MRT mit Liquorflussmessung
vor und nach endoskopischer Ventrikulostomie bei Aquäduktstenose

Zusammenfassung.

Ziel: Beurteilung der MRT-Bildgebung und Liquorflussdarstellung zur präoperativen Planung einer endoskopischen Ventrikulostomie bei triventrikulärem Verschlusshydrozephalus auf dem Boden einer idiopathischen oder tumorösen Aquäduktstenose und zur postoperativen Verlaufsbeurteilung. Patienten und Methode: 17 Patienten mit einem triventrikulären Verschlusshydrozephalus wurden vor und nach endoskopischer Ventrikulostomie magnetresonanztomographisch mit einer pulsgetriggerten T₂-gewichteten Turbo-Spin-Echosequenz und einer flusssensitiven Phasenkontrast-Multi-Herzphasen-Sequenz (PCMHP, 16 Bilder/Herzzyklus) untersucht. Diese Untersuchungen wurden hinsichtlich der Beurteilbarkeit der anatomischen Details bzw. der Durchgängigkeit des Ventrikulostomas ausgewertet. Ergebnisse: Bei allen 17 Patienten waren die operationsrelevanten anatomischen Strukturen abgrenzbar. Mit der flusssensitiven Sequenz konnten der Verschluss des Aquädukts und die postoperative Durchgängigkeit des Ventrikulostomas sicher nachgewiesen werden, auch wenn sonstige Merkmale wie z. B. eine Abnahme der Ventrikelweite noch nicht vorlagen. Schlussfolgerungen: Die MRT erlaubt bei triventrikulärem Verschlusshydrozephalus mit pulsgetriggerter T2-Bildgebung und Liquorflussbestimmung eine präoperative Patientenselektion und exakte Planung einer endoskopischen Ventrikulostomie. Postoperativ ist eine nicht invasive Erfolgskontrolle und Verlaufsbeobachtung möglich, die besonders bei nicht eindeutiger Symptomatik wichtig ist.

MR imaging and CSF flow measurement before and after neuroendoscopic third ventriculostomy.

Purpose: Evaluation of MR imaging and CSF flow measurement for planning and follow-up of neuroendoscopic third ventriculostomy in occlusive triventricular hydrocephalus. Method: 17 patients with occlusive hydrocephalus due to idiopathic or neoplastic aqueductal stenosis were examined before and after surgery with cardiac-gated T ₂-weighted and cardiac-gated phase contrast cine sequences. The visibility of anatomic structures and the patency of the ventriculostomy were evaluated. Results: In all 17 patients, the relevant anatomic structures were visible. The cine sequence demonstrated occlusion of the aqueduct and patency of the ventriculostomy in all cases, even in patients with doubtful clinical patterns. Conclusions: MR imaging with additional cardiac-gated cine sequences allows exact preoperative diagnosis of occlusive hydrocephalus as well as patient selection and planning for endoscopic third ventriculostomy. Non-invasive follow-up, especially in patients with a doubtful clinical pattern, is possible.

Verschlusshydrozephalus - triventrikulär; Ventrikulostomie - endoskopisch; MRT - Diagnostik; MRT - Flussmessung; ZNS - Liquor

Brain - Hydrocephalus; brain - Surgery; brain - Endoscopic third ventriculostomy; MR - Imaging; MR - CSF flow measurement

