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Endoscopic third ventriculostomy: predicting outcome with phase-contrast MR imaging.

Stavros M Stivaros1, Deborah Sinclair, Paul A Bromiley

  • 1Department of Imaging Science, Wolfson Molecular Imaging Centre, University of Manchester, 27 Palatine Rd, Withington, Manchester M20 3LJ, England. stavros.stivaros@postgrad.manchester.ac.uk

Radiology
|July 10, 2009
PubMed
Summary

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Phase-contrast MRI measures of cerebral blood flow and cerebrospinal fluid dynamics can predict response to endoscopic third ventriculostomy (ETV). These simple metrics show potential as biomarkers for ETV success in hydrocephalus patients.

Area of Science:

  • Neurosurgery
  • Radiology
  • Medical Imaging

Background:

  • Hydrocephalus is a condition characterized by abnormal accumulation of cerebrospinal fluid (CSF) within the brain's ventricles.
  • Endoscopic third ventriculostomy (ETV) is a surgical procedure to treat hydrocephalus by creating an opening in the floor of the third ventricle.
  • Predicting the success of ETV is crucial for patient management and outcomes.

Purpose of the Study:

  • To evaluate phase-contrast magnetic resonance (MR) imaging metrics of preoperative cerebral blood flow (CBF) and CSF hydrodynamics.
  • To determine if these MR imaging metrics can serve as biomarkers for predicting response to ETV in patients with hydrocephalus.

Main Methods:

  • A prospective study involving 13 patients with obstructive hydrocephalus undergoing ETV and 10 healthy control subjects.

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  • Phase-contrast MR imaging at 1.5 T was used to measure CBF and CSF flow rates at the ventriculostomy defect, foramen magnum (FM), and cerebral aqueduct.
  • Statistical analysis included Pearson correlation coefficients, Mann-Whitney tests, and Wilcoxon signed-rank tests.

    • Main Results:

    • Patients with hydrocephalus exhibited significantly lower CBF rates (356 mL/min vs. 518 mL/min, P < .001) compared to control subjects.
    • CSF flow rates at the foramen magnum were also significantly lower in patients (17.62 mL/min vs. 36.35 mL/min, P < .05).
    • These preoperative hydrodynamic measurements showed potential for predicting ETV outcomes.

    Conclusions:

    • Endoscopic third ventriculostomy (ETV) leads to measurable changes in brain volume and CBF.
    • Preoperative phase-contrast MR imaging metrics of CBF and CSF hydrodynamics can predict these changes and serve as potential biomarkers for ETV response.
    • These findings support further investigation in larger prospective studies to validate these techniques.