Why does endoscopic aqueductoplasty fail so frequently? Analysis of cerebrospinal fluid flow after endoscopic third ventriculostomy and aqueductoplasty using cine phase-contrast magnetic resonance imaging
The aim of this study was to evaluate and compare CSF flow after endoscopic third ventriculostomy (ETV) and endoscopic aqueductoplasty (EAP) in patients presenting with obstructive hydrocephalus caused by aqueductal stenosis. In patients harboring aqueductal stenosis who underwent EAP (n=8), ETV (n=...
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| Veröffentlicht in: | Journal of neurosurgery 2012-07, Vol.117 (1), p.141-149 |
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| creator | Schroeder, Christiane Fleck, Steffen Gaab, Michael R Schweim, Klaus H Schroeder, Henry W S |
| description | The aim of this study was to evaluate and compare CSF flow after endoscopic third ventriculostomy (ETV) and endoscopic aqueductoplasty (EAP) in patients presenting with obstructive hydrocephalus caused by aqueductal stenosis.
In patients harboring aqueductal stenosis who underwent EAP (n=8), ETV (n=8), and both ETV and EAP (n=6), CSF flow through the restored aqueduct and through the ventriculostomy was investigated using cine cardiac-gated phase-contrast MRI. For qualitative evaluation of CSF flow, an in-plane phase-contrast sequence in the midsagittal plane was used. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct and/or floor of the third ventricle.
Evaluation revealed significantly higher CSF flow through the ventriculostomies compared with flow through the aqueducts. This was true both when comparing the ETV group with the EAP group and when comparing the flow of the ventriculostomy and aqueduct within the ETV and EAP group. There was no difference in aqueductal CSF flow between patients who underwent EAP alone and patients who underwent ETV and EAP. There was also no difference in ventriculostomy CSF flow between patients who underwent ETV alone and patients who underwent ETV and EAP. Fifty percent of the restored aqueducts became occluded at a mean of 46 months after surgery (range 18-126 months). In contrast, all ETVs remained patent in the mean follow-up period of 110 months after surgery, although 1 patient required shunt placement after 66 months.
Cerebrospinal fluid flow through ventriculostomies is significantly higher than aqueductal CSF flow after EAP. This could be one factor to explain why the reclosure rate of aqueducts after EAP is higher than the reclosure rate of the ventriculostoma after ETV. |
| doi_str_mv | 10.3171/2012.3.JNS111926 |
| format | Article |
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In patients harboring aqueductal stenosis who underwent EAP (n=8), ETV (n=8), and both ETV and EAP (n=6), CSF flow through the restored aqueduct and through the ventriculostomy was investigated using cine cardiac-gated phase-contrast MRI. For qualitative evaluation of CSF flow, an in-plane phase-contrast sequence in the midsagittal plane was used. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct and/or floor of the third ventricle.
Evaluation revealed significantly higher CSF flow through the ventriculostomies compared with flow through the aqueducts. This was true both when comparing the ETV group with the EAP group and when comparing the flow of the ventriculostomy and aqueduct within the ETV and EAP group. There was no difference in aqueductal CSF flow between patients who underwent EAP alone and patients who underwent ETV and EAP. There was also no difference in ventriculostomy CSF flow between patients who underwent ETV alone and patients who underwent ETV and EAP. Fifty percent of the restored aqueducts became occluded at a mean of 46 months after surgery (range 18-126 months). In contrast, all ETVs remained patent in the mean follow-up period of 110 months after surgery, although 1 patient required shunt placement after 66 months.
Cerebrospinal fluid flow through ventriculostomies is significantly higher than aqueductal CSF flow after EAP. This could be one factor to explain why the reclosure rate of aqueducts after EAP is higher than the reclosure rate of the ventriculostoma after ETV.</description><identifier>EISSN: 1933-0693</identifier><identifier>DOI: 10.3171/2012.3.JNS111926</identifier><identifier>PMID: 22577744</identifier><language>eng</language><publisher>United States</publisher><subject>Adolescent ; Adult ; Cerebral Aqueduct - pathology ; Cerebral Aqueduct - surgery ; Cerebral Ventricles - surgery ; Constriction, Pathologic ; Endoscopy - adverse effects ; Endoscopy - methods ; Female ; Follow-Up Studies ; Humans ; Hydrocephalus - cerebrospinal fluid ; Hydrocephalus - surgery ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Neurosurgical Procedures - adverse effects ; Neurosurgical Procedures - methods ; Third Ventricle - surgery ; Treatment Failure ; Ventriculostomy - adverse effects ; Young Adult</subject><ispartof>Journal of neurosurgery, 2012-07, Vol.117 (1), p.141-149</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1694-c109a4e190ffc764efd5d11a748b73ad66a14d3b27bad80feccba9ff6d2fd2e43</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22577744$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schroeder, Christiane</creatorcontrib><creatorcontrib>Fleck, Steffen</creatorcontrib><creatorcontrib>Gaab, Michael R</creatorcontrib><creatorcontrib>Schweim, Klaus H</creatorcontrib><creatorcontrib>Schroeder, Henry W S</creatorcontrib><title>Why does endoscopic aqueductoplasty fail so frequently? Analysis of cerebrospinal fluid flow after endoscopic third ventriculostomy and aqueductoplasty using cine phase-contrast magnetic resonance imaging</title><title>Journal of neurosurgery</title><addtitle>J Neurosurg</addtitle><description>The aim of this study was to evaluate and compare CSF flow after endoscopic third ventriculostomy (ETV) and endoscopic aqueductoplasty (EAP) in patients presenting with obstructive hydrocephalus caused by aqueductal stenosis.
