Endoscopic assessment of ventricular anomalies diagnosed by MRI in hydrocephalus associated with myelomeningocele.

PURPOSE: Post-myelomeningocele (MMC) repair hydrocephalus is associated with intraventricular anomalies that influence the outcomes of endoscopic third ventriculostomy (ETV) and choroid plexus cauterization (CPC). This study aimed to evaluate the sensitivity of FIESTA-C/CISS MRI in detecting anatomical variants with potential surgical implications during ETV and CPC.

METHODS

A prospective study was conducted over a 2-year period on 23 patients with hydrocephalus following MMC repair. All patients underwent FIESTA-C/CISS MRI before and after ETV and CPC. Anomalies in the intraventricular pathway of ETV or CPC were assessed and compared to intraoperative findings to evaluate MRI sensitivity.

RESULTS

The study included 11 males (47.8%) and 12 females (52.2%). One patient underwent CPC alone, while the remaining 22 patients had both ETV and CPC. The sensitivity of FIESTA-C/CISS MRI for detecting anatomical variants was: body of the fornix (52.2%), septum pellucidum (82.6%), foramen of Monro (91.3%), third ventricle size (90.9%), massa intermedia (86.8%), thickness of the third ventricle floor (86.4%), floor inclination (90.9%), prepontine interval (PPI) size (100%), and presence of arachnoid membranes (81.8%). There was no mortality in our cohort. Thirteen (56.5%) had successful ETV/CPC procedures during follow-up, while ten patients required ventriculoperitoneal shunt (VPS) placement.

CONCLUSION

FIESTA-C/CISS MRI effectively detects intraventricular and CSF-related anatomical variants prior to endoscopy. The high sensitivity of FIESTA-C/CISS MRI makes it valuable for surgical planning and may contribute to improved success rates of ETV and CPC procedures.