Relationships of intracranial pressure, cerebrospinal fluid space and head circumference in young children

Abstract

The purpose of this study was to retrospectively evaluate and analyze the relationships between intracranial pressure (ICP), cerebrospinal fluid space (CSF) and head circumference (HC). The medical records at single institution from 2007 through 2011 inclusive were reviewed to identify 780 patients under 6-year-old who underwent a lumbar puncture for measuring the ICP. Exclusion criteria were as follows; 1) unrecorded HC or ICP on chart; 2) diagnosed craniosynostosis or intracranial tumor; and 3) performed shunt or cranial vault operation. The enrolled patients were divided into three age-groups (group 1: up to 12 months; group 2: over 12 to 36 months; group 3: over 36 to 72 months). Eighty eight of total 780 patients were enrolled. The study group was composed of 62 boys and 26 girls, with a mean age of 20.6 ± 17.9 months. First aged group (group 1, n=38) was composed of 23 boys and 15 girls, with a mean age of 6.6 ± 2.7 months. In this group, a mean HC was 43.7 ± 4.8cm (56.6 ± 38.4 percentile) and a mean ICP was 24.1 ± 5.8cmH2O. An average Evans ratio was 0.27 ± 0.06. The significant subdural hygroma (SDHG) was detected in 25 patients and the average thickness of it was 3.4 ± 2.7mm. There was a significant positive correlation between the ICP and the HC (r=.474, p=.003). Second aged group (group 2, n=31) was composed of 23 boys and 8 girls, with a mean age of 19.5 ± 6.7 months. In this group, a mean HC was 48.9 ± 3.4cm (68.6 ± 35.6 percentile) and a mean ICP was 27.6 ± 7.7cmH2O. An average Evans ratio was 0.29 ± 0.10. The SDHG was detected in 11 patients and the average thickness of it was 1.9 ± 2.5mm. There was a significant positive correlation between the ICP and the HC percentile (r=.408, p=.023). The ICP and the thickness of SDHG were also significantly correlated (r=.429, p=.016). Third aged group (group 3, n=19) was composed of 16 boys and 3 girls, with a mean age of 50.5 (± 9.9 months). A mean HC was 50.1 ± 3.2cm (54.1 ± 36.9 percentile) and a mean ICP was 25.9 ± 6.6cmH2O. An average Evans ratio was 0.25 ± 0.05. The SDHG was detected in two cases. There was no significant correlation between any factors in this group. With closure of cranial suture, the ICP related to the HC especially in infant with non- or less closed sutures, and the SDHG related to the ICP in toddler with partial closed cranial sutures. In these results, the HC may be reflected in the ICP at early period with rapidly growing HC, and thickness of the SDHG could be expected from the ICP at period with cranial suture closure to some degree.

본 연구의 목적은 두개 성장이 급속히 일어나는 환아에 있어 뇌압, 뇌척수액 공간, 두위의 상관관계에 대해 후향적으로 분석하는 것이다. 2007 년부터 2011 년까지 단일 의료기간에서 뇌압 측정을 위해 요추 천자를 시행 받은 6 세 이하의 환아 780 명을 대상으로 의무기록 및 영상 자료를 분석하였다. 그 중 1) 두위나 뇌압 측정치가 기록되지 않은 경우, 2)두개골 조기유합증 또는 뇌종양이 진단된 경우, 3) 뇌실 단락술이나 두개 수술을 시행 받은 경우는 대상에서 제외하였다. 모집된 집단은 세 집단으로 재분류 하였다. 출생 시부터 12 개월까지는 제 1 집단, 12 개월 초과부터 36 개월까지는 제 2 집단, 그리고 36 개월 이후는 제 3 집단으로 명명하였다. 총 780 명 중 88 명이 연구 대상으로 선정되었고, 남아가 62 명, 여아가 26 명으로 구성되었으며 평균 연령은 20.6 ± 17.9 개월이었다. 제 1 집단에서는 뇌압과 두위가 서로 유의한 상관관계가 있는 것으로 나타났다 (r=.359, p=.027). 제 2 집단에서 마찬가지로 뇌압과 두위가 유의한 상관관계를 보였고 (r=.408, p=.023) 뇌압과 뇌경막하수종의 두께 또한 유의한 양의 상관관계를 나타냈다 (r=.429, p=.016). 제 3 집단에서는 상관관계에 있는 요소가 없었다. 두개 봉합선이 열려 있는 영유아의 경우 뇌압은 두위 증가에 영향을 주었고, 두개 봉합선 부분적으로 닫혀가는 과정인 아동에 있어서는 뇌경막하수종이 뇌압 상승에 영향을 주었다. 이를 바탕으로 두개골 성장이 급속히 일어나는 기간에는 두위 증가 정도를 측정함으로써 뇌압을 예측할 수 있고, 어느 정도 두개 봉합이 이뤄진 후에는 뇌경막하수종의 정도를 통해 뇌압을 예측할 수 있을 것으로 사료된다.