gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Article

Send article

Significance of (early) high-resolution MRI imaging for a better understanding of paediatric hydrocephalus

Meeting Abstract

Search Medline for

  • M. Schuhmann - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • B. Ries - Abteilung für Neuroradiologie, Universitätsklinikum Tübingen
  • C. Nagel - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • U. Ernemann - Abteilung für Neuroradiologie, Universitätsklinikum Tübingen
  • M. Tatagiba - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • T. Nägele - Abteilung für Neuroradiologie, Universitätsklinikum Tübingen

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.15-06

doi: 10.3205/09dgnc107, urn:nbn:de:0183-09dgnc1070

Published: May 20, 2009

© 2009 Schuhmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: The biggest challenge in paediatric hydrocephalus is to understand the individual cause of hydrocephalus - to be able to think beyond symptomatic therapy by draining excess CSF via a shunt. Therefore we performed – in addition to standard sequences – high-resolution MR imaging on a routine basis in pediatric hydrocephalus cases to gain maximum knowledge of a possible underlying pathophysiology before first treatment or before a shunt revision was undertaken.

Methods: Hydrocephalic children were included before initial treatment or at shunt failure. To visualize the CSF spaces we performed - in addition to standard T2 spin echo sequences - either an incubator coil operated high resolution T2 sequence (newborns and premature babies, SL 1-2 mm, TR 5711, TE 120), a 3D-CISS sequence (constructive Interference in Steady State SL 0.7 mm, TR 12.06, TE 6.03) or a 3D-trueFISP sequence (True Fast Imaging with Steady Precession, SL 1 mm, TR 4.97, TE 2.49). If possible, CSF pulsation studies were added. A standard 1.5 T MR scanners were used.

Results: 30 children (age 32w-16y) were recruited. There were 13 premature and mature newborns, 9 and 7 children up to 6 years without a shunt or with a shunt, respectively, and 1 older child with a shunt. In contrast to standard T2 weighted SE images, high-resolution MRI did point to an obstructive nature of the hydrocephalus in all patients by visualising an intra- or extraventricular obstruction within the CSF pathways. Especially in all 14 post-hemorrhagic cases, where hydrocephalus is often perceived as aresorptive, obstruction was clearly visible.

Conclusions: The findings of high resolution MRI imaging do support the theory that all cases of pediatric hydrocephalus are of an obstructive nature. It especially makes it possible to visualize extraventricular obstruction, e.g. within the basal cisterns. This information is crucial for the decision about endoscopic treatment options. All children should receive high resolution MR scanning prior to any therapeutic decision in order to reveal as much of the underlying pathology as possible.