CSF pulsation patterns in occlusive hydrocephalus

Abstract

Fifteen patients with solid and cystic occlusions of the cerebrospinal fluid (CSF) circulation pathways were examined with MRI using an ECG retrogated two-dimensional FISP sequence to determine whether there are certain defined pathological CSF flow patterns in these patients. All patients were clinically still compensated. The results of the measurements of CSF flow velocities at different locations in the CSF system were compared with the results from 8 healthy volunteers. In all patients with occlusive processes of the intraventricular CSF pathways (4 aqueduct stenoses, 1 membranous occlusion of the fourth ventricular outlets, 1 solid tumour at the foramen of Monro and 1 solid fourth ventricular tumour) we observed hyperdynamic CSF pulsation above the lesion. This was transmitted into the spinal canal. Close by a solid occlusion within the aqueduct the flow velocity curve over the RR cycle was typically shifted, resulting in a mirroring of the flow velocity curve compared with normals. In cystic lesions (n = 4) there was transmission of the pulsation wave through the lesion and therefore no mirroring of the flow velocity curve. This technique allows very good delineation of cystic structures in the peripineal region (n = 4), also due to the opposite direction of flow within the cyst compared with the surrounding CSF spaces, depending on the extent of communication.