Anık I, Ceylan S, Koc K, Anık Y, Etus V, Genc H
University of Kocaeli, School of Medicine, Department of Neurosurgery, Kocaeli, Turkey.
Minim Invasive Neurosurg. 2011 Apr;54(2):68-74. doi: 10.1055/s-0031-1277172. Epub 2011 Jun 7.
The purpose of the present study was to observe Liliequist's membrane (LM) and membranous structures located in the prepontine cistern via 3-Tesla magnetic resonance imaging (MRI) with 3D driven equilibrium radio frequency reset pulse (DRIVE) sequence and multiplanar reformat (MPR) images and to evaluate the success of endoscopic third ventriculostomy (ETV) by assessing these membranes in adult aqueduct stenosis.
29 patients (17 female, 12 male) with primary aqueductus sylvii stenosis were included in the study. 19 patients were diagnosed as long-standing overt ventriculomegaly in adults (LOVA) and patients had severe ventriculomegaly, macrocephalus, and aqueduct stenosis on MR imaging. 10 patients were diagnosed as aqueduct stenosis presented with acute onset of hydrocephalus with symptoms of raised ICP. All patients in the study group were analyzed with conventional and cine MRI before and after treatment. We performed 3D DRIVE sequence and MPR at 3-T MR equipment to determine the membranous structures in 3 dimensions. We correlated the success of the procedure considering the preoperative, postoperative MRI and intraoperative images.
5 patients (26.3%) with LOVA and 2 patients (20%) with aqueduct stenosis, in total 7 patients (24.1%), did not respond to ETV. Cerebrospinal fluid (CSF) flow was blocked by membranous structures located in the prepontine cistern in 4 of 8 patients. In 2 patients, CSF through the stoma was blocked either by the LM or closed tuber cinerum. In 1 patient insufficient CSF flow was observed through the stoma and the LM accompanying prepontine membranes.Totally closed membranes were observed in the prepontine cistern in 5 patients (17.24%) according to the postoperative MRI. LM was verified in all patients intraoperatively that were also demonstrated in the preoperative MRI.
3D sequences with MPR may help to observe not only the LM but also other membranes located through the prepontine cistern, which may be the reason of failed ETV.
本研究的目的是通过3特斯拉磁共振成像（MRI）的三维驱动平衡射频重置脉冲（DRIVE）序列和多平面重建（MPR）图像观察Liliequist膜（LM）及脑桥前池内的膜性结构，并通过评估这些膜来评价成人导水管狭窄患者内镜下第三脑室造瘘术（ETV）的成功率。
本研究纳入29例原发性中脑导水管狭窄患者（17例女性，12例男性）。19例患者被诊断为成人长期显性脑室扩大（LOVA），这些患者在磁共振成像上有严重脑室扩大、巨头畸形及导水管狭窄。10例患者被诊断为导水管狭窄并伴有急性脑积水及颅内压升高症状。研究组所有患者在治疗前后均接受了常规MRI和电影MRI分析。我们在3-T磁共振设备上进行了三维DRIVE序列和MPR检查以三维确定膜性结构。我们结合术前、术后MRI及术中图像分析手术成功率。
5例（26.3%）LOVA患者和2例（20%）导水管狭窄患者，共7例（24.1%）对ETV无反应。8例患者中有4例脑脊液（CSF）流动被位于脑桥前池的膜性结构阻塞。2例患者中，通过造口的CSF被LM或封闭的灰结节阻塞。1例患者中，观察到通过造口及伴随脑桥前膜的LM的CSF流动不足。根据术后MRI，5例患者（17.24%）脑桥前池内观察到完全封闭的膜。术中所有患者均证实存在LM，术前MRI也显示了这一点。
带有MPR的三维序列不仅有助于观察LM，还能观察脑桥前池内的其他膜，这可能是ETV失败的原因。
