title: Magnetic resonance imaging flow void changes after cerebrospinal fluid shunt in post-traumatic hydrocephalus: clinical correlations and outcome.
abstract: The assessment of the flow-void in the cerebral aqueduct of patients with post-traumatic hydrocephalus on magnetic resonance imaging (MRI) evaluation could concur the right diagnosis and have a prognostic value. We analysed prospectively 28 patients after a severe head injury (GCS<or=8), with radiological or clinical suspicion of post-traumatic hydrocephalus and a fast flow-void signal in the cerebral acqueduct on T2-weighted and proton density MRI. Twenty-two patients were shunted (n=19) or revised (n=3). Six patients were followed-up without surgery. Twenty out of 22 shunted patients (91%) showed variable reduction of the fast flow-void. Eighteen of the operated patients (82%) presented a significant clinical improvement at 6-month follow-up. All patients (n=2) who had no change of the fast flow-void after surgery did not clinically improve. The six non-shunted patients did not present any clinical or radiological improvement. In head-injured patients, fast flow-void in the cerebral aqueduct is diagnostic for post-traumatic hydrocephalus and its reduction after ventriculo-peritoneal shunt is correlated with a neurological improvement. In already shunted patients, a persistent fast flow-void is associated with a lack of or very slow clinical improvement and it should be considered indicative of under-drainage.
authors.affiliation: Department of Neurosciences, Neurosurgery and Neuroradiology, University of Rome "La Sapienza", Fondazione Santa Lucia IRCSS, Rome, Italy. missorp@yahoo.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Missori
authors.forename: Massimo
authors.initials: M
authors.lastname: Miscusi
authors.forename: Rita
authors.initials: R
authors.lastname: Formisano
authors.forename: Simone
authors.initials: S
authors.lastname: Peschillo
authors.forename: Filippo M
authors.initials: FM
authors.lastname: Polli
authors.forename: Antonio
authors.initials: A
authors.lastname: Melone
authors.forename: Stefano
authors.initials: S
authors.lastname: Martini
authors.forename: Sergio
authors.initials: S
authors.lastname: Paolini
authors.forename: Roberto
authors.initials: R
authors.lastname: Delfini
mesh_terms: D000293:Adolescent; D000328:Adult; D002535:Cerebral Aqueduct / Q000473:pathology; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome