Rault E, Lacalm A, Massoud M, Massardier J, Di Rocco F, Gaucherand P, Guibaud L. Eur J Paediatr Neurol. Notice the normal fourth ventricle size. Dominant findings include enlargement of the third ventricle inferior recesses, size of the lateral and third ventricles (especially enlargement of the smaller lateral ventricle), and an abnormally thin and/or dysgenetic corpus callosum. Postnatal magnetic resonance imaging showed triventricular hydrocephalus, suggesting aqueductal stenosis. Vials F, Ruiz P, Quiroz G, Guerra FA, Correa F, Martnez D, Puerto B. Fetal Diagn Ther. To assess the utility of gradient echo (GRE) magnetic resonance (MR) imaging in documenting aqueductal patency, spin-echo (SE) and GRE axial images were obtained with a 1.5-T system in 26 patients with aqueductal or periaqueductal lesions and in 26 control subjects. MRI Axial T1 The MRI sequences demonstrate a marked dilatation of the 3rd and lateral ventricles with mild transependymal edema and normal size and configuration of the 4th ventricle. Besides, the bulging may be difficult to measure in this region, because it may be hindered in posthemorrhagic or postmeningitic AS.7, All of these direct or indirect signs are operator-dependent, difficult to reproduce, and lack validated cutoff values. To assess the utility of gradient echo (GRE) magnetic resonance (MR) imaging in documenting aqueductal patency, spin-echo (SE) and GRE axial images were obtained with a 1.5-T system in 26 patients with aqueductal or periaqueductal lesions and in 26 control subjects. 12, No. It is likely that some cases of aqueductal stenoses are the consequence of a compression of the brain stem by an overpressurized ambient cistern, whether communicating or not with the subarachnoid spaces. AS indicates aqueductal stenosis. 2022 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X. CT. CT. Axial non-contrast. The fourth ventricle posterior fossa basal cisterns are unremarkable, and the cortical sulci are effaced. Not included in this material are cases of aqueductal stenosis caused by a number of interesting inflammatory lesions such as syphilis, tuberculosis, cysticercosis, toxoplasmosis, histoplasmosis, and from ependymitis following the creation of a shunt. Association of fetal hydrocephalus with other embryological anomalies: A prenatal ultrasound-based study. Brain. This graphic shows the importance (x-axis) of each evaluated prenatal MR imaging finding (y-axis) with respect to the diagnosis of CAS. It is not usually visible in cases of benign stenosis but may be seen in membranous obstruction. In 1967, a study used radiologic features on ventriculography to define signs and different shapes of AS.23 Nevertheless, radiologic investigation of hydrocephalus currently relies on MR imaging examinations, and heterogeneous studies use variable and nonvalidated criteria to define AS: triventricular dilation with a relatively small 4th V, periventricular signs of CSF active resorption, the presence of a space-occupying lesion, a downward bulging of the 3rd V, and the absence of the flow void sign. Would you like email updates of new search results? Imaging studies were also analyzed for malformations of cortical and cerebellar development. Enter your email address below and we will send you the reset instructions. 2014 Jul;44(7):849-56. doi: 10.1007/s00247-014-2877-4. 4, Journal of Neurology, Neurosurgery & Psychiatry, Vol. 78, No. 2022 Mar 21;12(3):764. doi: 10.3390/diagnostics12030764. The acquisition planes were selected perpendicular to the presumed direction of the flow and are represented in Fig 1. Bateman24 found similar results in patients with NPH, by measuring the AVD, which was significantly reduced, corresponding to the venous flush occurring earlier in the CC. Value of pre- and postnatal magnetic resonance imaging in the evaluation of congenital central nervous system anomalies. Further detail inspection of the aqueduct reveals a thin membrane (arrows) that is responsible for the Aqueduct Stenosis. For the arterial flows, we calculated the mean cerebral arterial total blood flow in milliliters per minute, which was the sum of mean arterial flows in the left and right internal carotid and vertebral arteries. Furthermore, 7 patients in our population had undergone ETV, with good clinical outcome at 1 year (improvement of headaches or gait/memory disturbance). Aqueductal stenosis (AS) includes a large variety of etiologies: posthemorrhagic or postmeningitic obstruction, compression of the aqueduct, or presence of a third ventricle mass.1 Patients with late-onset AS present with various clinical and radiologic features.13 New theories have emerged about the pathogenesis of AS in adults, and venous hypertension has been suggested as the primary phenomenon responsible for ventricle dilation and aqueductal obstruction.4 As a consequence, the determination of the underlying mechanism in hydrocephalus is relevant due to surgical implications because endoscopic third ventriculostomy (ETV) is mainly successful in obstructive hydrocephalus.5,6, Conventional MR imaging provides useful information in AS, because it may show triventricular dilation, CSF pathway obstruction at the aqueductal level on sagittal T2 sequences, downward bulging of the floor of the third ventricle (3rd V), anterior bulging of the 3rd V, etc.7 Nevertheless, these criteria depend on a subjective evaluation by the neuroradiologist, may be difficult to assess in some patients, and thus are hardly comparable in postsurgical outcome studies.6,8. 1, British Journal of Neurosurgery, Vol. However, idiopathic AS is frequent, and checking for indirect signs of obstruction is usually recommended.7, Downward bulging of the floor of the 3rd V, underneath the line from the chiasma to the mamillary bodies, has been proposed as a sign of a raised pressure gradient between the 3rd V and the prepontine cistern and, thus, as an indirect sign of AS.7 In our population, this sign was absent in 7 patients with AS. Thank you for your interest in spreading the word on American Journal of Neuroradiology. At least both sagittal and axial T2 sequences were necessary and reread by a neuroradiologist blinded to the final diagnosis and to PC-MR imaging results. This report points up the local effect of the distended suprapineal recess, the resulting specific symptom of vertical ocular paresis, not hitherto associated with aqueduct stenosis, and the ventriculographic features. 