Prediction of endoscopic third ventriculostomy (ETV) success with 3D-SPACE technique

Evaluation of hydrocephalus patients with 3D-SPACE technique using variant FA mode at 3T

The major advantages of three-dimensional sampling perfection with application optimized contrasts using different flip-angle evolution (3D-SPACE) technique are its high resistance to artifacts that occurs as a result of radiofrequency or static field, the ability of providing images with sub-millimeter voxel size which allows obtaining reformatted images in any plane due to isotropic three-dimensional data with lower specific absorption rate values. That is crucial during examination of cerebrospinal-fluid containing complex structures, and the acquisition time, which is approximately 5 min for scanning of entire cranium. Recent data revealed that T2-weighted (T2W) 3D-SPACE with variant flip-angle mode (VFAM) imaging allows fast and accurate evaluation of the hydrocephalus patients during both pre- and post-operative period for monitoring the treatment. For a better assessment of these patients; radiologists and neurosurgeons should be aware of the details and implications regarding to the 3D-SPACE technique, and they should follow the updates in this field. There could be a misconception about the difference between T2W-VFAM and routine heavily T2W 3D-SPACE images. T2W 3D-SPACE with VFAM imaging is only a subtype of 3D-SPACE technique. In this review, we described the details of T2W 3D-SPACE with VFAM imaging and comprehensively reviewed its recent applications.

Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

OBJECTIVE After endoscopic third ventriculostomy (ETV), some patients develop recurrent symptoms of hydrocephalus. The optimal treatment for these patients is not clear: repeat ETV (re-ETV) or CSF shunting. The goals of the study were to assess the effectiveness of re-ETV relative to initial ETV in pediatric patients and validate the ETV success score (ETVSS) for re-ETV. METHODS Retrospective data of 624 ETV and 93 re-ETV procedures were collected from 6 neurosurgical centers in the Netherlands (1998-2015). Multivariable Cox proportional hazards modeling was used to provide an adjusted estimate of the hazard ratio for re-ETV failure relative to ETV failure. The correlation coefficient between ETVSS and the chance of re-ETV success was calculated using Kendall's tau coefficient. Model discrimination was quantified using the c-statistic. The effects of intraoperative findings and management on re-ETV success were also analyzed. RESULTS The hazard ratio for re-ETV failure relative to ETV failure was 1.23 (95% CI 0.90-1.69; p = 0.20). At 6 months, the success rates for both ETV and re-ETV were 68%. ETVSS was significantly related to the chances of re-ETV success (τ = 0.37; 95% bias corrected and accelerated CI 0.21-0.52; p < 0.001). The c-statistic was 0.74 (95% CI 0.64-0.85). The presence of prepontine arachnoid membranes and use of an external ventricular drain (EVD) were negatively associated with treatment success, with ORs of 4.0 (95% CI 1.5-10.5) and 9.7 (95% CI 3.4-27.8), respectively. CONCLUSIONS Re-ETV seems to be as safe and effective as initial ETV. ETVSS adequately predicts the chance of successful re-ETV. The presence of prepontine arachnoid membranes and the use of EVD negatively influence the chance of success.