MRT mit Liquorflussmessung
vor und nach endoskopischer Ventrikulostomie bei Aquäduktstenose

Zusammenfassung.

Ziel: Beurteilung der MRT-Bildgebung und Liquorflussdarstellung zur präoperativen Planung einer endoskopischen Ventrikulostomie bei triventrikulärem Verschlusshydrozephalus auf dem Boden einer idiopathischen oder tumorösen Aquäduktstenose und zur postoperativen Verlaufsbeurteilung. Patienten und Methode: 17 Patienten mit einem triventrikulären Verschlusshydrozephalus wurden vor und nach endoskopischer Ventrikulostomie magnetresonanztomographisch mit einer pulsgetriggerten T₂-gewichteten Turbo-Spin-Echosequenz und einer flusssensitiven Phasenkontrast-Multi-Herzphasen-Sequenz (PCMHP, 16 Bilder/Herzzyklus) untersucht. Diese Untersuchungen wurden hinsichtlich der Beurteilbarkeit der anatomischen Details bzw. der Durchgängigkeit des Ventrikulostomas ausgewertet. Ergebnisse: Bei allen 17 Patienten waren die operationsrelevanten anatomischen Strukturen abgrenzbar. Mit der flusssensitiven Sequenz konnten der Verschluss des Aquädukts und die postoperative Durchgängigkeit des Ventrikulostomas sicher nachgewiesen werden, auch wenn sonstige Merkmale wie z. B. eine Abnahme der Ventrikelweite noch nicht vorlagen. Schlussfolgerungen: Die MRT erlaubt bei triventrikulärem Verschlusshydrozephalus mit pulsgetriggerter T2-Bildgebung und Liquorflussbestimmung eine präoperative Patientenselektion und exakte Planung einer endoskopischen Ventrikulostomie. Postoperativ ist eine nicht invasive Erfolgskontrolle und Verlaufsbeobachtung möglich, die besonders bei nicht eindeutiger Symptomatik wichtig ist.

MR imaging and CSF flow measurement before and after neuroendoscopic third ventriculostomy.

Purpose: Evaluation of MR imaging and CSF flow measurement for planning and follow-up of neuroendoscopic third ventriculostomy in occlusive triventricular hydrocephalus. Method: 17 patients with occlusive hydrocephalus due to idiopathic or neoplastic aqueductal stenosis were examined before and after surgery with cardiac-gated T ₂-weighted and cardiac-gated phase contrast cine sequences. The visibility of anatomic structures and the patency of the ventriculostomy were evaluated. Results: In all 17 patients, the relevant anatomic structures were visible. The cine sequence demonstrated occlusion of the aqueduct and patency of the ventriculostomy in all cases, even in patients with doubtful clinical patterns. Conclusions: MR imaging with additional cardiac-gated cine sequences allows exact preoperative diagnosis of occlusive hydrocephalus as well as patient selection and planning for endoscopic third ventriculostomy. Non-invasive follow-up, especially in patients with a doubtful clinical pattern, is possible.

Schlüsselwörter:

Verschlusshydrozephalus - triventrikulär; Ventrikulostomie - endoskopisch; MRT - Diagnostik; MRT - Flussmessung; ZNS - Liquor

Key words:

Brain - Hydrocephalus; brain - Surgery; brain - Endoscopic third ventriculostomy; MR - Imaging; MR - CSF flow measurement

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