Literatur

• 1 Dandy W. An operative procedure for hydrocephalus.  Johns Hopkins Hosp Bull. 1922;  33 189-190
• 2 Mixter W. Ventriculoscopy and puncture of the floor of the third ventricle.  Boston Med Surg J. 1923;  188 277-278
• 3 Bauer B, Hellwig D. Minimally invasive endoscopic neurosurgery. A survey.  Acta Neurochir (Wien) Suppl. 1994;  61 1-12
• 4 Brockmeyer D, Abtin K, Carey L, Walker M. Endoscopic third ventriculostomy: An outcome analysis.  Pediatr Neurosurg. 1998;  28 236-240
• 5 Gangemi M, Donati P, Maiuri F, Longatti P, Godano U, Mascari C. Endoscopic third ventriculostomy for hydrocephalus.  Minim Invas Neurosurg. 1999;  42 128-132
• 6 Goumnerova L, Frim D. Treatment of hydrocephalus with third ventriculocisternostomy Outcome and CSF flow patterns.  Pediatr Neurosurg. 1997;  27 149-152
• 7 Grant J, McLone D. Third ventriculostomy. A review.  Surg Neurol. 1997;  47 210-212
• 8 Hopf N, Grunert P, Fries G, Resch K, Perneczky A. Endoscopic third ventriculostomy: Outcome analysis of 100 consecutive procedures.  Neurosurgery. 1999;  44 795-806
• 9 Kunz U, Goldmann A, Bader C, Waldbaur H, Oldenkott P. Endoscopic fenestration of the third ventricular floor in aquaeductal stenosis.  Minim Invas Neurosurg. 1994;  37 42-47
• 10 Sainte-Rose C, Chumas P. Endoscopic third ventriculostomy techniques.  Neurosurgery. 1996;  1 176-184
• 11 Teo C. Third ventriculostomy in the treatment of hydrocephalus: Experience with more than 120 cases.  In: Hellwig D, Bauer BL (eds) Minimally Invasive Techniques for Neurosurgery. Berlin, Heidelberg: Springer Verlag 1998: 73-76
• 12 Tuli S, Alshail E, Drake J. Third ventriculostomy versus cerebrospinal fluid shunt as a first procedure in pediatric hydrocephalus.  Pediatr Neurosurg. 1999;  30 11-15
• 13 Jones R, Kwok B, Stening W, Vonau M. The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus.  Minim Invas Neurosurg. 1994;  37 28-36
• 14 Bhadelia R, Bogdan A, Wolpert S. Analysis of cerebrospinal fluid flow waveforms with gated phase-contrast MR velocity measurements.  Am J Neuroradiol. 1995;  16 389-400
• 15 Enzmann D, Pelc N. Cerebrospinal fluid flow measured by phase-contrast cine MR.  Am J Neuroradiol. 1993;  14 1301-1307 discussion 1309 - 1310
• 16 Atlas S, Mark A, Fram F. Aquaeductal stenosis: Evaluation with gradient-echo rapid MR imaging.  Radiology. 1998;  169 449-553
• 17 Enzmann D, Pelc N. Normal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase-contrast cine MR imaging.  Radiology. 1991;  178 467-474
• 18 Gideon P, Thomsen C, Stählberg F, Henriksen O. Cerebrospinal fluid production and dynamics in normal aging. A MRI phase-mapping study.  Acta Neurologica Scandinavica. 1994;  89 362-366
• 19 Quencer R, Post M, Hinks R. Cine mr in the evaluation of normal and abnormal CSF flow: intracranial and intraspinal studies.  Neuroradiology. 1990;  32 371-391
• 20 Gutberlet M, Venz S, Kahl A, Ehrenstein T, Puls R, Hosten N, Frei U, Felix R. Blood flow quantification in hemodialysis shunts by phase contrast magnetic resonance angiography (PC-MRA) compared with duplex sonography.  Fortschr Röntgenstr. 1998;  169 163-169
• 21 Reimer P, Wilhelm M, Lentschig M, Wortler K, Marx C, Allkemper T, Boettger U, Heinecke A, Rummeny E, Peters P. Combined use of ECG-triggered 2D-phase contrast MR angiography and 2D-time-of-flight MR angiography for planning and follow up before and after vascular intervention of pelvic and leg arteries.  Fortschr Röntgenstr. 1998;  168 243-249
• 22 Teo C, Rahmann S, Boop F, Cherky B. Complications of endoscopic neurosurgery.  Child's Nerv Syst. 1996;  12 248-253
• 23 Tisell M, Almstrom O, Stephensen H, Tullberg M, Wikkelso C. How effective is endoscopic third ventriculostomy in treating adult hydrocephalus caused by primary aquaeductal stenosis? Neurosurgery.  2000;  46 104-110
• 24 Hyman R, Gorey M. Imaging strategies for MR of the brain.  Radiol Clin North Am. 1988;  26 471-503
• 25 Tamaki N, Nagashima T, Ehara K, Shirakuni T, Matsumoto S. Hydrocephalic oedema in normal-pressure hydrocephalus.  Acta Neurochir Suppl (Wien). 1990;  51 348-350
