Third ventriculostomy, phase-contrast cine MRI and endoscopic techniques

Endoscopic third ventriculostomy has become an increasingly popular procedure. This is mainly due to the improvement of the endoscopes. The progress in imaging techniques and Phase-Contrast Cine MRI in particular offers a reliable method of pre-and post-operative assessment of the patients. Two endoscopes, NeuroPEN and Channel Neuroendoscope (Medtronic PS Medical, CA, USA) have been evaluated in our center for third ventriculostomy. These instruments are light, have a good maneuverability and are disposable. The illumination and the quality of the image are excellent. We have performed Phase-Contrast Cine MRI pre-operatively and post-operatively for our patients. It offers a good assessment of the patency of the ventriculostomy and the fluid dynamics of the CSF pathways. Endoscopic third ventriculostomy is the technique of choice for the treatment of obstructive hydrocephalus. This is mainly due to two points: The progress in the endoscopic instrumentation (namely the reduction in size of endoscopes and introduction of disposable models), and the establishment of Phase-Contrast Cine MRI as the gold standard method for the pre- and post-operative evaluation of the CSF dynamics. However, to date, no technique can show the patency of the subarachnoid space, which is the most important predictive factor of surgical outcome.