• Pawel Tabakow, Marcin Czyz, Pawel Szewczyk, Artur Weiser, and Wlodzimierz Jarmundowicz.
• Departments of †Neurosurgery and ‡General Radiology, Interventional Radiology, and Neuroradiology, Wrocław Medical University, Wrocław, Poland.
• Neurosurgery. 2013 Oct 1;73(4):730-8; discussion 738.

BackgroundEndoscopic third ventriculostomy (ETV) is the preferred method for the treatment of noncommunicating hydrocephalus. The different success rates of ETV indicate the difficulties in predicting the success of this procedure.ObjectiveTo show the usefulness of intraoperative ventriculography performed by the low-field 0.15-T magnetic resonance imager Polestar N20 during ETV.MethodsThe study was conducted in 11 patients with noncommunicating hydrocephalus caused by tumors or cysts of the third ventricle (n = 5), nontumoral stenosis of the sylvian aqueduct (n = 3), and fourth ventricle outlet obstruction (n = 3). Intraoperative magnetic resonance (iMR) ventriculography was performed before and after the ETV.ResultsIn each case, iMR-ventriculography was a safe procedure and determined the exact site of obstruction of cerebrospinal fluid flow. In all cases, iMR-ventriculography performed after ETV showed with the greatest accuracy the patency of the performed fenestrations, demonstrating in 9 patients good flow of the contrast from the third ventricle to the basal cisterns, restricted flow in 1 patient, and no flow in 1 patient. The results of ventriculography were consistent with the postoperative neurological status of operated-on patients. In 3 patients, the opinion of the surgeons about the patency of endoscopic fenestration, based on intraoperative observation of the third ventricle floor, was inconsistent with the results from iMR-ventriculography.ConclusionLow-field iMR-ventriculography is a safe procedure that can be successfully applied during ETV to determine the site of obstruction in hydrocephalus and the patency of performed ventricle fenestration.

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