Cerebral Hemodynamics in Pediatric Hydrocephalus: Evaluation by Means of Transcranial Doppler Sonography

Book excerpt: Active, progressive hydrocephalus in children leads to increase of intracranial pressure, dilatation of cerebral ventricles, and decrease of intracranial compliance. These changes lead to disorder of regulation of cerebral circulation and development of cerebral hypoperfusion resulting in the secondary brain damage. Ependymal disruption, periventricular edema, and compression of the periventricular capillaries can be developed. Ischemia of the white matter can be developed due to hypoperfusion. But it is reversible if treated early and adequately. Transcranial Doppler sonography enables to determine hemodynamic parameters of cerebral circulation in various physiological and pathophysiological conditions. As transcranial Doppler sonography has been regarded to be noninvasive and appropriate for bedside treatment, it can also be applied in children at any age. The goal of this chapter is to assess changes of cerebral circulation in children with hydrocephalus and application of data from scientific studies of intracranial dynamics in children with hydrocephalus in clinical practice. The work is also focused on evaluation of impact of intracranial factors on Doppler parameters of cerebral circulation, especially in neonates with hydrocephalus. The ambition of this chapter is to improve indication and timing of drainage procedure in children with hydrocephalus by application of the results and clinical experience in daily clinical practice.