Aimed at alleviating the elevated intracranial pressure (ICP), the most common treatment consists of CSF diversion to another anatomical location outside of the central nervous system via an invasive ventricular shunt 5. Intracranial hypertension and ventriculomegaly are major complications of hydrocephalus 3, 5, which could lead to compromised cerebral blood flow (CBF), brain ischemia, inflammation, secondary neurovascular damage, and brain herniation 3, 6. Affecting 1.1‰ of infants 2, it is the leading cause for brain surgery in newborns and results in long-term neurologic disabilities in up to 78% of patients 3, 4. Hydrocephalus involves abnormal cerebrospinal fluid (CSF) accumulation in the brain ventricles 1. These findings suggest that CEUS-based CMC measurement is a plausible noninvasive method for assessing the ICP and detecting ischemia. For cerebral ischemia cases, the nondimensionalized cortical micro-perfusion decreases by an order of magnitude when ICP exceeds 50% of the MAP. Combining CMC with hemodynamic parameters yields functional relationships between cortical micro-perfusion and ICP, with correlation coefficients exceeding 0.85. Regional microvascular perfusions are quantified by the cerebral microcirculation (CMC) parameter, which accounts for the concentration of micro-vessels and flow velocity in them. Here we use clinical contrast-enhanced ultrasound (CEUS) imaging and intravascular microbubble tracking algorithms to map the cerebral blood flow in hydrocephalic pediatric porcine models. Since conventional invasive ICP monitoring is risky, early neurosurgical interventions could benefit from noninvasive techniques. It is the leading cause for brain surgery in newborns, often causing long-term neurologic disabilities or even death. Affecting 1.1‰ of infants, hydrocephalus involves abnormal accumulation of cerebrospinal fluid, resulting in elevated intracranial pressure (ICP).
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