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Published on: October 14, 2022
Role of magnetic resonance ventriculography in multiloculated hydrocephalus
Gurpreet S Gandhoke1, Paolo Frassanito, Nagesh Chandra
1Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India. gurpreet.gandhoke@gmail.com
Insights
Gd-enhanced MR ventriculography (MRV) is a safe and effective tool for diagnosing pediatric multiloculated hydrocephalus. This imaging technique accurately visualizes ventricular anatomy and obstructions, aiding treatment planning and postoperative assessment.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Neurosurgery
Background:
- Multiloculated hydrocephalus presents complex anatomical challenges in pediatric patients.
- Accurate visualization of intraventricular septations and CSF flow pathways is crucial for effective treatment planning.
Purpose of the Study:
- To evaluate the clinical utility of gadolinium-enhanced MR ventriculography (MRV) in pediatric patients with multiloculated hydrocephalus.
- To assess the safety and diagnostic accuracy of MRV in defining ventricular morphology and obstruction sites.
Main Methods:
- Eighteen pediatric patients with multiloculated hydrocephalus underwent MRV after intraventricular gadodiamide injection.
- T1-weighted sagittal, coronal, and axial images were acquired to assess septations and CSF flow.
- Postoperative MRV was performed in select cases to evaluate endoscopic treatment outcomes.
Main Results:
- MRV demonstrated high accuracy in defining septae and ventricular walls, aiding in diagnosis and ruling out cases.
- Obstruction sites and intercommunication between compartments were clearly identified.
- No adverse events were reported following contrast administration.
Conclusions:
- Gd-enhanced MRV is a safe, effective, and reliable imaging modality for pediatric multiloculated hydrocephalus.
- Accurate anatomical definition facilitates optimal treatment planning and potentially reduces the need for repeat procedures.
- MRV is valuable for postoperative assessment of endoscopic interventions, particularly in complex cases.
Object:
In this paper the authors' goal was to investigate the clinical usefulness of Gd-enhanced MR ventriculography (MRV) in pediatric patients affected by multiloculated hydrocephalus.
Methods:
Eighteen patients (11 boys and 7 girls, age range 2-14 months) with a diagnosis of multiloculated hydrocephalus were included in the study. After injection of gadodiamide (0.02-0.04 mmol) into the lateral ventricle by tapping the anterior fontanel, sagittal, coronal, and axial T1-weighted MR images were acquired. The location of the septations and the sites of obstruction of CSF flow were assessed. Postoperative MRV was obtained to confirm the results of endoscopic treatment in most complex cases.
Results:
No adverse events were observed after injection of contrast medium into the ventricular system. Preoperative MRV accurately defined the exact morphology of septae and ventricular walls in all cases. In 1 case the diagnosis of multiloculated hydrocephalus was ruled out. Sites of obstruction of CSF flow within the ventricular system were also well established. In 4 cases the multiple compartments were proven to intercommunicate. Postoperative MRV was useful in assessing the functional status of third ventriculostomy, aqueductoplasty, and other endoscopic fenestrations.
Conclusions:
Magnetic resonance ventriculography is a safe, effective, and reliable technique. The accurate definition of the anatomy of the ventricles and the site of obstruction in multiloculated hydrocephalus can help to plan the most appropriate treatment and minimize the number of procedures. Although MRV is also useful during postoperative follow-up to determine the results of endoscopic treatment, it should be limited to particularly complex cases, due to its invasiveness.
