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

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.

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

Pediatric Neurosurgery ◽

10.1159/000323413 ◽

2010 ◽

Vol 46 (5) ◽

pp. 344-350 ◽

Cited By ~ 13

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

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Analysis of aqueductal cerebrospinal fluid flow after endoscopic aqueductoplasty by using cine phase-contrast magnetic resonance imaging

Journal of Neurosurgery ◽

10.3171/jns.2000.93.2.0237 ◽

2000 ◽

Vol 93 (2) ◽

pp. 237-244 ◽

Cited By ~ 82

Author(s):

Henry W. S. Schroeder ◽

Christiane Schweim ◽

Klaus H. Schweim ◽

Michael R. Gaab

Keyword(s):

Cerebrospinal Fluid ◽

Magnetic Resonance ◽

Mr Imaging ◽

Healthy Volunteers ◽

Phase Contrast ◽

Aqueductal Stenosis ◽

Csf Flow ◽

Content Type ◽

Endoscopic Aqueductoplasty ◽

Fine Print

Object. The purpose of this prospective study was to evaluate aqueductal cerebrospinal fluid (CSF) flow after endoscopic aqueductoplasty. In all patients, preoperative magnetic resonance (MR) imaging revealed hydrocephalus caused by aqueductal stenosis and lack of aqueductal CSF flow.Methods. In 14 healthy volunteers and in eight patients with aqueductal stenosis who had undergone endoscopic aqueductoplasty, aqueductal CSF flow was investigated using cine cardiac-gated phase-contrast MR imaging. For qualitative evaluation of CSF flow, the authors used an in-plane phase-contrast sequence in the midsagittal plane. 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. Evaluation revealed no significant difference in aqueductal CSF flow between healthy volunteers and patients with regard to temporal parameters, CSF peak and mean velocities, mean flow, and stroke volume. All restored aqueducts have remained patent 7 to 31 months after surgery.Conclusions. Aqueductal CSF flow after endoscopic aqueductoplasty is similar to aqueductal CSF flow in healthy volunteers. The data indicate that endoscopic aqueductoplasty seems to restore physiological aqueductal CSF flow.

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Establishing successful cerebrospinal fluid flow for radioimmunotherapy

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.12.peds11433 ◽

2012 ◽

Vol 9 (3) ◽

pp. 316-319 ◽

Cited By ~ 2

Author(s):

Kim Kramer ◽

Heather J. McCrea ◽

Cheryl Fischer ◽

Jeffrey P. Greenfield

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Imaging Study ◽

Cerebral Aqueduct ◽

Third Ventriculostomy ◽

Intraventricular Administration ◽

Csf Flow ◽

Opening Pressure ◽

Cerebrospinal Fluid Flow ◽

Cine Mr ◽

Flow Through

Successful delivery of intraventricular radioimmunotherapy is contingent on adequate CSF flow. The authors present a patient with medulloblastoma in whom obstructed CSF flow was causing hydrocephalus, which was initially corrected by implantation of a programmable shunting device. While managing the hydrocephalus, an endoscopic third ventriculostomy (ETV) needed to be performed in a collapsed ventricular system to ensure adequate radioimmunotherapy distribution. This 18-month-old patient with medulloblastoma involving leptomeningeal dissemination presented for intraventricular radioimmunotherapy. A CSF 111In-DTPA scintigraphy study obtained through the existing programmable ventriculoperitoneal shunt demonstrated activity in the lateral and third ventricles, but no activity over the cerebral convexities or spinal canal, consistent with obstruction at the level of the cerebral aqueduct. By maximization of ventricular size in a controlled setting, the patient was able to undergo a trial of ETV through very small ventricles. A postoperative CINE MR imaging study confirmed patent ETV. The pressure settings on the shunt were kept at the highest opening pressure (200 mm H2O) to maximize flow through the stoma and improve the distribution of CSF throughout the subarachnoid space. The CSF flow scintigraphy study was again performed, this time with tracer activity demonstrated down the thecal sac at 3 hours, and symmetrically over the cerebral convexities at 24 hours. The patient began weekly intraventricular administration of 131I-3F8 therapy. Successful rerouting of CSF flow for the purpose of therapeutic radioisotope administration is possible. Endoscopic third ventriculostomy can be considered in patients with programmable shunting devices; normal or slit ventricles do not preclude successful ETV.

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Semiautomatic Analysis of Phase Contrast Magnetic Resonance Imaging of Cerebrospinal Fluid Flow through the Aqueduct of Sylvius

Magnetic Resonance Materials in Physics Biology and Medicine ◽

10.1007/s10334-006-0030-6 ◽

2006 ◽

Vol 19 (2) ◽

pp. 78-87 ◽

Cited By ~ 19

Author(s):

Yudy Natalia Flórez ◽

David Moratal ◽

Juana Forner ◽

Luis Martí-Bonmatí ◽

Estanislao Arana ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cerebrospinal Fluid ◽

Fluid Flow ◽

Magnetic Resonance ◽

Phase Contrast ◽

Resonance Imaging ◽

Cerebrospinal Fluid Flow ◽

Phase Contrast Magnetic Resonance ◽

Contrast Magnetic Resonance ◽

Flow Through

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Analysis of aqueductal cerebrospinal fluid flow after endoscopic aqueductoplasty by using cine phase-contrast magnetic resonance imaging

Neurosurgical FOCUS ◽

10.3171/foc.2000.9.2.7 ◽

2000 ◽

Vol 9 (2) ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Henry W. S. Schroeder ◽

Christiane Schweim ◽

Klaus H. Schweim ◽

Michael R. Gaab

Keyword(s):

Cerebrospinal Fluid ◽

Magnetic Resonance ◽

Mr Imaging ◽

Healthy Volunteers ◽

Phase Contrast ◽

Aqueductal Stenosis ◽

Mean Flow ◽

Csf Flow ◽

Significant Difference ◽

Endoscopic Aqueductoplasty

Object The purpose of this prospective study was to evaluate aqueductal cerebrospinal fluid (CSF) flow after endoscopic aqueductoplasty. In all patients, preoperative magnetic resonance (MR) imaging revealed hydrocephalus caused by aqueductal stenosis and lack of aqueductal CSF flow. Methods In 14 healthy volunteers and in eight patients with aqueductal stenosis who had undergone endoscopic aqueductoplasty, aqueductal CSF flow was investigated using cine cardiac-gated phase-contrast MR imaging. For qualitative evaluation of CSF flow, the authors used an in-plane phase-contrast sequence in the midsagittal plane. 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. Evaluation revealed no significant difference in aqueductal CSF flow between healthy volunteers and patients with regard to temporal parameters, CSF peak and mean velocities, mean flow, and stroke volume. All restored aqueducts have remained patent 7 to 31 months after surgery. Conclusions Aqueductal CSF flow after endoscopic aqueductoplasty is similar to aqueductal CSF flow in healthy volunteers. The data indicate that endoscopic aqueductoplasty seems to restore physiological aqueductal CSF flow.

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