अमूर्त

Post-operative changes following endoscopic third ventriculostomy by MR imaging.

Dalia Mohamed El-Mossly*, Assem Mounir Abdel Latif, Hanaa Abdelkader Ahmed, Samar Ramzy Hanna, Shaimaa Abdelsattar Mohammad

Background: Endoscopic Third Ventriculostomy (ETV) has increased in popularity in recent years as an acceptable and effective treatment for many children with hydrocephalus. Purpose: To describe the post-operative findings after ETV with clinical correlation and to see if changes in ventricular size existed after ETV are correlated to clinical result. Methods and Materials: A total of 15 pediatric patients underwent ETV at our institution for hydrocephalus during the period of 2019 and 2020. MRI was routinely performed within the first week after surgery and its 3-month follow up. Post-operative clinical assessment was conducted by the neurosurgery team in the early post-operative period and at three and six months if the patient remained well. Results: The overall success rate and failure rate to restore CSF circulation was 73.3% and 26.7%, respectively. It demonstrated the strong association between clinical success and radiographic findings of ventriculostomy success by the presence of signal void within the expected site of third ventriculostoma on T2 weighted sequence (P=0.0088). Also, There was a statistically significant association between late clinical outcome and CSF collection with a signal void seen within it on T2 WI (P<0.001). Prepontine adhesions were seen in all the four failed ETVs. No apparent correlation between the magnitude of the change in ventricular size by Evans’ index even shortly after surgery or after three months and the clinical outcome Conclusion: The MRI study especially T2 weighted images can demonstrate successful ETV procedure by the presence of signal void at the ventriculostomy site, prepontine adhesions and a subcutaneous CSF collection with a signal void seen within it.