• 26 Jack C R, Mokri B, Laws E R, Houser O W, Baker H L, Petersen R C. MR findings in normal-pressure hydrocephalus: significance and comparison with other forms of dementia.  J Comput Assist Tomogr. 1987;  11 923-931
• 27 Tanna N, Kohn M, Horwich D, Jolles P, Zimmermann R, Alves W, Alavi A. Analysis of brain and cerebrospinal fluid volumes with MR imaging impact on PET data correction for atrophy. Part II. Aging and Alzheimer dementia.  Radiology. 1991;  178 123-130
• 28 Ciraolo L, Mascalchi M, Bucciolini M, Dal Pozzo G. Fast multiphase MR imaging of aquaeductal CSF flow: 1. Study of healthy subjects.  Am J Neuroradiol. 1990;  11 589-596
• 29 Mascalchi M, Ciraolo L, Bucciolini M, Intizari D, Arnetoli G, Dal Pozzo G. Fast multiphase MR imaging of aqueductal CSF flow: 2. Study in patients with hydrocephalus.  Am J Neuroradiol. 1990;  11 597-603
• 30 Schroth G, Klose U. Cerebrospinal fluid flow. I. Physiology of cardiac-related pulsation.  Neuroradiology. 1992;  35 1-9
• 31 Schroth G, Klose U. Cerebrospinal fluid flow: II. Pathological cerebrospinal fluid pulsations.  Neuroradiology. 1992;  35 16-24
• 32 Schroth G, Klose U. Cerebrospinal fluid flow: III. Physiology of respiration-related pulsation.  Neuroradiology. 1992;  35 10-15
• 33 Naidich T, Altman N, Gonzales-Arias S. Phase contrast cine magnetic resonance imaging: Normal cerebrospinal fluid oscillation and applications to hydrocephalus.  Neurosurg Clin N Am. 1993;  4 677-705
• 34 Nitz W, Bradley W, Watanabe A, Lee R, Burgoyne B, O'Sullivan R, Herbst M. Flow dynamics of cerebrospinal fluid: Assessment with phase-contrast velocity MR imaging performed with retrospec-tive cardiac gating.  Radiology. 1992;  183 395-405
• 35 Curless R, Quencer R, Katz D, Campanione M. Magnetic resonance demonstration of intracranial CSF flow in children.  Neurology. 1992;  42 377-381
• 36 Kohn M, Tanna N, Herman G, Resnick S, Mozley P, Gur R, Alavi A, Zimmerman R, Gur R. Analysis of brain and cerebrospinal fluid volumes with MR imaging. Part I. Methods, reliability, and validation.  Radiology. 1991;  178 115-122
• 37 Maeder P, Gudinchet F, Meuli R, Frankhauser H. Dynamic MRI of cerebrospinal fluid flow in endoscopic percutaneous ventriculostomy.  Br J Neurosurg. 1998;  12 18-20
• 38 Parkkola R, Komu M, Kotilainen E, Valtonen S, Thomsen C, Gideon P. Cerebrospinal fluid flow in patients with dilated ventricles studied with MR imaging.  Eur Radiol. 2000;  10 1442-1446
• 39 Schroeder H, Schweim C, Schweim K, Gaab M. Analysis of aqueductal cerebrospinal fluid flow after endoscopic aqueductoplasty by using cine phase-contrast magnetic resonance imaging.  J Neurosurg. 2000;  93 237-244
• 40 Oka K, Go Y, Kin Y, Utsunomiya H, Tomonaga M. The radiographic restoration of the ventricular system after third ventriculostomy.  Minim Invas Neurosurg. 1995;  38 158-162
• 41 Kulkarni A, Drake J, Armstrong D, Dirks P. Imaging correlates of successful endosopic third ventriculostomy.  J Neurosurg. 2000;  92 915-919
• 42 Wilcock D, Jaspan T, Worthington B, Punt J. Neuro-endoscopic third ventriculostomy: evaluation with magnetic resonance imaging.  Clin Radiol. 1997;  52 50-54
• 43 Wilcock D, Jaspan T, Punt J. CSF flow through third ventriculostomy demonstrated with colour Doppler ultrasonography.  Clin Radiol. 1996;  51 127-129
• 44 Brinkmann G, Harlandt O, Muhle C, Brossmann J, Heller M. Flussquantifizierung mit der Magnetresonanz-Tomographie: Eine experimentelle Studie an einem Flussmodell und Liquorflussmessungen im Aquaeductus cerebri bei Probanden.  Fortschr Röntgenstr. 2000;  172 1043-1051
• 45 Barkhof F, Kouwenhoven M, Scheltens P, Sprenger M, Algra P, Valk J. Phase-contrast cine MR imaging of normal aqueductal CSF flow. Effect of aging and relation to CSF void on modulus MR.  Acta Radiol. 1994;  35 123-130
• 46 Thomsen C, Ståhlberg F, Stubgaard M, Nordell B, Group  TSF. Fourrier analysis of cerebrospinal fluid flow velocities - MR imaging study.  Radiology. 1990;  177 659-665
• 47 Enzmann D, Pelc N. Cerebrospinal fluid flow measurement by phase-contrast cine mr.  American Journal of Neuroradiology. 1994;  14 1301-1307