[Lumbar cisternography in the evaluation of hydrocephalus in premature infants]

Radionuclide lumbar cisternography with 111In-DTPA was utilized as a bedside procedure to evaluate CSF dynamics and the patency of the ventricular system in 29 preterm infants with hydrocephalus. Serial images of the brain were obtained at 0, 1, 2, 6, 24 and 48 hours after instillation of the isotope in the lumbar subarachnoid space. Three distinct patterns were seen. Infants with posthemorrhagic hydrocephalus displayed prompt ventricular filling but markedly delayed emptying with minimal flow over the cerebral convexities. Infants with ventriculomegaly secondary to suspected brain atrophy or periventricular leukomalacia demonstrated a pattern of prompt ventricular filling, delayed emptying, but with flow present over the convexities. An infant with noncommunicating hydrocephalus secondary to an Arnold-Chiari malformation showed a pattern of complete obstruction with no ventricular filling. Radionuclide lumbar cisternography appears to be a safe, well-tolerated procedure which produces images of sufficient resolution to provide valuable information about CSF dynamics, delineating basal cisternae, ventricles, and subarachnoid flow paths.