title: Usefulness of intraoperative magnetic resonance ventriculography during endoscopic third ventriculostomy.
abstract: BACKGROUND
  Endoscopic third ventriculostomy (ETV) is the preferred method for the treatment of noncommunicating hydrocephalus. The different success rates of ETV indicate the difficulties in predicting the success of this procedure.
  
  
  OBJECTIVE
  To show the usefulness of intraoperative ventriculography performed by the low-field 0.15-T magnetic resonance imager Polestar N20 during ETV.
  
  
  METHODS
  The study was conducted in 11 patients with noncommunicating hydrocephalus caused by tumors or cysts of the third ventricle (n = 5), nontumoral stenosis of the sylvian aqueduct (n = 3), and fourth ventricle outlet obstruction (n = 3). Intraoperative magnetic resonance (iMR) ventriculography was performed before and after the ETV.
  
  
  RESULTS
  In each case, iMR-ventriculography was a safe procedure and determined the exact site of obstruction of cerebrospinal fluid flow. In all cases, iMR-ventriculography performed after ETV showed with the greatest accuracy the patency of the performed fenestrations, demonstrating in 9 patients good flow of the contrast from the third ventricle to the basal cisterns, restricted flow in 1 patient, and no flow in 1 patient. The results of ventriculography were consistent with the postoperative neurological status of operated-on patients. In 3 patients, the opinion of the surgeons about the patency of endoscopic fenestration, based on intraoperative observation of the third ventricle floor, was inconsistent with the results from iMR-ventriculography.
  
  
  CONCLUSIONS
  Low-field iMR-ventriculography is a safe procedure that can be successfully applied during ETV to determine the site of obstruction in hydrocephalus and the patency of performed ventricle fenestration.
authors.affiliation: Departments of †Neurosurgery and ‡General Radiology, Interventional Radiology, and Neuroradiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Tabakow
authors.forename: Marcin
authors.initials: M
authors.lastname: Czyz
authors.forename: Pawel
authors.initials: P
authors.lastname: Szewczyk
authors.forename: Artur
authors.initials: A
authors.lastname: Weiser
authors.forename: Wlodzimierz
authors.initials: W
authors.lastname: Jarmundowicz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002552:Cerebral Ventricles / Q000601:surgery; D014695:Cerebral Ventriculography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D014696:Ventriculostomy / Q000379:methods*; D055815:Young Adult