Diffusion and Flow MR Imaging to Investigate Hydrocephalus Patients Before and After Endoscopic Third Ventriculostomy

In patients with noncommunicating hydrocephalus, dilation of the ventricles stresses white matter fibers and alters the cerebral blood flow (CBF) and cerebrospinal fluid (CSF) dynamics. The purpose of this work was to investigate, non-invasively, how endoscopic third ventriculostomy (ETV) impacts white matter, CSF oscillations, and CBF.

Eleven patients presenting with chronic headaches and noncommunicating hydrocephalus due to aqueductal stenosis were treated by ETV. Phase Contrast-MRI (PCMRI) and Diffusion Tensor Imaging (DTI) were performed before and after surgery to evaluate CSF and CBF as well as white matter stresses in the Corpus Callosum (CC) and Corona Radiata (CR). ETV success was confirmed by quantification of the CSF oscillations through the aperture in the third ventricle.

All patients improved after surgery. CSF stroke volume was five times greater than normal ventricular stroke volume. Decrease in cervical CSF oscillations and increase in CBF were observed after ETV. In CR, fiber anisotropy decreased, while water diffusion increased. In CC, anisotropy did not vary, while water diffusion also increased.

Even if static ICP typically do not increase, CSF and blood flow are impacted. PCMRI and DTI can provide useful information to help neurosurgeons select patients with good chance to improve after ETV.