Advanced Imaging Diagnosis And Surgical Treatment Strategies Of Hydrocephalus

Objective: To investigate the clinical efficacy of advanced imaging diagnosticmethods and surgical treatment strategies of communicating hydrocephalus andnon-communicating hydrocephalus.Methods: In the first session, we performed MRI3D-SPACE sequence scanningfor76cases suffered from hydrocephalus after failed shunt. Based on DICOM data of3D-SPACE sequence, we three-dimensionally reconstructed the ventricles andsimulated virtual endoscopy with software3D-Slicer. Surgical strategy wasmade after evaluation of3D-SPACE sequence and virtual endoscopy images. In thesecond session, for209patients who had ventriculo-peritoneal shunt, we operatedwith laparoscopy and neuro-endoscopy. The effect of subsequent shunt systemsurvival was analyzed with Kaplan-Meier survival analysis, to study the effects ofcombined application of laparoscopy and neuro-endoscopy for ventriculo-peritonealshunt. In the third session, in65patients of pineal region tumors and obstructivehydrocephalus, we performed endoscopic third ventriculostomy (ETV) and tumorbiopsy. Tumor specimens were get and analyzed histopathologically. According to thepathological diagnosis, we decided the following treatment strategy.Results: In the first session, the sensitivity of3D-SPACE for the diagnosis ofnon-communicating hydrocephalus was98.3%(57/58cases), which is significantlyhigher than that of conventional T2-weighted MRI (72.4%,42/58cases) for thediagnosis of non-communicating hydrocephalus. Virtual endoscopy based on3D-SPACE images was helpful to depict the aqueduct or foramen of Monroobstructions, and confirm the reason of shunt failure. Finally, there were56hydrocephalus cases (73.7%) were treated with ETV, without shunt catheter insertion.In the second session,209patients received255times of ventriculo-peritoneal shuntsor revisions (mean:1.22times per person). All operations were successfully completed. No craniotomy or open operation were needed for technical-relatedcomplications. Forty-six revisions were performed in all patients. After the operations,203patients with hydrocephalus improved at different level after surgery. Follow-upperiod ranged from1month to4years, the shunt system efficiency were91.0%,86.7%,83.9%and82.0%respectively from the end of the first year to the end of thefourth year. In the third session,65patients were successfully operated with ETV andpineal region tumor biopsy, while the histological diagnosis yield rate was98.5%(64/65cases). PEB chemotherapy (Cisplatin+Etoposide+Bleomycin) andradiotherapy were used in37cases of germ cell tumors and6cases of pinealblastomas. The therapy effective rate of germ cell tumors was91.7%(33/36cases). Atotal of56.9%(37/65cases) patients benefited from this treatment strategy withouttraditional craniotomy or shunt.Conclusion: For patients suffer from shunt failure of hydrocephalus, MRI3D-SPACE sequence images and virtual endoscopy has high diagnostic yield ratefor providing more detailed anatomical information than conventional MR imaging.Hence, these advanced imaging methods are helpful for surgical treatment strategydecision making. For ventriculo-peritoneal shunt, neuroendoscopy and laparoscopycan respectively help to insert shunt catheter to better spots, either in the ventricles orthe peritoneal cavity. Hence, the combination of these two modalities can reduce thefailure rate of shunt catheter insertion and have significant impact on shunt systemsurvival. Treatment of pineal region tumor induced non-communicatinghydrocephalus. ETV and endoscopic tumor biopsy can relief hydrocephalus whileobtaining pathological diagnosis at a relative low risk. Most of the patients sufferedfrom germ cell tumors and pineoblastomas may avoid craniotomy and shunt. It canbecome a routine treatment protocol for pineal region tumors withnon-communicating hydrocephalus.