Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Medical Biophysics

Supervisor

de Ribaupierre, Sandrine

2nd Supervisor

Fenster, Aaron

Co-Supervisor

Abstract

Preterm neonates are at risk for intraventricular hemorrhage (IVH) and subsequent post-hemorrhagic hydrocephalus (PHH). A well-accepted interventional therapy for PHH is ventricular tap (VT). Permanent treatment, ventriculo peritoneal shunt surgery (VPS) is required in the case of some neonates under some conditions (weight, immunological status, CSF protein level) who receive multiple interventions. The objective of this study was to apply a 3D ultrasound system clinically to determine CSF volume within the ventricle, to guide the neurosurgeon regarding the amount of CSF should be removed during every intervention, which lateral ventricle is better to intervene and to predict the possibilities of the requirement of the shunt. After ethics approval and parental consent, this 3D US system was used in a clinical study where data of 70 neonates having IVH were analyzed retrospectively and 22 preterm neonates were recruited prospectively. 3D US system was used to measure the ventricle volume of the neonates. In addition, we have changed the posture of some neonates to find the volume variation in two lateral postures. We found that 3D US ventricle volume had a higher correlation (Pearson correlation 0.739) with the amount of CSF removed in each tap than other parameters (weight, age, head circumference). After changing the posture of the neonates, we did not find any significant volume change of two lateral ventricle volumes (P-value was 0.353 in case of the right ventricle in two different postures and 0.473 in case of the left ventricle in two different postures). We also found more volume change after VT in those patients who required VPS than who did not need a VPS (volume change was18.70 ± 10.98 cm3 in shunt treated patients and 7.52 ± 3.35 cm3 in patients with no shunt where P- value was 0.0001). Therefore, our study suggests that a volumetric measurement of total lateral ventricles by the 3D US could be used concurrently with other physical parameters for better management of the neonates having PHH.

Summary for Lay Audience

Babies who are born earlier than the expected time of delivery usually suffer from many health hazards. One of the most common hazards is bleeding inside the brain. In the human brain, there are fluid-filled spaces called ventricles. This bleeding often occurs inside the ventricle and causes dilatation of ventricles by the excess amount of fluid that cannot circulate well because of the bleeding. This situation is very threatful for babies’ development and may even cause death. This condition is diagnosed by a 2D head ultrasound (2D US) and monitoring head enlargement. Primary treatment is the removal of excess fluid from the ventricles by needle aspiration. 2D US cannot measure how much fluid is inside the brain, therefore cannot guide the physician how much fluid should be removed safely at one time. Thus, we have developed a new 3D head US system where the exact volume measurement of the ventricle is possible. We recruited 22 babies who were born earlier than expected, and also, we analyzed data of another 70 babies with bleeding in the ventricles for this study. We measured the fluid amount in the ventricle using the 3D US system. We also changed the position of some of the babies to see if the ventricle volume changes with the position of the head, but we did not find significant changes in ventricle volume after changing position. But we found a good correlation between how much fluid is inside the brain and how much fluid should be removed at any time. Moreover, we could identify those babies for whom only removing fluid is not enough, treatment by permanent surgery is needed by calculating the 3D US volume difference before and after removing the fluid. We are hoping that this research will help the clinicians to manage the babies with ventricle bleeding more effectively.

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