Role of interpeduncular and prepontine cistern cerebrospinal fluid flow measurements in prediction of endoscopic third ventriculostomy success in pediatric triventricular hydrocephalus.

Aim: The aim of the present study was to evaluate the correlation of the clinical success of the endoscopic third ventriculostomy (ETV) procedure with the measurements of cerebrospinal fluid (CSF) flow through the interpeduncular and prepontine cisterns in pediatric triventricular hydrocephalus.

Methods: 51 children (age range: 25-201 months; mean: 55.3 months) with primary aqueductal stenosis who have been treated with ETV were included in the study. All patients were analyzed by conventional and cine magnetic resonance imaging (MRI) before and after endoscopic treatment. Both the stroke volume and the flow velocity of CSF in the interpeduncular and prepontine cisterns were evaluated. The MRI findings were correlated with clinical outcome. Simple descriptive and independent t tests were used for statistical analyses, and receiver operating characteristic curve analysis was used for the cutoff value of the 'flow index' (FI).

Results: Among the 51 patients, 37 patients (72.5%) responded to ETV clinically during long-term follow-up. A further analysis was made for the prediction of who would respond to ETV, using the formula (stroke volume of prepontine cistern/stroke volume of interpeduncular cistern) ×100, which was defined as the FI. Early postoperative FI values of over 40% were significantly correlated with ETV success.

Conclusion: Our results suggest that ETV success can be predicted by the ratio of early CSF stroke volume values of the interpeduncular and prepontine cisterns.