Volume 12 Supplement 1

Abstracts from Hydrocephalus 2015

Open Access

Comparison between pre-operative MRI and intra-operative endoscopic findings for idiopathic normal pressure hydrocephalus

  • Daisuke Kita1, 2Email author,
  • Yasuhiko Hayashi2,
  • Issei Fukui2,
  • Masahiro Oishi2,
  • Cheho Park1 and
  • Mitsutoshi Nakada2
Fluids and Barriers of the CNS201512(Suppl 1):O40

https://doi.org/10.1186/2045-8118-12-S1-O40

Published: 18 September 2015

Introduction

Endoscopic examination of the intra-ventricular walls is rarely performed for cases of idiopathic normal pressure hydrocephalus (iNPH) since shunting is the first treatment option for iNPH. We conducted intra-operative endoscopy during shunt surgery in patients with iNPH and compared the findings with their pre-operative MRI data.

Methods

Eleven patients (6 men and 5 women, age range: 67-84 years, mean age: 75.5 years) with probable iNPH consistent with the Japanese iNPH guideline were included in this study. High-resolution MRI (T1-3D-SPGR or FIESTA) was conducted pre-operatively. Intra-ventricular observations were performed with a flexible endoscope, Olympus VEF-type V, via a frontal burr hole during shunt surgery. Student's t-test and Fisher's direct method were employed for statistical analyses.

Results

Laceration of the septum pellucidum was found in 4 patients (36.3%) by direct endoscopic observations. The foramen of Monro and Sylvian aqueduct were not stenosed in any case, as revealed both radiologically and endoscopically. For all cases, downward ballooning of the third ventricle floors was not observed in pre-operative MRIs, while thin third ventricular floor and lamina terminalis were observed in intra-operative endoscopic views. The interspace between the bilateral mammillary bodies varied from being wide to narrow, as revealed by endoscopy. A significant correlation was found between laceration of the septum pellucidum and the callosal angle measured by MRI (104 ± 5.77 degrees for lacerated vs. 70.3 ± 7.44 degrees for non-lacerated, p < 0.001). Width of the third ventricle and that of the interspace between the bilateral mammillary bodies showed a non-significant correlation (14.2 ± 1.86 for widely opened vs. 11.7 ± 2.49 for narrowly closed, p = 0.052).

Conclusion

In iNPH, the pre-operative MRI findings of dull callosal angle and wide third ventricle were closely related to the intra-operative endoscopic findings of laceration of the septum pellucidum and wide opening between the bilateral mammillary bodies, respectively.

Authors’ Affiliations

(1)
Department of Neurosurgery, Noto General Hospital
(2)
Department of Neurosurgery, Kanazawa University

References

  1. Kita D, Hayashi Y, Kitabayashi T, Kinoshita M, Okajima M, Taniguchi T, Hamada J I: “Detection of the development of late-onset idiopathic aqueductal stenosis (LIAS) by chronological magnetic resonance imaging: a case report.”. Child's nervous system. 2014, 1317-9. 30View ArticlePubMedGoogle Scholar

Copyright

© Kita et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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