Radiological characteristics of hydrocephalus due to idiopathic extraventricular cisternal obstruction

Initially, hydrocephalus was divided into communicanting and non-communicanting by W. Dandy. After that terms “intraventricular” and “extraventricular” obstruction were determined. Improvement of radiological technologies have allowed to determine the level of CSF obstruction exactly. In some situations, CSF-disorders combine signs of different forms hydrocephalus. Their correct classification allows you to choose the type of surgical treatment, which reduces the rate of complications and patient’s visits on the doctor.

PURPOSE OF THE STUDY: To study the radiological signs of hydrocephalus in idiopathic obstruction of the posterior cranial fossa cisterns.

MATERIALS AND METHODS. From 2007 to 2020, 289 adult patients with idiopathic hydrocephalus were operated in the Burdenko Neurosurgical Institute. Sixty five (18,7 %) had clinical and radiological signs of extraventricular cistern obstruction. Gender distribution was 25 and 40 (38.5 % and 61.5 %), respectively. A lot radiological sings were marked and determined to the different forms of hydrocephalus.

RESULTS. FOHR was the highest (compared with other forms of idiopathic hydrocephalus (mean 0.52)). Other ventricular indexes were also high. None of them correlated with patient’s condition. Ventral dislocation of the premamillary membrane was in 89.2 %. Turkish saddle was of normal size in 51 (78.4 %) patients, and its enlarged was in 13 (20 %). A change in the periventricular signal was noted in 18.4 %. Aqueduct and IV ventricle outlets were patent in all cases. The cerebral aqueduct was dilated in 63 (96.9 %) patients. Enlargement of the cisterna magna and hypotrophy of the caudal cerebellum simultaneously was noted in 90.7 %, and this sign was significant for extraventricular cisternal obstruction (p < 0.001). FIESTA scans were showed additional membranes in the subarachnoid spaces between the ventral brainstem and the clivus. These were found in 100 % of patients, which was also a pathognomonic sign (p < 0.001).

CONCLUSION. The MRI of hydrocephalus with obstruction of the posterior cranial fossa cisterns has specific signs. It combines the sings of other forms of hydrocephalus, chronic disease in combination with symptoms of obstruction of the CSF pathways. It can be classified into a separate form and both endoscopic and shunt-surgery can be used to treatment.

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