SignificanceBenign external hydrocephalus (BEH) is considered a self-limiting pathology with a good prognosis. However, some children present a pathological intracranial pressure (ICP) characterized by quantitative and qualitative alterations (the so-called B-waves) that can lead to neurological sequelae.AimOur purpose was to evaluate whether there were cerebral hemodynamic changes associated with ICP B-waves that could be evaluated with noninvasive neuromonitoring.ApproachWe recruited eleven patients (median age 16 months, range 7 to 55 months) with BEH and an unfavorable evolution requiring ICP monitoring. Bedside, nocturnal monitoring using near-infrared time-resolved and diffuse correlation spectroscopies synchronized to the clinical monitoring was performed.ResultsBy focusing on the timing of different ICP patterns that were identified manually by clinicians, we detected significant tissue oxygen saturation (StO2) changes (p = 0.002) and blood flow index (BFI) variability (p = 0.005) between regular and high-amplitude B-wave patterns. A blinded analysis looking for analogs of ICP patterns in BFI time traces achieved 90% sensitivity in identifying B-waves and 76% specificity in detecting the regular patterns.ConclusionsWe revealed the presence of StO2 and BFI variations—detectable with optical techniques—during ICP B-waves in BEH children. Finally, the feasibility of detecting ICP B-waves in hemodynamic time traces obtained noninvasively was shown.
One sedative drug to induce anesthesia during surgery is propofol. It diminishes the cerebral metabolic rate of oxygen (CMRO2), preventing memory formation and is coupled with a decrease in the cerebral blood flow (CBF). Anesthesia depth is commonly monitored by the bispectral index (BIS) to avoid awareness. Optical hybrid near-infrared spectroscopies have the potential to assess CMRO2 and other physiological signals (i.e. CBF). Optical signals acquired alongside BIS in surgeries were compared to it and provided additional information. Overall, agreement was found at different levels (group analysis, single subject analysis and simultaneity in time of changes).
Intracranial pressure (ICP) is a critical biomarker measured invasively with the risk of complications. There is a need for non-invasive methods to estimate ICP. Diffuse correlation spectroscopy (DCS) allows the non-invasive measurement of pulsatile, microvascular cerebral blood flow which contains information about ICP. Recently, our proof-of-concept study used machine-learning to deduce ICP from DCS signals to estimate ICP resulting in excellent linearity and a reasonable accuracy (±4 mmHg). Here, we extend to a multi-center (three centers) data set of adults with acute brain injury (N=34). We will present the results from the complete data set as new data flows in.
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