Extraventricular Intracisternal Obstructive Hydrocephalus – A Hypothesis to Explain Successful 3rd Ventriculostomy in Communicating Hydrocephalus

Kehler, Uwe; Gliemroth, Jan

doi:10.1159/000068053

Cited by 79 publications

(44 citation statements)

References 13 publications

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“…Although this assumption seems to be against traditional concept, a few case reports have been published with only 1 exit foramen of the fourth ventricle obstructed, causing tetraventricular hydrocephalus and responding to surgery. [23][24][25][26][27][28][29][30][31][32] These results overlap with observation in our large study cohort. The second step was the acquisition of the 3D-CISS sequence to determine whether there was obstructing membrane either within or outside the ventricular system.…”

Section: Mr Evaluationsupporting

confidence: 89%

“…The membranes that obscured only the cisterns (ie, interpeduncular, prepontine, and premedullary) were defined as communicating hydrocephalus with cisternal obstruction. [22][23][24] The hydrocephalus was categorized as noncommunicating, even if one of the fourth ventricular outlets appeared obstructed while the others were patent. Although this assumption seems to be against traditional concept, a few case reports have been published with only 1 exit foramen of the fourth ventricle obstructed, causing tetraventricular hydrocephalus and responding to surgery.…”

Section: Mr Evaluationmentioning

confidence: 99%

See 1 more Smart Citation

Is All “Communicating” Hydrocephalus Really Communicating? Prospective Study on the Value of 3D-Constructive Interference in Steady State Sequence at 3T

Di̇nçer¹,

Kohan²,

Özek³

2009

AJNR Am J Neuroradiol

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Section: Mr Evaluationsupporting

confidence: 89%

Section: Mr Evaluationmentioning

confidence: 99%

Is All “Communicating” Hydrocephalus Really Communicating? Prospective Study on the Value of 3D-Constructive Interference in Steady State Sequence at 3T

Di̇nçer¹,

Kohan²,

Özek³

2009

AJNR Am J Neuroradiol

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“…Kehler et al showed that downward bulging third ventricular floors are associated with effectiveness of ETV treatment in cases of communicating hydrocephalus. 19 Bulging reflects the pressure gradient between the third ventricle and interpeduncular/prepontine cisterns. 20 In our patients, many with bulging third ventricular floors had prepontine membranes.…”

Section: Discussionmentioning

confidence: 99%

Panventriculomegaly with a wide foramen of Magendie and large cisterna magna

Kageyama

Miyajima

Ogino

et al. 2016

JNS

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C ertain congenital anomalies of adult-onset hydrocephalus share clinical symptoms with idiopathic normal pressure hydrocephalus (iNPH), such as long-standing overt ventriculomegaly, aqueductal stenosis, 29 and Blake's pouch cyst. 8 However, no disease-associated gene mutations have been identified, including those responsible for these congenital diseases. Moreover, although L1CAM mutations can cause aqueductal stenosis, patients carrying these mutations have clinical features different from patients with NPH. obJective The authors' goal in this paper is to provide the first clinical, radiological, and genetic studies of panventriculomegaly (PaVM) defined by a wide foramen of Magendie and large cisterna magna. methods Clinical and brain imaging data from 28 PaVM patients (including 10 patients from 5 families) were retrospectively studied. Five children were included. In adult patients, the age at onset was 56.0 ± 16.7 years. Tetraventricular dilation, aqueductal opening with flow void on T2-weighted images, and a wide foramen of Magendie and large cisterna magna (wide cerebrospinal fluid space at the fourth ventricle outlet) were essential MRI findings for PaVM diagnosis. 3D fast asymmetrical spin echo sequences were used for visualization of cistern membranes. Time-spatial labeling inversion pulse examination was performed to analyze cerebrospinal fluid movement. Copy number variations were determined using high-resolution microarray and were validated by quantitative polymerase chain reaction with breakpoint sequencing. results Adult patients showed gait disturbance, urinary dysfunction, and cognitive dysfunction. Five infant patients exhibited macrocranium. Patients were divided into 2 subcategories, those with or without downward bulging third ventricular floors and membranous structures in the prepontine cistern. Patients with bulging floors were successfully treated with endoscopic third ventriculostomy. Genetic analysis revealed a deletion in DNAH14 that encodes a dynein heavy chain protein associated with motile cilia function, and which co-segregated with patients in a family without a downward bulging third ventricular floor. coNclusioNs Panventriculomegaly with a wide foramen of Magendie and a large cisterna magna may belong to a subtype of congenital hydrocephalus with familial accumulation, younger age at onset, and symptoms of normal pressure hydrocephalus. In addition, a family with PaVM has a gene mutation associated with dysfunction of motile cilia.

