification who were subsequently shown to have no abnormality. The cross-sectional area and circumference of the sinuses were measured at 4 levels. The hydraulic and effective diameters were calculated. An area stenosis of 65% or greater was deemed significant. A total cerebral blood flow greater than two standard deviations above the mean for controls was taken to be abnormal. There were a total of 55 children with hydrocephalus compared to 118 age matched control MRV’s and 35 control flow quantification studies. A high grade stenosis occurred in 56% of patients but in none of the controls (p < 0.0001). The commonest site of narrowing was in the distal sigmoid sinus. Cerebral hyperemia occurred in 13% of patients but did not occur in the controls. The elevation in ICP in symptomatic hydrocephalus is multifactorial. Both high grade venous stenosis and cerebral hyperemia are common in childhood hydrocephalus. High grade stenosis was noted to be a risk factor for conservative management failure. Hyperemia was a good prognostic indicator.Keywords
This publication has 43 references indexed in Scilit:
- Morphometric and volumetric MRI changes in idiopathic intracranial hypertensionCephalalgia, 2013
- Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model PredictionsAmerican Journal of Neuroradiology, 2011
- A mathematical model of idiopathic intracranial hypertension incorporating increased arterial inflow and variable venous outflow collapsibilityJournal of Neurosurgery, 2009
- Idiopathic hydrocephalus in children and idiopathic intracranial hypertension in adults: two manifestations of the same pathophysiological process?Journal of Neurosurgery: Pediatrics, 2007
- An Approach to the Management of Arrested and Compensated HydrocephalusPediatric Neurosurgery, 1993
- Hydrocephalus in an achondroplastic child treated by venous decompression at the jugular foramenJournal of Neurosurgery, 1990
- Pressure-volume relationships in shunt-dependent childhood hydrocephalusJournal of Neurosurgery, 1986
- Intracranial venous sinus hypertension: cause or consequence of hydrocephalus in infants?Journal of Neurosurgery, 1984
- The intracranial pressure in infantsJournal of Neurosurgery, 1980
- Hydrocephalus and the Dural Venous SinusesJournal of Neurosurgery, 1962