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Changes of third ventricle diameter (TVD) mirror changes of the entire ventricular system after initial therapy and
Susanne R Kerscher1, Louise L Schweizer2, Thomas Nägele3
1Department of Neurosurgery, Pediatric Neurosurgery, University Hospital of Tuebingen, Germany; Department of Neurosurgery, University Hospital of Tuebingen, Germany.
Insights
Measuring the third ventricle diameter (TVD) offers a radiation-free method to monitor pediatric hydrocephalus. Changes in TVD reliably reflect overall ventricular system changes, aiding treatment assessment.
Area of Science:
- Pediatric Neurosurgery
- Medical Imaging
- Hydrocephalus Management
Background:
- Regular monitoring of ventricular size is crucial for managing pediatric hydrocephalus.
- Current methods like MRI/CT involve anesthesia risks and radiation exposure.
- Ultrasound offers a potential radiation-free alternative for assessing ventricular size.
Purpose of the Study:
- To evaluate if third ventricle diameter (TVD) changes correlate with overall ventricular system changes in pediatric hydrocephalus.
- To assess TVD as a potential surrogate for monitoring ventricular size during hydrocephalus treatment.
Main Methods:
- Retrospective analysis of MRI/CT scans from 117 children with hydrocephalus.
- Measurements included axial TVD and standard lateral ventricular indices (Evans Index, FOHR Index, CMI).
- Correlation analysis was performed between TVD changes and ventricular indices before, during, and after treatment.
Main Results:
- Relative changes in TVD significantly correlated with relative changes in all measured ventricular indices (EI, FOHR, CMI).
- Intra-subject correlations between TVD and ventricular indices were outstanding (r > 0.98).
- These correlations were independent of patient age, hydrocephalus etiology, and ventricular width.
Conclusions:
- Third ventricle diameter (TVD) is a reliable indicator of ventricular system size changes in pediatric hydrocephalus.
- TVD measurement via ultrasound presents a feasible, radiation-free alternative for monitoring hydrocephalus.
- This method can aid in assessing treatment effectiveness and disease progression.
Purpose:
Regular measurement of ventricular size is important in children with hydrocephalus. After closure of the fontanelle this is currently addressed by repetitive cranial MRI or CT imaging, coming along with risks of anaesthesia or radiation. As the third ventricle is accessible via the temporal bone window using ultrasound, determination of its diameter might be an easy and radiation-free alternative to assess the ventricular system. An essential precondition is that changes of the third ventricle diameter (TVD) mirror changes of the whole ventricular system. This study compares changes of TVD with changes of ventricular indices before and after initial treatment of hydrocephalus and during the following evolution.
Methods:
MRT/CT images from 117 children with hydrocephalus were evaluated at time of diagnosis, after initial therapy and during follow-up with functional shunts. Measurements included axial TVD and three standard linear measures of the lateral ventricles (Evans Index - EI, fronto-occipital horn ratio - FOHR Index, and Cella Media Index - CMI). Furthermore, a correlation within subjects was calculated in 8 patients over the entire available follow-up.
Results:
Relative changes of TVD were significantly correlated to relative changes of all ventricular indices (r = 0.48, r = 0.68 and r = 0.701 for EI, FOHR and CMI, respectively, p < 0.01). The correlation within subjects was outstanding for EI (r = 0.988), FOHR (r = 0.99) and CMI (r = 0.99).
Conclusion:
TVD showed a significant correlation with all three linear indices at the time of diagnosis and during follow-up changes independently of age, aetiology and ventricular width. TVD and its changes are therefore a reliable surrogate of changes in ventricular size in pediatric hydrocephalus undergoing treatment.
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