Cerebrospinal Fluid Flow Studies Research Articles

Pediatric leptomeningeal metastasis: 111In-DTPA cerebrospinal fluid flow studies.

Nine children (five girls and four boys) ranging in age from 1 to 18 years (median age, 12 years) with leptomeningeal metastasis were evaluated for cerebrospinal fluid compartmentalization with cerebrospinal fluid flow studies using ventricular diethylenetriaminepentaacetic acid labeled with indium 111 (111In-DTPA). Histologic diagnosis included medulloblastoma (two), primitive neuroectodermal tumor (two), acute lymphoblastic leukemia (two), pineoblastoma (one), ependymoma (one), and anaplastic astrocytoma (one). Sixteen 111In-DTPA cerebrospinal fluid flow studies were performed, of which nine demonstrated normal anterograde cerebrospinal fluid flow of radionuclide, with the following cerebrospinal fluid compartment median times to appearance, with ranges in parentheses: ventricles, 1 minute (0 to 3 minutes); cisterna magna/basal cisterns, 5 minutes (3 to 5 minutes); cervical subarachnoid space, 8 minutes (5 to 10 minutes); thoracic subarachnoid space, 15 minutes (10 to 30 minutes); lumbar subarachnoid space, 35 minutes (20 to 45 minutes); and sylvian cistern, 80 minutes (60 to 90 minutes). Blockage of normal anterograde cerebrospinal fluid flow was seen in seven 111In-DTPA cerebrospinal fluid flow studies in the following cerebrospinal fluid compartments: cervical subarachnoid space (four), lumbar subarachnoid space (two), and cisterna magna/basal cisterns (one). Five 111In-DTPA cerebrospinal fluid flow studies were performed after demonstration of cerebrospinal fluid compartmentalization and treatment with limited-field radiation therapy to involved regions; cerebrospinal fluid flow blocks resolved in three. In conclusion, cerebrospinal fluid compartmentalization, as shown by radionuclide ventriculography, is a common occurrence in pediatric leptomeningeal metastasis (four of nine patients, or 44%) and may be palliated by involved-field radiotherapy.

Double Compartment Hydrocephalus—a New Clinical Entity

We are reporting eight patients who demonstrated double compartment hydrocephalus, i.e., supratentorial and infratentorial hydrocephalus in clinical sequence and separately. One infant with veil occlusion of the aqueduct was operated on to remove the veil and then later demonstrated panhydrocephalus. Six patients had been treated months to years earlier by the performance of a ventriculoperitoneal shunt for aqueductal hydrocephalus and then developed characteristic cerebellar-brain stem deficits from 4th ventricle enlargement. The work-up included computed tomographic scan, air study, isotope cerebrospinal fluid flow study, and direct 4th ventricle pressure studies. Operation with removal of a veil occlusion of the upper 4th ventricle aqueduct produced immediate recovery in five of six patients. The conversion of aqueductal stenosis to veil occlusion is postulated as the mechanism of "primary" veil obstruction found in infants. This new clinical entity is more common than realized. We report one patient with compartmental 4th ventricular hydrocephalus.

Iodinated serum albumin dynamic cerebrospinal fluid flow studies. Pathological variations and positive and negative images.

The use of iodinated serum albumin cerebrospinal fluid flow studies in the evaluation of a multiplicity of central nervous system abnormalities is described and correlated with contrast studies and surgical and pathological findings. The concept of negative-positive images is presented. The negative images correspond to localized areas of decreased or absent radoiactivity and are due to localized obstructions in the subarachnoid spaces. The focal nature of these holes in the scans can be diagnostic features in entities such as subdural hematoma, hemispheric tumors, and processes filling or infiltrating the subarachnoid spaces. The positive images or puddles of increased or retained activity in the scans correspond to destructive focal cortical lesions and correlate with posttraumatic areas of encephalomalacia, areas of vascular degeneration, and atrophies of the cortex seen in degenerative and developmental disorders.

Use of radio-iodinated serum albumin in the study of cerebrospinal fluid flow.

Use of radio-iodinated serum albumin in the study of cerebrospinal fluid flow.