S1-08 NEAR INFRA-RED CEREBRAL OXIMETRY IN DIAGNOSTIC OF CRANIOCEREBRAL DISPROPORTION

Abstract

Introduction: Currently, the near infra-red spectroscopy for cerebral oximetry is quite widely used with patients in critical conditions, as well as at the stage of diagnostics in the perioperative period. This reveals the patient’s oxygenation disorders and prevents the development of ischemic attacks. This is especially important given that hypoxia and ischemia of the structures of the central nervous system are the main cause of disability and congenital deteriorations of patients with various neurosurgical pathologies. Phenomena of craniocerebral disproportion is expressed at patients with severe deformities of the skull with various forms of craniosynsthosis. The most frequent clinical aspects of craniocerebral disproportion are considered to be speech development delay, neurosis-like disorders and intracranial hypertension. Clinical manifestations occur in patients much later than the formation of deformity. Noninvasive near infer-red spectroscopy may be an alternative to other neuroimaging diagnostic methods in some cases. Methods: In 2017–2018, NIRS was performed in 23 patients with craniosynostosis: sagittal-3(13%), metopic-11(48%), coronal-5(22%), bicoronal-2(8,5%), pansynostosis-2(8.5%). The StO2 assessment was performed by the Casmed Fore-Sight pediatric sensors according to the weight and age of the patient. The study was conducted in symmetrical areas of the skull: right and left frontal, parietal, occipital areas. In cases of specific deformation of the skull, cerebral oximetry data are additionally evaluated in the area of maximum deformation and in the symmetric intact part of the skull. Results: Normal values of StO2 were obtained in all studies: the maximum value obtained is 81%, the minimum is 62%. However, in some cases, significant hemispheric asymmetry and regional changes in StO2 were obtained. Thus, the differences between the obtained StO2 values of less than 2% were obtained in 9 patients (39%). A 5–9% difference in StO2 between regions of potential compression and intact brain areas was expressed at 12 patients (52%). The difference of StO2 over 10% (maximum value - 11%) was obtained at 2 patients (9%). Both patients were with unilateral coronal craniosynostosis. Comparison of MR-perfusion data at these patients allowed us to confirm hypoperfusion sites in the areas of interest. Conclusion: The use of NIRS in patients with severe synostotic deformities of the skull helps to avoid additional neuroimaging examination methods. This will help to reduce the radiation load on the child and avoid medical sedation for the study. Moreover, NIRS seems to be one of the best methods of diagnostic of craniocerebral disproportion in children with craniosynostosis deformity.