Novel Application of Time-Spatial Labeling Inversion Pulse Magnetic Resonance Imaging for Diagnosis of External Hydrocephalus

Shifting subdural fluid collection and hydrocephalus after foramen magnum decompression for basilar invagination

Background: Postoperative hydrocephalus and subdural fluid collection (SFC) have been reported as the rare complications following foramen magnum decompression in patients with Chiari malformation.Case Description: The paper reports the case of a 63-year-old female patient who underwent foramen magnum decompression for basilar invagination. The patient developed a shifting, bilateral SFC and subsequent acute hydrocephalus. A ventriculoperitoneal shunting was performed and the clinical symptom resolved. The dramatic change in CSF distribution supported the diagnosis of external hydrocephalus, which was associated with a postoperative cervical pseudomeningocele.Conclusions: Postoperative SFC in patients underwent foramen magnum decompression may harbor different mechanisms. Subdural drainage for patients having external hydrocephalus may have a higher recurrence rate.

[Application of a modified Time-SLIP MRI sequence for visualization of cerebrospinal fluid movement in the cerebral aqueduct and cervical spinal canal]

Direct visualization of rapid cerebrospinal fluid movements is a topical task of neurosurgery, which has applications such as evaluating hydrocephalus and the effectiveness of 3rd ventriculostomy.

PURPOSE

The study purpose was to evaluate the capabilities of a modified Time-SLIP pulse MRI sequence for visualization of fluid (CSF) movements in the phantom, healthy subject, and patient.

MATERIAL AND METHODS

The study was performed in a phantom simulating pulsed CSF movements, healthy volunteers (9 people), and patients without impaired CSF dynamics (12 people), whose data were used to determine mean CSF flow parameters, as well as in 1 patient after 3rd ventriculostomy. A 1.5 T MRI instrument was used. The Time-SLIP parameters were as follows: TR = 8,500 ms; TEeff = 80 ms; Thk = 5.0 mm; tag spacing = 30 mm; NEX 7; inversion time (BBTI) = 2,000/3,000 ms; no cardiosynchronization. Scanning time was 2:16 min. The estimated parameter was the length of motion (LOM) of CSF.

RESULTS

According to a study on a phantom simulating various conditions of oscillatory fluid motion, the mean LOM determination error in the modified Time-SLIP mode was 20%. This technique provided the following LOM data for the cerebral aqueduct (median, 25-75% quartiles): 13.0 (9.5-16.0) mm for BBTI of 2,000ms and 30.2 (23.7-35.3) mm for BBTI of 3,000 ms, i.e. 2.3-fold higher. This difference may be explained by an intense turbulent current leading to rapid CSF exchange between the 3rd and 4th ventricles and prolonged CSF movement during several heart contractions. Quantitative parameters of CSF movement at the C1-C2 level were determined. Additionally, Time-SLIP was used to evaluate performance of a third ventricle fistula.

CONCLUSION

We have proposed a modified Time-SLIP pulse sequence that does not require cardiosynchronization. The mean relative error in determining the CSF movement distance was 20%. The mean quantitative parameters of CSF movement in the cerebral aqueduct and at the C1-C2 level were obtained. Turbulent CSF flow is found in the cerebral aqueduct, which leads to rapid exchange between the 3rd and 4th ventricles.