Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

Xiao, Dexuan; Ragab, Mahmoud H.; Luciano, Mark

doi:10.1017/s0317167100008179

Cited by 22 publications

(6 citation statements)

References 25 publications

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“…Although some patients may show adequate qualitative and quantitative data of flow through the ventriculostomy above the cutoff values, they display symptoms and signs of clinical deterioration and this is explained as inefficient ETV due to basal cisterns obstruction and considered communicating hydrocephalus which was observed by Di et al [18] , which was not reported in our study.…”

Section: Discussioncontrasting

confidence: 61%

Analysis of Cerebrospinal Fluid Flowmetry in Evaluating the Efficiency of Endoscopic Third Ventriculostomy in Aqueductal Stenosis

Shahba

Alhady

Samouly

et al. 2019

International Journal of Medical Arts

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Background: Endoscopic third ventriculostomy (ETV) approach was gaining popularity over shunt placement in obstructive hydrocephalus. Postoperative ETV assessment and patients follow up remains a matter of controversy and challenge to ensure efficiency and patency of ventriculostomy. Aim of the work: To assess whether cerebrospinal fluid (CSF) flow is restored after ETV and similarity to flow in normal aqueduct with patients clinical and ventricular size changes assessment. Patients and Methods: From April 2016 to April 2019, 30 patients with hydrocephalus due to aqueductal stenosis (AS) were treated with ETV. They were followed up for ventriculostomy patency within the 1 st , 6 th and 9 th month after surgery and compared to 22 persons as a control group of normal aqueductal flow with phase contrast magnetic resonance imaging (PC MRI). Results: Twenty three (23) patients restored pulsatile bidirectional pattern of CSF flow across the ventriculostomy similar to that of aqueductal flow. While one patient had no flow during the 1st follow up and 6 patients showed initial pulsatile flow then developed flow disturbance during the 2nd follow up period. Absolute stroke volume values showed significant statistical difference between ETV and control groups (p value < 0.001). The value of 85 μl showed sensitivity and specificity of 84.3% and 81.7%, respectively as a cutoff value of ETV efficiency. Conclusion: ETV is an efficient technique to restores the physiological pulsatile Cerebrospinal fluid flow. Absolute stroke volume was a good predictor of ETV efficiency.

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Section: Discussioncontrasting

confidence: 61%

Analysis of Cerebrospinal Fluid Flowmetry in Evaluating the Efficiency of Endoscopic Third Ventriculostomy in Aqueductal Stenosis

Shahba

Alhady

Samouly

et al. 2019

International Journal of Medical Arts

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“…One study, in which most patients had elevated aqueductal stroke volume, showed only a small, non-significant decrease in flow pulsatility after ETV [184]. A more recent study found no association between ETV success and CSF flow pulsatility in the basal cisterns or at the cervicomedullary junction [185]. Thus, at present there is no obvious connection between CSF pulsatility and the success of ETV surgery.…”

Section: The Intracranial Pulse Wave - Clinical Studiesmentioning

confidence: 99%

The pulsating brain: A review of experimental and clinical studies of intracranial pulsatility

Wagshul

Eide

Madsen

2011

Fluids Barriers CNS

386

311

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The maintenance of adequate blood flow to the brain is critical for normal brain function; cerebral blood flow, its regulation and the effect of alteration in this flow with disease have been studied extensively and are very well understood. This flow is not steady, however; the systolic increase in blood pressure over the cardiac cycle causes regular variations in blood flow into and throughout the brain that are synchronous with the heart beat. Because the brain is contained within the fixed skull, these pulsations in flow and pressure are in turn transferred into brain tissue and all of the fluids contained therein including cerebrospinal fluid. While intracranial pulsatility has not been a primary focus of the clinical community, considerable data have accrued over the last sixty years and new applications are emerging to this day. Investigators have found it a useful marker in certain diseases, particularly in hydrocephalus and traumatic brain injury where large changes in intracranial pressure and in the biomechanical properties of the brain can lead to significant changes in pressure and flow pulsatility. In this work, we review the history of intracranial pulsatility beginning with its discovery and early characterization, consider the specific technologies such as transcranial Doppler and phase contrast MRI used to assess various aspects of brain pulsations, and examine the experimental and clinical studies which have used pulsatility to better understand brain function in health and with disease.

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“…This indicates that the distal CSF pathways beyond the basal cisterns, around the brain stem and cervicomedullary junction, may play an essential role in achieving ETV success in addition to an adequate fenestration. [61] Surgical Technique ETV is performed in supine position with head flexed so that the burr hole site is at the highest point. This also avoids over drainage of CSF and an entry of air in the ventricles and subdural space, especially in large ventriculomegaly.…”

Section: Pre-operative Imaging and Patient Selectionmentioning

confidence: 99%

Endoscopic third ventriculostomy

Yadav

Parihar

Pande

et al. 2012

Journal of Neurosciences in Rural Practice

101

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Endoscopic third ventriculostomy (ETV) is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of long term follow up.

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Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

Cited by 22 publications

References 25 publications

Analysis of Cerebrospinal Fluid Flowmetry in Evaluating the Efficiency of Endoscopic Third Ventriculostomy in Aqueductal Stenosis

Analysis of Cerebrospinal Fluid Flowmetry in Evaluating the Efficiency of Endoscopic Third Ventriculostomy in Aqueductal Stenosis

The pulsating brain: A review of experimental and clinical studies of intracranial pulsatility

Endoscopic third ventriculostomy

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