In patients harboring aqueductal stenosis who underwent EAP (n=8), ETV (n=8), and both ETV and EAP (n=6), CSF flow through the restored aqueduct and through the ventriculostomy was investigated using cine cardiac-gated phase-contrast MRI. For qualitative evaluation of CSF flow, an in-plane phase-contrast sequence in the midsagittal plane was used. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct and/or floor of the third ventricle.
Evaluation revealed significantly higher CSF flow through the ventriculostomies compared with flow through the aqueducts. This was true both when comparing the ETV group with the EAP group and when comparing the flow of the ventriculostomy and aqueduct within the ETV and EAP group. There was no difference in aqueductal CSF flow between patients who underwent EAP alone and patients who underwent ETV and EAP. There was also no difference in ventriculostomy CSF flow between patients who underwent ETV alone and patients who underwent ETV and EAP. Fifty percent of the restored aqueducts became occluded at a mean of 46 months after surgery (range 18-126 months). In contrast, all ETVs remained patent in the mean follow-up period of 110 months after surgery, although 1 patient required shunt placement after 66 months.
Cerebrospinal fluid flow through ventriculostomies is significantly higher than aqueductal CSF flow after EAP. This could be one factor to explain why the reclosure rate of aqueducts after EAP is higher than the reclosure rate of the ventriculostoma after ETV.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Cerebral Aqueduct - pathology</subject><subject>Cerebral Aqueduct - surgery</subject><subject>Cerebral Ventricles - surgery</subject><subject>Constriction, Pathologic</subject><subject>Endoscopy - adverse effects</subject><subject>Endoscopy - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hydrocephalus - cerebrospinal fluid</subject><subject>Hydrocephalus - surgery</subject><subject>Image Processing, Computer-Assisted</subject><subject>Magnetic Resonance Imaging, Cine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neurosurgical Procedures - adverse effects</subject><subject>Neurosurgical Procedures - methods</subject><subject>Third Ventricle - surgery</subject><subject>Treatment Failure</subject><subject>Ventriculostomy - adverse effects</subject><subject>Young Adult</subject><issn>1933-0693</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplUU1rVTEQDYLYWt27klm6ea_5atK7klKsVopdtOLykZtM-iJ5yTVzb-X-R3-UASsIbs7AOWfOHBjG3gi-VcKKU8mF3Krt5y93QohBmmfsWAxKbbgZ1BF7SfSdc2G0kS_YkZRn1lqtj9mvb_sVQkUCLKGSr1Py4H4sGBY_1yk7mleILmWgCrFhV8qc1_dwUVxeKRHUCB4bjq3SlDoJMS8pdKw_wcUZ27_J8z61AI89oyW_5EpzPazgSvjv5kKpPIBPBWHaO8KNr32pS3BwDwXnHtaQanHFI6TOdfsr9jy6TPj6aZ6wr1cf7i8_bW5uP15fXtxsvDCD7sgHp1EMPEZvjcYYzoIQzurz0SoXjHFCBzVKO7pwziN6P7ohRhNkDBK1OmHv_uROrfbaNO8OiTzm7ArWhXaCSyUHabXt1rdP1mU8YNhNrXdt6-7vB9RvON2PLw</recordid><startdate>201207</startdate><enddate>201207</enddate><creator>Schroeder, Christiane</creator><creator>Fleck, Steffen</creator><creator>Gaab, Michael R</creator><creator>Schweim, Klaus H</creator><creator>Schroeder, Henry W S</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201207</creationdate><title>Why does endoscopic aqueductoplasty fail so frequently? Analysis of cerebrospinal fluid flow after endoscopic third ventriculostomy and aqueductoplasty using cine phase-contrast magnetic resonance imaging</title><author>Schroeder, Christiane ; Fleck, Steffen ; Gaab, Michael R ; Schweim, Klaus H ; Schroeder, Henry W S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1694-c109a4e190ffc764efd5d11a748b73ad66a14d3b27bad80feccba9ff6d2fd2e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Cerebral Aqueduct - pathology</topic><topic>Cerebral Aqueduct - surgery</topic><topic>Cerebral Ventricles - surgery</topic><topic>Constriction, Pathologic</topic><topic>Endoscopy - adverse effects</topic><topic>Endoscopy - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Hydrocephalus - cerebrospinal fluid</topic><topic>Hydrocephalus - surgery</topic><topic>Image Processing, Computer-Assisted</topic><topic>Magnetic Resonance Imaging, Cine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neurosurgical Procedures - adverse effects</topic><topic>Neurosurgical Procedures - methods</topic><topic>Third Ventricle - surgery</topic><topic>Treatment Failure</topic><topic>Ventriculostomy - adverse effects</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schroeder, Christiane</creatorcontrib><creatorcontrib>Fleck, Steffen</creatorcontrib><creatorcontrib>Gaab, Michael R</creatorcontrib><creatorcontrib>Schweim, Klaus H</creatorcontrib><creatorcontrib>Schroeder, Henry W S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schroeder, Christiane</au><au>Fleck, Steffen</au><au>Gaab, Michael R</au><au>Schweim, Klaus H</au><au>Schroeder, Henry W S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Why does endoscopic aqueductoplasty fail so frequently? Analysis of cerebrospinal fluid flow after endoscopic third ventriculostomy and aqueductoplasty using cine phase-contrast magnetic resonance imaging</atitle><jtitle>Journal of neurosurgery</jtitle><addtitle>J Neurosurg</addtitle><date>2012-07</date><risdate>2012</risdate><volume>117</volume><issue>1</issue><spage>141</spage><epage>149</epage><pages>141-149</pages><eissn>1933-0693</eissn><abstract>The aim of this study was to evaluate and compare CSF flow after endoscopic third ventriculostomy (ETV) and endoscopic aqueductoplasty (EAP) in patients presenting with obstructive hydrocephalus caused by aqueductal stenosis.
In patients harboring aqueductal stenosis who underwent EAP (n=8), ETV (n=8), and both ETV and EAP (n=6), CSF flow through the restored aqueduct and through the ventriculostomy was investigated using cine cardiac-gated phase-contrast MRI. For qualitative evaluation of CSF flow, an in-plane phase-contrast sequence in the midsagittal plane was used. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct and/or floor of the third ventricle.
Evaluation revealed significantly higher CSF flow through the ventriculostomies compared with flow through the aqueducts. This was true both when comparing the ETV group with the EAP group and when comparing the flow of the ventriculostomy and aqueduct within the ETV and EAP group. There was no difference in aqueductal CSF flow between patients who underwent EAP alone and patients who underwent ETV and EAP. There was also no difference in ventriculostomy CSF flow between patients who underwent ETV alone and patients who underwent ETV and EAP. Fifty percent of the restored aqueducts became occluded at a mean of 46 months after surgery (range 18-126 months). In contrast, all ETVs remained patent in the mean follow-up period of 110 months after surgery, although 1 patient required shunt placement after 66 months.
Cerebrospinal fluid flow through ventriculostomies is significantly higher than aqueductal CSF flow after EAP. This could be one factor to explain why the reclosure rate of aqueducts after EAP is higher than the reclosure rate of the ventriculostoma after ETV.</abstract><cop>United States</cop><pmid>22577744</pmid><doi>10.3171/2012.3.JNS111926</doi><tpages>9</tpages></addata></record> |
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| subjects | Adolescent Adult Cerebral Aqueduct - pathology Cerebral Aqueduct - surgery Cerebral Ventricles - surgery Constriction, Pathologic Endoscopy - adverse effects Endoscopy - methods Female Follow-Up Studies Humans Hydrocephalus - cerebrospinal fluid Hydrocephalus - surgery Image Processing, Computer-Assisted Magnetic Resonance Imaging, Cine Male Middle Aged Neurosurgical Procedures - adverse effects Neurosurgical Procedures - methods Third Ventricle - surgery Treatment Failure Ventriculostomy - adverse effects Young Adult |
| title | Why does endoscopic aqueductoplasty fail so frequently? Analysis of cerebrospinal fluid flow after endoscopic third ventriculostomy and aqueductoplasty using cine phase-contrast magnetic resonance imaging |
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