Abstract
Background This is a prospective study to evaluate the role of CINE MRI to predict obstructive
hydrocephalus in the preoperative work-up.
Patients/Material and Methods A total of 16 patients with aqueductal obstruction demonstrated by CINE MRI who were
undergoing ETV were included. MRI was performed preoperatively, at 3 months, at 12
months and at 24 months after surgery. Prior to the fenestration of the third ventricular
floor aqueductal patency was evaluated using intraoperative ventriculography. A successful
outcome was defined by using radiological and clinical criteria.
Results In 8 patients with aqueductal obstruction on preoperative CINE MRI aqueductal patency
was proven intraoperatively. ETV failed in all patients with intraoperatively proven
aqueductal patency. Out of these 8 patients, 1 patient had no risk factors for ETV
failure, 3 had 1 risk factor, 3 had 2 risk factors, and 1 had 3 risk factors. Most
of the failure (6 out of 8 patients) occurred within 8 weeks of the initial procedure.
A lumbar puncture was performed in these patients to avoid misinterpretation of the
clinical course.
Conclusion The present study demonstrates that cine phase constrast MR may be a poorer choice
to determine aqueductal patency compared to high resolution structural imaging. Interestingly,
intraoperative ventriculography was an adjunct to better predict outcome after ETV
in patients with obstructive hydrocephalus. In cases with non-conclusive preoperative
imaging, postoperative decision making may be supported by the use of intraoperative
ventriculography with the goal of reducing unnecessary tests and procedures. However,
the analysis of the study data has to be considered as explorative. Therefore, findings
should be validated with a larger patient population.
Keywords
obstructive hydrocephalus - third ventriculostomy - ventriculoperitoneal shunt - cine
phase contrast MRI
