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Functional analysis of third ventriculostomy patency by quantification of CSF stroke volume by using cine phase-contrast MR imaging.
[hydrocephalus with stenosis of the aqueduct of sylvius]
Endoscopic
third
ventriculostomy
(
ETV
)
is
increasingly
used
as
alternative
treatment
for
obstructive
hydrocephalus
.
The
aim
of
this
study
was
to
determine
the
utility
of
quantitative
and
qualitative
examinations
with
cine
phase-contrast
MR
imaging
to
determine
the
efficacy
of
ventriculostomy
across
time
and
whether
CSF
pulsation
is
restored
after
ETV
.
Thirty
-
eight
patients
treated
with
ETV
were
evaluated
with
cine
phase-contrast
MR
within
1
month
after
surgery
.
Follow-up
studies
were
performed
after
1
year
in
25
patients
and
after
2
years
in
12
.
We
evaluated
flow
void
changes
in
the
floor
of
the
third
ventricle
and
quantified
the
stroke
volume
at
the
site
of
the
ventriculostomy
.
We
also
recorded
changes
in
ventricular
size
and
clinical
outcome
.
To
determine
the
restoration
of
CSF
pulsation
,
we
compared
the
CSF
waveform
at
the
ventriculostomy
with
the
CSF
waveform
at
the
aqueduct
in
a
healthy
control
group
.
After
ventriculostomy
,
restoration
of
pulsate
motion
characteristics
of
CSF
circulation
was
observed
.
The
stroke
volume
registered
at
ventriculostomy
was
maintained
with
time
.
There
was
a
statistically
significant
relationship
between
clinical
outcome
and
stroke
volume
.
Overall
flow
magnitude
was
the
most
effective
variable
to
determine
which
patients
would
improve
after
surgery
.
Values
>
75
mm
3
showed
a
sensitivity
of
76
.
7
%
and
a
specificity
of
87
.
5
%
There
was
no
relationship
between
ventricular
size
changes
and
clinical
outcome
.
Patients
with
primary
aqueduct
stenosis
had
the
best
response
to
surgery
,
whereas
patients
with
Arnold
Chiari
malformation
or
communicating
hydrocephalus
had
the
worst
response
.
Quantitative
analysis
with
phase-contrast
MR
imaging
indicates
that
ETV
is
an
efficient
technique
for
restoring
CSF
pulsation
,
with
efficacy
being
maintained
during
the
follow-up
controls
.
Quantification
of
stroke
volume
at
ventriculostomy
is
a
good
indicator
of
the
functional
status
of
ETV
,
and
a
high
stroke
volume
in
the
ventriculostomy
appears
to
be
a
positive
predictor
of
favorable
clinical
outcome
.