Changes in cerebral perfusion hormone profile and cerebrospinal fluid flow across the third ventriculostomy after endoscopic third ventriculostomy in patients with aqueductal stenosis: a prospective study. Clinical article.
OBJECTIVE
The object of the present study was 3-fold: 1) to study regional cerebral perfusion before and after endoscopic third ventriculostomy (ETV) in patients with obstructive hydrocephalus by using (99m)Tc ethyl cysteinate dimer SPECT: 2) to study any correlation between clinically successful third ventriculostomy and CSF flow across the third ventriculostomy; and 3) to determine any changes in hormone profile following ETV.


METHODS
The authors prospectively studied 15 patients with aqueductal stenosis who underwent ETV during the last 2 years. All the patients underwent pre- and postoperative MR imaging, brain (99m)Tc ethyl cysteinate dimer SPECT, and hormone profile studies.


RESULTS
Eight patients were infants. The mean follow-up duration was 17.6 months. Thirteen patients (86.7%) exhibited clinical improvement after surgery. In all patients with clinical improvement the studies documented CSF flow through the ventriculostomy site. Clinical progress could be correlated with SPECT changes in 14 cases (93.3%). In the 13 clinically successful cases, 12 were substantiated by improvement on SPECT scans, whereas in the 2 failed cases, SPECT images revealed no improvement of perfusion defects. Hormone analysis conducted in 14 patients revealed hyperprolactinemia in 8, low triiodothyronine values in 2 patients, and hypocortisolemia in 1, which was reversed after ETV.


CONCLUSIONS
Clinical improvement is not well correlated with a decrease in ventricular size following ETV. Brain SPECT is a valuable tool for the follow-up of patients with hydrocephalus after ETV, particularly in cases in which MR imaging findings are not clear. There are subtle hormonal changes in patients with hydrocephalus that may improve following ETV.
Garg
Anil Kumar
AK
Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Suri
Ashish
A
Sharma
Bhavani S
BS
Shamim
Shamin A
SA
Bal
Chander S
CS
D000293:Adolescent; D001921:Brain / Q000098:blood supply; D002535:Cerebral Aqueduct / Q000000981:diagnostic imaging / Q000601:surgery*; D002555:Cerebrospinal Fluid / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D003545:Cysteine / Q000031:analogs & derivatives; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000601:surgery*; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007091:Image Processing, Computer-Assisted; D007223:Infant; D007427:Intracranial Pressure / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D015609:Organotechnetium Compounds; D010908:Pituitary Hormones, Anterior / Q000097:blood*; D011183:Postoperative Complications / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011388:Prolactin / Q000097:blood; D011446:Prospective Studies; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon; D014284:Triiodothyronine / Q000097:blood; D014696:Ventriculostomy / Q000379:methods*
D015609:Organotechnetium Compounds; D010908:Pituitary Hormones, Anterior; D014284:Triiodothyronine; D011388:Prolactin; C059659:technetium Tc 99m bicisate; D003545:Cysteine; D006854:Hydrocortisone