Background Symptomatic or active hydrocephalus in children is linked to an elevation in intracranial pressure (ICP), which is likely to be multifactorial in origin. The CSF outflow resistance, venous sinus resistance and total cerebral blood flow are likely factors in the ICP elevation. The purpose of this paper is to define the incidence, site and significance of venous sinus stenosis and/or cerebral hyperemia in a cohort of children diagnosed with hydrocephalus at a tertiary referral hospital. Methods The imaging database was reviewed over a 10 year period and the index MRI of all children between the ages of 4 months and 15 years, who were diagnosed with treatment naive hydrocephalus of any type (excluding secondary to tumor) and had magnetic resonance venography (MRV) and flow quantification were selected. Patients were compared with children undergoing an MRI with MRV and flow quantification who were subsequently shown to have no abnormality. The cross-sectional area and circumference of the sinuses were measured at 4 levels. The hydraulic and effective diameters were calculated. An area stenosis of 65% or greater was deemed significant. A total cerebral blood flow greater than two standard deviations above the mean for controls was taken to be abnormal. Results There were a total of 55 children with hydrocephalus compared to 118 age matched control MRV’s and 35 control flow quantification studies. A high grade stenosis occurred in 56% of patients but in none of the controls (p < 0.0001). The commonest site of narrowing was in the distal sigmoid sinus. Cerebral hyperemia occurred in 13% of patients but did not occur in the controls. Conclusions The elevation in ICP in symptomatic hydrocephalus is multifactorial. Both high grade venous stenosis and cerebral hyperemia are common in childhood hydrocephalus. High grade stenosis was noted to be a risk factor for conservative management failure. Hyperemia was a good prognostic indicator.

中文翻译：

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儿童脑积水显着静脉窦狭窄和脑充血的发生率：区分活动性和代偿性疾病的预后价值

背景 儿童有症状或活动性脑积水与颅内压 (ICP) 升高有关，这可能是由多因素造成的。脑脊液流出阻力、静脉窦阻力和总脑血流量是 ICP 升高的可能因素。本文的目的是确定在三级转诊医院诊断为脑积水的一组儿童中静脉窦狭窄和/或脑充血的发生率、部位和意义。方法回顾了 10 年的影像数据库和所有年龄在 4 个月至 15 岁之间的儿童的索引 MRI，这些儿童被诊断为任何类型的初治脑积水（不包括肿瘤继发性）并进行了磁共振静脉造影（ MRV）和流量定量。将患者与接受 MRV 和流量量化的 MRI 的儿童进行比较，后者随后被证明没有异常。在 4 个水平上测量窦的横截面积和周长。计算水力直径和有效直径。65% 或更大的区域狭窄被认为是显着的。总脑血流量大于对照平均值两个标准偏差被认为是异常的。结果 共有 55 名儿童患有脑积水，而 118 名年龄匹配的对照 MRV 和 35 名对照血流定量研究。56% 的患者出现高度狭窄，但没有一个对照组（p < 0.0001）。最常见的狭窄部位是远端乙状窦。13% 的患者出现脑充血，但对照组未出现脑充血。结论 症状性脑积水患者的ICP升高是多因素的。高度静脉狭窄和脑充血在儿童脑积水中很常见。高度狭窄被认为是保守治疗失败的危险因素。充血是一个很好的预后指标。