RELATIONSHIP BETWEEN ANTERIOR FONTANELLE PRESSURE MEASUREMENTS AND CLINICAL SIGNS IN INFANTILE HYDROCEPHALUS

The treatment of choice in progressive hydrocephalus is drainage of ce rebrospinal fluid in order to reduce elevated intracranial pressure (I CP). Defining the right moment for surgical intervention, however, in a hydrocephalic infant on the basis of clinical signs alone can be a d ifficult task. Clinical signs of raised ICP are known to be unreliable and sometimes even misleading. In the present study, the relationship between long-term anterior fontanelle pressure (AFP) measurements and clinical signs was investigated in 37 infants with hydrocephalus. The decision as to whether to operate or not was based on clinical signs alone; AFP values were not taken into account. There was an overall di fference between the non-operated group and the preoperative measureme nts in the operated group, and also between the preoperative and the p ostoperative measurements in the latter, in regard to both AFP measure ments and clinical signs. Almost all preoperative AFP values were incr eased. The direct correlation (phi) between most individual clinical s igns and AFP levels, however, was low (phi=0.15-0.41). The clinical si gn ''tense fontanelle'' showed the best correlation with the AFP level s (phi=0.75). Furthermore, using logistic regression analysis, no comb ination of clinical signs could be found which reliably predicted the AFP. The relationship between the AFP pressure variables and clinical signs was also examined. The pathological A-waves occurred only in the presence of raised (baseline) AFP, a situation in which considerably more frequent B-waves were observed as well. It was concluded that cli nical signs of raised ICP in infantile hydrocephalus are not very reli able and AFP monitoring can therefore provide valuable information on intracranial dynamics in patients with dubious neurological manifestat ions of progressive hydrocephalus.