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“…Therefore, it has been hypothesized that intact cistern flows around the brain stem and CMJ are essential to achieve ETV success. 20 Physiologically, the CSF that exits from the foramen of Magendie is directed to the cisterna magna. From the cisterna magna, the CSF travels superiorly into the subarachnoid space over the cerebellar hemispheres, and caudally into the spinal subarachnoid space and cephalad into the premedullary, prepontine, and interpenduncular cisterns.…”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23] Those CSF absorption devices declined possibly due to lengthy intracranial hypertension, especially in the patient with CSF diversion. 17,20,24 In other words, the previous ETV-treated OHCP might already coexist with "communicating HCP" due to the decrease in CSF absorption even before initial ETV.…”

Section: Discussionmentioning

confidence: 99%

Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

Xiao

Ragab

Luciano

2009

Can. j. neurol. sci.

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Endoscopic third ventriculostomy (ETV) has been a popular surgical option for obstructive hydrocephalus (OHCP) in recent decades. [1][2][3] A number of studies worldwide have reported favorable outcomes; 4-6 however, in some cases, ETV fails to resolve symptoms, even when it is technically successful with adequate patent stoma and fenestrated Lillequist membrane. [7][8][9][10][11] It has been hypothesized that patients might suffer from hydrocephalus caused by other obstructive membranes or by fibrosis in the subarachnoid space, especially around basal cisterns. Cine phase-contrast magnetic resonance imaging (PC MR) has been utilized as a method of distinguishing between ABSTRACT: Background: To predict success of endoscopic third ventriculostomy (ETV) in patients with obstructive hydrocephalus, we evaluated pre-and post-operative phase-contrast cine magnetic resonance images (PC MRI) on cerebrospinal fluid (CSF), cine flow in basal cisterns around the brain stem, and cervical medullar junction (CMJ) retrospectively. Methods: The study involved 102 patients with mean age of 36.74±23.25, and F/M = 1.55. All patients had PC MRI taken both pre-and post-operatively. A dynamic MRI video of PC MRI was reviewed at sagittal, axial, and coronal sections to determine cistern flows around the brain stem and CMJ. For quantitative analysis, quadrants were divided around midbrain axially to evaluate interpeduncular, quadrageminal, and ambient cisterns of both sides using scores of 0 to 60. Pre-and post-pontine and CMJ flows were shown in sagittal view and scored 0 to 20, and lateral cerebellopontine cisterns of both sides were measured on coronal image and scored 0 to 20. Results: No significant difference in CSF flow was seen from three individual views and total cine score, or between ETV success and failure groups by multivariate analysis of variance. Kaplan-Meier Analysis and Spearman's Correlation Test produced no relationship between MRI cine flow scores and interval period after surgery to ETV failure. Conclusion: PC MRI cine flow failed to demonstrate significant differences between successful and failed ETV groups. This indicates in addition to achieving an adequate fenestration, CSF pathways beyond the basal cisterns around the brain stem and CMJ may play an essential role in achieving ETV success. Aucune différence significative du flux du LCR n'a été observée sur trois clichés individuels et l'analyse de variance multivariée n'a décelé aucune différence significative du score ciné total ou entre les groupes dont la VET a été un succès ou un échec. Le test de Kaplan-Meier et le test de corrélation de Spearman n'ont pas montré de relation entre les scores du flux au ciné IRM et l'intervalle entre la chirurgie ou entre les scores et l'échec de la VET. Conclusion : Le ciné IRM CP du flux n'a pas montré de différence significative entre le groupe dont la VET a été un succès et le groupe dont la VET a été un échec. Ceci indique qu'en plus de réussir à établir une fenestration adéquate, les voies du LCR au-delà des citer...

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Extraventricular Intracisternal Obstructive Hydrocephalus – A Hypothesis to Explain Successful 3rd Ventriculostomy in Communicating Hydrocephalus

Cited by 79 publications

References 13 publications

Is All “Communicating” Hydrocephalus Really Communicating? Prospective Study on the Value of 3D-Constructive Interference in Steady State Sequence at 3T

Is All “Communicating” Hydrocephalus Really Communicating? Prospective Study on the Value of 3D-Constructive Interference in Steady State Sequence at 3T

Panventriculomegaly with a wide foramen of Magendie and large cisterna magna

Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

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