gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

3D-CISS MRI imaging in hydrocephalus occlusus – Relevance for endoscopic third ventriculostomy and clinical results

3D-CISS MRT bei Hydrozephalus occlusus – Bedeutung für die endoskopische Ventrikulozisternostomie und klinische Ergebnisse

Meeting Abstract

  • corresponding author M. Kunz - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München
  • G. Schulte-Altedorneburg - Abt. für Neuroradiologie, Klinikum Großhadern, Ludwig-Maximilians-Universität, München
  • E. Uhl - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München
  • R. Schmid-Elsaesser - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München
  • S. Zausinger - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 01.5

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Kunz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Endoscopic third ventriculostomy (ETV) is the treatment of choice in hydrocephalus occlusus caused by aqueductal stenosis. We reviewed surgical treatment and clinical course of 40 patients with special regard to pre- and postoperative refined MRI imaging.

Methods: All patients (mean age: 44.3 y, follow-up 10.6 months) were evaluated pre- and postoperatively neurologically and by 3D constructive interference in steady-state MRI imaging (3D-CISS), producing high-resolution images that display the margin between the CSF and solid structures in detail. Following findings were evaluated: Thickness of floor and extension of the third ventricle (V3), distances clivus – basilar/posterior cerebral artery, flow-void in the aqueduct and in the ventriculostomy. Radiological findings were correlated with intraoperative course concerning consistence of the floor of V3, duration of the procedure and postoperative clinical course.

Results: The 3D-CISS MRI allowed precise visualisation of the course of the basilar artery, its distance to the clivus, and of the thickness of the floor of the V3, which could be confirmed intraoperatively. A membrane in the aqueduct was clearly identified in 77.5% of the patients and in 17.5% a space occupying tectal or mesencephalic lesion. The flow related signal void in the aqueduct was absent in 90%. Postoperatively, in 29 patients a flow-void was detectable in the ventriculostomy. In this group with positive flow-void 74.1% had a significant benefit (Karnofsky Index) after ETV, 22.2% a moderate improvement and only one patient required secondary shunting. In the remaining 11 patients without visible flow-void only 54% strongly improved, 3 stoma failures (two shunts, one re-ETV) were identified and two cases with only slight or no relief of symptoms.

Conclusions: ETV in patients with hydrocephalus occlusus is safe and mostly successful. 3D-CISS MRI seems to be a valuable method, not only for precisely identifying anatomy of the relevant structures, thereby facilitating the surgical procedure, but also for displaying the ventriculostomy flow-void with its strong impact on long-term course.