Role of Interpeduncular and Prepontine Cistern Cerebrospinal Fluid Flow Measurements in Prediction of Endoscopic Third Ventriculostomy Success in Pediatric Triventricular Hydrocephalus

2010 ◽  
Vol 46 (5) ◽  
pp. 344-350 ◽  
Author(s):  
Ihsan Anik ◽  
Volkan Etus ◽  
Yonca Anik ◽  
Savas Ceylan
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Flow Measurements ◽  
Cerebrospinal Fluid Flow ◽  
Prepontine Cistern ◽  
Endoscopic Third Ventriculostomy Success ◽  
Triventricular Hydrocephalus

Why does endoscopic aqueductoplasty fail so frequently? Analysis of cerebrospinal fluid flow after endoscopic third ventriculostomy and aqueductoplasty using cine phase-contrast magnetic resonance imaging

2012 ◽  
Vol 117 (1) ◽  
pp. 141-149 ◽  
Author(s):  
Christiane Schroeder ◽  
Steffen Fleck ◽  
Michael R. Gaab ◽  
Klaus H. Schweim ◽  
Henry W. S. Schroeder
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Phase Contrast ◽  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Csf Flow ◽  
Cerebrospinal Fluid Flow ◽  
Flow Through ◽  
Endoscopic Aqueductoplasty

Object The aim of this study was to evaluate and compare CSF flow after endoscopic third ventriculostomy (ETV) and endoscopic aqueductoplasty (EAP) in patients presenting with obstructive hydrocephalus caused by aqueductal stenosis. Methods In patients harboring aqueductal stenosis who underwent EAP (n = 8), ETV (n = 8), and both ETV and EAP (n = 6), CSF flow through the restored aqueduct and through the ventriculostomy was investigated using cine cardiac-gated phase-contrast MRI. For qualitative evaluation of CSF flow, an in-plane phase-contrast sequence in the midsagittal plane was used. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct and/or floor of the third ventricle. Results Evaluation revealed significantly higher CSF flow through the ventriculostomies compared with flow through the aqueducts. This was true both when comparing the ETV group with the EAP group and when comparing the flow of the ventriculostomy and aqueduct within the ETV and EAP group. There was no difference in aqueductal CSF flow between patients who underwent EAP alone and patients who underwent ETV and EAP. There was also no difference in ventriculostomy CSF flow between patients who underwent ETV alone and patients who underwent ETV and EAP. Fifty percent of the restored aqueducts became occluded at a mean of 46 months after surgery (range 18–126 months). In contrast, all ETVs remained patent in the mean follow-up period of 110 months after surgery, although 1 patient required shunt placement after 66 months. Conclusions Cerebrospinal fluid flow through ventriculostomies is significantly higher than aqueductal CSF flow after EAP. This could be one factor to explain why the reclosure rate of aqueducts after EAP is higher than the reclosure rate of the ventriculostoma after ETV.

Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging.

Radiology ◽  
1996 ◽  
Vol 198 (2) ◽  
pp. 523-529 ◽  
Author(s):  
W G Bradley ◽  
D Scalzo ◽  
J Queralt ◽  
W N Nitz ◽  
D J Atkinson ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Mr Imaging ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Flow Measurements ◽  
Cerebrospinal Fluid Flow

Endoscopic Third Ventriculostomy in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 129-134 ◽  
Author(s):  
Michelangelo Gangemi ◽  
Francesco Maiuri ◽  
Simona Buonamassa ◽  
Giuseppe Colella ◽  
Enrico de Divitiis
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Endoscopic Third Ventriculostomy ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Gait Disturbance ◽  
High Rate ◽  
Third Ventriculostomy ◽  
Duration Of Symptoms ◽  
Cerebrospinal Fluid Flow

Abstract OBJECTIVE: To define the role and indications for an endoscopic third ventriculostomy (ETV) in patients with idiopathic normal pressure hydrocephalus (INPH). A series of 25 patients treated by endoscopic technique was analyzed, and the results were compared with those of 14 studies reporting patients treated by shunting. METHODS: Twenty-five patients with INPH were treated by ETV from January 1994 through December 2000. All were younger than 75 years of age, had a preoperative clinical history of 1 year or less, had prevalence of gait disturbance with scarce or mild dementia, had marked ventricular enlargement on magnetic resonance imaging (MRI), and had intracranial pressure values ranging from 8 to 12 mm Hg. All were studied by a phase-contrast MRI flow study 1 month after ETV. The 14 reviewed series of patients treated by shunting (all published after 1980) each include more than 25 patients, for a total of 777 patients. RESULTS: The overall rate of neurological improvement after ETV in our series was 72% (including two patients reoperated on because of absence of flow in the MRI scan); this percentage is slightly higher than that found in the 14 series of shunted patients (66%). Gait disturbance showed a high rate of improvement when compared with other symptoms, both in our ETV study and in other shunting series. Postoperative complications occurred only in one patient (4%) with an intracerebral frontal hemorrhage and in 37.9% of patients from the series including shunted patients. CONCLUSION: In patients with INPH showing short duration of symptoms, prevalence of gait disturbance, and slight mental impairment, ETV provides similar results to those of shunting. We suggest performing ETV in these patients and reserving shunting only for those who do not improve after ETV, despite the presence of cerebrospinal fluid flow through the ventriculostomy on MRI flow studies. The good results after ETV in our series indirectly confirm that the cerebrospinal fluid absorption is good or at least sufficient in selected patients with INPH.

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