Value of MRI CSF Flowmetry in Assessment of Grey Zone Hydrocephalic Patients

Study Overview
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Brief Summary
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To evaluate accuracy of (MRI) cerebrospinal fluid flowmetry after shunt operation in patients with borderline (grey zone) hydrocephalus.

Detailed Description
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Hydrocephalus could be defined as disturbance of formation, flow or absorption of CSF. We encounter some challenging cases with intermittent non specific symptoms as delayed milestones and headache with concomitant imaging showing dilated ventricular system, so we find ourselves hesitating to take the decision of surgical intervention to put shunt or not, therefore MRI CSF flowmetry gives us a chance to overcome this problem. Phase contrast MR imaging is a rapid, simple and non-invasive technique which is sensitive to even small CSF flows, and can be used to evaluate CSF flow both qualitatively and quantitatively. CSF flow measurement at the suspected level of obstruction gives reliable and reproducible results for more accurate diagnosis and can be used to guide therapeutic decisions in a more reliable manner, and follow up post treatment outcome. With the CT and magnetic resonance imaging (MRI) techniques, it is possible to localize with accuracy the exact site of blockage of flow to CSF. Hence classification is as follows: The hydrocephalus may be due to 1) overproduction of CSF 2) obstructive 3) absorption defect. Depending on the exact aetiology, a secondary classification could be added under the following headings: 1) congenital, 2) acquired, eg; traumatic inflammatory, neoplastic, and degenerative . Bypassing the site of obstruction to CSF flow by diverting the CSF from ventricular cavity to a site where it is readily absorbed is the basic principle underlying the treatment of hydrocephalus. Extensive range of complications has been reported for shunting for hydrocephalus. They could be classified as mechanical or flow-related complications as CSF over drainage leading to subdural hematoma, subdural collections, low-pressure headaches cranial deformity, and asymmetrical drainage can lead to trapping or isolation of a part of a ventricular system. The slit ventricular syndrome is a complication related to absorption. Besides, ascites, loculations, hydrocele, perforation of the stomach, large and small bowel are also described. The success rates of shunt operation for hydrocephalus depend on the age of the patient and the reason why the shunt is needed. Generally, there is around a 50% failure rate for ventriculoperitoneal shunts.

Official Title
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Value of MRI CSF Flowmetry in Assessment of Grey Zone Hydrocephalic Patients

Conditions
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Hydrocephalus

Intervention / Treatment
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* Other: MR CSF flowmetry


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with borderline hydrocephalus Clinically:suspicious and non specific symptoms as Headache Macrocranium Vomiting Gait instability Dementia Urine incontinence. delayed milestone. Radiologicaly: dilated ventricular system. Exclusion Criteria: Documented or clinically and radiologically evident cases of hydrocephalus Patients known to have contraindications for MRI, e.g. an implanted magnetic device, pacemakers or claustrophobia.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: grey zone hydrocephalic patients<br>MR CSF flowmetry CT brain Ventriculoperitoneal shunt | Other: MR CSF flowmetry<br>* MR flowmetry in grey zone hydro cephalic patients followed by ventriculoperitoneal shunt<br>* Other names: Ventriculoperitoneal shunt;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Decompressive changes in CT brain | CT brain showing decompression of the ventricular system in response to ventriculoperitoneal shunt | 2 months |