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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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Year : 2002  |  Volume : 7  |  Issue : 4  |  Page : 174-183

Role of transcranial doppler sonography and pressure provocation test to evaluate the need for cerebrospinal fluid drainage i n hydrocephalic children


TNMC and BYL Nair Hospital, Mumbai, India

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P Gera
TNMC and BYL Nair Hospital, Mumbai
India
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Source of Support: None, Conflict of Interest: None


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ABSTRACT: This study was carried out in a tertiary care hospital on 40 patients and 20 controls, over a period of 2 years. The age of the patients ranged from 1 day to 9 years. There were 15 females and 25 males. Out of 49 patients we had 10 neonates, 13 infants and 17 children. Head circumference, resistive index (RI) and pressure provocation test (PPT) were done preoperatively and on 10th postoperative day. The direct intracranial pressure was also measured during shunt placement. Twenty nine patients underwent shunt placement, of which direct intracranial pressure measurement was done in 27 patients. The cut off value for normal RI was 0.60 without pressure and 0.70 with pressure provocation. The cut off value for normal intracranial pressure is 10 cms of CSF. The mean preop RI was 0.66 +_ 0.12 and mean pre-op PPT was 0.75 +_ 0.12. Postsurgery mean RI and PPT fell to 0.58 +_ 0.07 and 0.59 +_ 0.07 respectively. These differences were statistically significant. The sensitivity, specificity and diagnostic accuracy of RI was 72.5 percent, 80 percent and 75 percent respectively. The sensitivity, specificity and diagnostic accuracy of PPT was 75 percent, 100 percent and 83 percent respectively. The application of PPT mainly improved the specificity of the RI by eliminating the false positives. The PPT was found very useful for follow up of patients with suspected shunt malfunction.






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  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

Online since 1st May '05