• Tito Vivas-Buitrago, Armelle Lokossou, Ignacio Jusué-Torres, Gabriel Pinilla-Monsalve, Ari M Blitz, Daniel A Herzka, Jamie Robison, Jiadi Xu, Hugo Guerrero-Cazares, Susumu Mori, Alfredo Quiñones-Hinojosa, Olivier Baledént, and Daniele Rigamonti.
• Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA; School of Medicine, Faculty of Health Sciences, Universidad de Santander UDES, Bucaramanga, Colombia.
• World Neurosurg. 2019 Aug 1; 128: e1118-e1125.

BackgroundIdiopathic normal pressure hydrocephalus (iNPH) is a cause of dementia that can be reversed when treated timely with cerebrospinal fluid (CSF) diversion. Understanding CSF dynamics throughout the development of hydrocephalus is crucial to identify prognostic markers to estimate benefit/risk to shunts.ObjectiveTo explore the cerebral aqueduct CSF flow dynamics with phase-contrast magnetic resonance imaging (MRI) in a novel rodent model of adult chronic communicating hydrocephalus.MethodsKaolin was injected into the subarachnoid space at the convexities in Sprague-Dawley adult rats. 11.7-T Bruker MRI was used to acquire T2-weighted images for anatomic identification and phase-contrast MRI at the cerebral aqueduct. Aqueductal stroke volume (ASV) results were compared with the ventricular volume (VV) at 15, 60, 90, and 120 days.ResultsSignificant ventricular enlargement was found in kaolin-injected animals at all times (P < 0.001). ASV differed between cases and controls/shams at every time point (P = 0.004, 0.001, 0.001, and <0.001 at 15, 60, 90, and 120 days, respectively). After correlation between the ASV and the VV, there was a significant correlation at 15 (P = 0.015), 60 (P = 0.001), 90 (P < 0.001), and 120 days. Moreover, there was a significant positive correlation between the VV expansion and the aqueductal CSF stroke between 15 and 60 days.ConclusionsAn initial active phase of rapid ventricular enlargement shows a strong correlation between the expansion of the VV and the increment in the ASV during the first 60 days, followed by a second phase with less ventricular enlargement and heterogeneous behavior in the ASV. Further correlation with complementary data from intracranial pressure and histologic/microstructural brain parenchyma assessments are needed to better understand the ASV variations after 60 days.Copyright © 2019 Elsevier Inc. All rights reserved.

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