3. Conclusion

Based on the clinical experience and scientific research on pediatric hydrocephalus, we can summarize the role of transcranial Doppler sonography in assessment of cerebral circulation and intracranial dynamics of pediatric hydrocephalus as follows:

	- Indication and timing of drainage procedure;

showed importance of transcranial Doppler sonography for indication of drainage procedure in children with hydrocephalus. However, the authors emphasize the importance of individual and careful assessment of Doppler parameters of cerebral circulation regarding children

Rodríguez-Nuñez et al. [64] confirmed the role of clinical manifestations of intracranial hypertension, radiological morphometric parameters of the brain (Evans' index), biochemical parameters of cerebrospinal fluid (level of hypoxanthine, xanthine, and urea acid), and Doppler parameters of the cerebral circulation during assessment of children hydrocephalus and

Based on the results of the works of several authors, it seems that optic nerve sheath diameter (ONSD) ultrasonography could be a good noninvasive method for the indirect detection of

The study of Ragauskas et al. [69] compared the diagnostic reliability of optic nerve sheath diameter ultrasonography with a transcranial Doppler sonography and the absolute values of intracranial pressure in neurological patients. The authors of this study found that the noninvasive ICP measurement method based on two-depth transcranial Doppler technology has a better diagnostic reliability on neurological patients than the ONSD method when expressed by the sensitivity and specificity for detecting elevated ICP >14.7 mmHg [69]. Tarzamni et al. [70] analyzed the diagnostic accuracy of ultrasonographic ONSD measurement and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure. While the ultrasonographic mean binocular ONSD was completely accurate in detecting elevated

Based on the recent literature, it seems to be a good idea to use sonographic methods, optic nerve sheath diameter ultrasonography and transcranial Doppler sonography for the noninvasive detection of intracranial hypertension. Further research for the application in clinical

Based on the clinical experience and scientific research on pediatric hydrocephalus, we can summarize the role of transcranial Doppler sonography in assessment of cerebral circulation

1. Assessment of Doppler parameters of cerebral circulation before drainage procedure in children with hydrocephalus revealed alteration of cerebral circulation which is potentially reversible. Doppler sonography showed the improvement of cerebral circulation

2. Results of compressive test on the anterior fontanelle increase validity of assessment of cerebral circulation by transcranial Doppler sonography and enable indirect assessment of decrease of intracranial compliance. Increase of basal Doppler parameters shows increase

ICP, color Doppler indices of the ophthalmic arteries were of limited value [70].

hydrocephalus in clinical practice [63].

58 Highlights on Hemodynamics

indication of drainage procedure [64].

raised intracranial pressure [65–68].

practice in pediatric hydrocephalus is needed.

and intracranial dynamics of pediatric hydrocephalus as follows:

after the drainage procedure in pediatric hydrocephalus.

3. Conclusion

of intracranial pressure.


To sum up, it can be said that including assessment of cerebral circulation by transcranial Doppler sonography into management of child with hydrocephalus provides additional information to clinical manifestations and morphological results of imaging studies. This helps better understand intracranial dynamics and activity of hydrocephalus in regard to indication and timing of drainage procedure.

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