2019, Neurosurgery Clinics of North America, Vol. Then flush flows occur in the cerebral venous and aqueductal CSF compartments. The purpose of this study was to identify specific anatomic findings on prenatal MR imaging that can be used as predictors of congenital aqueductal stenosis. Cerebrospinal fluid flow is restricted but still occurs. The absolute sum of this volume maximum change in the caudal and cranial directions during the CC defined the blood stroke volume responsible for the dynamic coupling and succession of cerebral flows, starting with the CSF cervical venting. An official website of the United States government. Neurologic symptoms and disease duration in patients are summarized in Table 1. Patients were supine. Similarly, CSF flow curves in the cervical and 4th V levels were integrated, providing the CSF stroke volumes, which represent the CSF volumes displaced in both directions through the considered region of interest at the corresponding level.9,10 These volumes represent the mobile compliance of the subarachnoid and ventricular compartments and contribute to rapid regulation of intracranial pressure throughout the CC. This AVD was represented in terms of percentage of CC, with the zero reference corresponding to the arterial inflow peak. 1996 Apr;12(4):188-91. doi: 10.1007/BF00301249. Optimal MRI Sequence for Identifying Occlusion Location in Acute Stroke: Which Value of Time-Resolved Contrast-Enhanced MRA? GRE imaging was performed . The total cerebral vascular flow curve was generated by calculating the difference between arterial and venous flows throughout the CC. government site. For each of these curves, amplitude and temporal characteristic parameters were analyzed. 4, No. This parameter is of great value because it proves the obstructive nature of hydrocephalus. The purpose of this study was to evaluate the support of the phase-contrast MR imaging (PC-MR imaging) technique (sensitive to CSF flows) for the diagnosis of AS. It was with the aim of understanding the variations in radiologic features within the group of lesions causing aqueductal stenosis that we reviewed the clinical, radiologic, and pathologic (when available) features in 88 patients with aqueductal stenosis hospitalized at the National Hospital for Nervous Diseases, London, England, and at the Atkinson-Morley Hospital, Wimbledon, England. Additionally, AS may be either idiopathic or related to secondary etiologies (arachnoiditis, cervical malformations, posterior fossa tumors).1 Furthermore, aqueductal aspects in AS are various, as has been emphasized in an earlier ventriculography study: club-shaped end, broad funnel, narrow funnel, membranous aqueduct, or aqueduct atresia are some of described AS configurations.23, Additionally, new theories have emerged in the past decades, based on the Monro-Kellie doctrine, stating that the intracranial pressure equilibrium is related to a mechanical coupling between the vascular, brain tissue, and CSF intracranial compartments. We treated the patient with a ventriculoperitoneal shunt. Abstract The entity, aqueductal stenosis, includes a variety of lesions affecting the aqueduct of Sylvius. Because it depends on both the pressure difference between the 2 compartments and on its duration, the downward bulging may be slight if the pressure gradient is low or of a short duration. It is suggested that assessment of the extracerebral pathways may be advisable before undertaking third ventriculostomy or ventriculo-cisternostomy, as it is more likely to be the result of hydrocephalus than the initial cause. 3, American Journal of Neuroradiology, Vol. 496, 2022 Radiological Society of North America, Uncommon third ventricle herniation with cyst formation as a possible result of obstructive hydrocephalus, Department of Radiology, Neuroradiology Section Albert Einstein College of Medicine Eastchester Road and Morris Park Avenue Bronx, N. Y. It appears that GRE imaging is useful in rapidly assessing aqueductal patency. For CSF flow curves, the main parameters were those corresponding to the flush phase, and they were analyzed for both patients and control populations. 1-3 New theories have . Three patients presented with the association of long-duration NPH symptoms and acute headaches related to acute intracranial hypertension. Background and purpose: Our study identified specific characteristics on fetal MR imaging that can be used as predictors of the diagnosis of congenital aqueductal stenosis. 8600 Rockville Pike 1 Patients with late-onset AS present with various clinical and radiologic features. AS diagnosis remains difficult because of heterogeneous clinical and etiologic features. 4, Acta Radiologica. In 18 of 20 obstructed aqueducts, low intensity was seen within the aqueducts on GRE images. The MR imaging parameters were as follows: TE, 69 ms; TR, 20 ms; flip angle, 25 for vascular flows, 20 for CSF flows; FOV, 16 12 mm2; matrix, 256 128; section thickness, 6 mm. Velocity (encoding) sensitization was set at 80 cm/s for the vascular flows, 10 cm/s for the aqueductal CSF flows, and 5 cm/s for the CSF at the cervical subarachnoid spaces and 4th V levels. The purpose of this study was to identify specific anatomic findings on prenatal MR imaging that can be used as predictors of congenital aqueductal stenosis. 2022 Jul-Aug;38(6):1617-1621. doi: 10.12669/pjms.38.6.5223. 6, Clinical Neurology and Neurosurgery, Vol. The mean values of key parameters of arterial, venous, and AV blood flows in patients and control groups are shown in Table 3. Background and purpose: To examine prenatal MRI and postnatal imaging in fetuses with congenital aqueductal stenosis (CAS) to determine the frequency of association of rhombencephalosynapsis (RES) and how it may affect neonatal intensive care unit (NICU) course. In membranous obstruction acute intracranial hypertension the association of Fetal hydrocephalus with other embryological anomalies: a prenatal study. Is of great value because it proves the obstructive nature of hydrocephalus of great value because it the... 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