RESUMO
OBJECTIVE: To analyze the anatomical changes of the IV ventricle and cisterna magna in the Chiari malformation I (CMI) and basilar invagination (type B). METHODS: This is a controlled study with 161 exams of magnetic resonance imaging (MRI) of adults grouped into control (n = 37), basilar invagination (BI; n = 31), Chiari malformation I (CMI; n = 37), and CMI+BI (n = 56). The MRIs were analyzed using the visualization software Osirix (Pixmeo, Bernex, Geneva, version 3.8.2). The morphometric variables were: distance from the obex to the McRae line; length of the IV ventricle floor; and the area and volume of the cisterna magna. The univariate ANOVA followed by Tukey's post-hoc test was applied to evaluate the difference between the groups. The difference between sexes was evaluated by the t test for each group. RESULTS: Alterations in the cisterna magna and IV ventricle were more evident only in the CMI and CMI+BI groups. For both sexes, the CMI and CMI+BI groups showed: a reduction in the CSF space (P < 0.001), cisterna magna with volume reduction (P < 0.001), low position of the obex (P < 0.001), and IV ventricle more elongated (male P = 0.007 and female P < 0.001). The BI group had no significant change in the analysis by sex. CONCLUSIONS: The CMI (isolated and associated with BI) showed a low obex position and elongation of the IV ventricle due to traction towards the spinal canal. The reduction of cisterna magna volume added to the occupation of the cerebellar tonsils can impact in the cerebrospinal fluid dynamics. The BI when isolated was not related to alterations in the parameters of cerebrospinal fluid spaces studied.
Assuntos
Malformação de Arnold-Chiari , Platibasia , Adulto , Humanos , Masculino , Feminino , Cisterna Magna/diagnóstico por imagem , Platibasia/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/complicações , Imageamento por Ressonância Magnética , Quarto Ventrículo/diagnóstico por imagemAssuntos
Neoplasias do Ventrículo Cerebral , Glioma Subependimal , Humanos , Glioma Subependimal/diagnóstico por imagem , Glioma Subependimal/cirurgia , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/cirurgia , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/cirurgiaRESUMO
PURPOSE: Evidence supporting the effectiveness of endoscopic aqueductoplasty (EA) for the treatment of isolated fourth ventricle (IFV) is limited to small surgical series of cases. Additionally, studies adopted different radiological outcome criteria, which makes it difficult to compare outcomes accurately. Thus, we aimed to develop a radiological score (RS) as an alternative assessment method for EA. METHODS: The cases of 20 consecutive pediatric patients harboring IFV and treated by EA were retrospectively reviewed. Clinical data and pre- and 1-year postoperative brain images were analyzed. The RS was based on the enlargement of the fourth ventricle and deformation of the cerebellum and brainstem. After randomization, three experts, blinded to patient outcomes, analyzed the brain images and established a consensus for the values of the score. Outcomes were validated by comparing the maximum anteroposterior distance of the fourth ventricle using the RS, pediatric functional status score, and clinical symptoms. RESULTS: The RS was strongly correlated with the anteroposterior distance of the fourth ventricle (Pearson's coefficient = 0.78), and the mean RS dropped from 6.15 to 3.90 (p < 0.001) 1 year after EA. Upward extension (p = 0.021) and brainstem deformation (p = 0.010) were the most significant improved features. There was agreement among RS and symptom improvement in 16 children (80%) and the pediatric functional status score in 14 children (70%). CONCLUSION: In this study, the proposed radiological score proved to be an accurate tool for the evaluation of IFV treatment with EA.
Assuntos
Hidrocefalia , Neuroendoscopia , Aqueduto do Mesencéfalo/cirurgia , Criança , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/cirurgia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Estudos Retrospectivos , Stents , VentriculostomiaAssuntos
Ventrículos Cerebrais/anormalidades , Quarto Ventrículo/anormalidades , Adolescente , Edema Encefálico/etiologia , Edema Encefálico/patologia , Ventrículos Cerebrais/patologia , Ventrículos Cerebrais/cirurgia , Serviço Hospitalar de Emergência , Feminino , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/patologia , Quarto Ventrículo/cirurgia , Humanos , Hidrocefalia/cirurgia , Imageamento por Ressonância Magnética/métodos , Derivação Ventriculoperitoneal/métodosRESUMO
OBJECTIVES: to propose standardisation of fourth ventricle dimensions and to study its characteristics in neurocysticercosis. METHOD: a control group (CG) constituted by 114 individuals with normal CT, and 80 patients with neurocysticercosis composed the group with neurocysticercosis (GN). Measures of the inner cranial diameter (Cr), fronto-polar distance between both lateral ventricles (FP), antero-posterior (AP) and latero-lateral (LL) fourth ventricle width based the standardisation of six indexes. RESULTS: AP/Cr, AP/LL and AP/FP were the more discriminative indexes, presenting in CG the mean values of 0.063, 0.267 and 0.582, respectively. The indexes in GN had values statistically higher than in CG. From GN, 51 patients had increased indexes values above 2 standard deviation of the CG mean. AP/Ll was >/= 1 in 95% of patients with ventricular shunting and in 88% with depression. It also occurred in 73% patients with satisfactory follow-up and in everybody who died. CONCLUSION: AP/Cr, AP/LL and AP/FP may represent fourth ventricle dimensions.