Radionuclide cisternography in diagnostics of obstruction hydrocephalus in introduced ventriculoperitoneal shunt.
BACKGROUND
To confirm or exclude a diagnosis of internal obstruction hydrocephalus in an 8-year old girl with an introduced ventriculoperitoneal (V-P) shunt.


METHODS
Establishing the V-P shunt is indisputably the route of choice in non-communicating hydrocephalus. The existence of a V-P shunt, however, is connected with numerous risks, especially of injuries, infection as well as increased intraabdominal pressure--e.g. in pregnancy. The development of endoscopy in neurosurgery allows the creation of communication via the bottom of the third ventricle with basal cisterns, and the subsequent cancellation of a V-P shunt.


METHODS
We describe the case of an 8-year old girl with congenital internal hydrocephalus with an assumed obliteration of the Sylvian aqueduct with an established V-P shunt. An MR scan described the membrane in the area of the Sylvian aqueduct, but the disproportion between the dilatation of the lateral ventricles, third ventricle and fourth ventricle led the physician to doubt as to the accuracy of the diagnosis of internal obstruction hydrocephalus. Therefore we performed a radionuclide cisternography (in a modified manner), which proved an existing communication between the third and fourth cerebral ventricle and which contradicted the clinical diagnosis of obstruction hydrocephalus.
Nuclear Medicine Clinic, University Hospital and Policlinic, Ostrava, Czech Republic. cernochova@mou.cz
Irena
I
Cernochova
Radim
R
Lipina
D002648:Child; D005260:Female; D005492:Folic Acid / Q000031:analogs & derivatives*; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging* / Q000209:etiology*; D009192:Myelography / Q000379:methods; D004369:Pentetic Acid / Q000031:analogs & derivatives*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
C108951:DTPA folate; D019275:Radiopharmaceuticals; D004369:Pentetic Acid; D005492:Folic Acid