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Objective: To investigate the value of magnetic resonance three dimensional sampling perfection with application optimized contrasts using different flip angle evolution (3D-SPACE) sequences in diagnosis and surgical strategy modification for obstructive hydrocephalus., Methods: From March 2013 to July 2014, there were 152 cases admitted in People's Liberation Army General Hospital suffered from hydrocephalus, including 88 male patients and 64 female patients aging from 8 months to 79 years. All patients were performed magnetic resonance T2WI and 3D-SPACE sequence scanning before operation. Surgical strategy was made after evaluation of 3D-SPACE sequence. Non-communicating hydrocephalus was treated with endoscopic third ventriculostomy (ETV) and communicating hydrocephalus was treated with ventriculo-peritoneal shunt. According to MR images of direct observation to site of obstruction to determine the detection rate. MRI 3D-SPACE and cranial CT examination were performed in regular follow-up studies., Results: The relevance ratio of 3D-SPACE for the diagnosis of non-communicating hydrocephalus was 98.3% (114/116), while the relevance ratio of conventional T2-weighted MRI was 72.4% (84/116). Among the 152 patients, there were 36 cases with cerebral aqueduct film obstruction, 22 cases with space-occupying lesions in pineal region, posterior part of the third ventricle, or space-occupying lesions in quadrigeminal bodies area, 10 cases with Dandy-Walker symptom, 18 cases with cyst of the anterior pool of the bridge, 16 cases with cysticercosis, 4 cases with cyst of lateral ventricle, 2 cases with cyst of fourth ventricle, 2 cases with space-occupying lesion in foramen ofmonro, 2 cases with foramen ofmonro atresia, 4 cases with craniopharyngioma, 36 cases with communicating hydrocephalus. There were 112 hydrocephalus cases (73.7%) were treated with ETV, without shunt catheter insertion in follow-up study from 1 to 18 months (average (14±9) months)., Conclusions: For obstructive hydrocephalus, MRI 3D-SPACE sequence image has high diagnostic yield rate for providing more detailed anatomical information than conventional MRI. Hence, the advanced imaging methods are helpful for surgical treatment strategy decision making.

Objective: To investigate the value of virtual endoscopy in diagnosis and treatment of hydrocephalus after failed shunt., Methods: we performed magnetic resonance imaging (MRI) 3D-SPACE sequence scanning for 76 patients suffering from hydrocephalus after failed shunt. Based on the DICOM data of 3D-SPACE sequence, we three-dimensionally reconstructed the ventricles and simulated virtual endoscopy with 3D-Slicer software. Surgical strategy was made after evaluation of virtual endoscopy images., Results: Virtual endoscopy based on 3D-SPACE images was helpful to depict the aqueduct or foramen of Monro obstructions, and confirm the reason of shunt failure. Finally, there were 56 hydrocephalus patients (73.7%) were treated with endoscopic assisted third ventricle fistula (ETV), without shunt catheter insertion., Conclusion: For patients suffering from shunt failure of hydrocephalus, virtual endoscopy has high diagnostic yield rate for providing more detailed anatomical information than conventional MR imaging. Hence, this advanced imaging method is helpful for surgical treatment strategy decision making.

Objective: To explore the complications of endoscopic third ventriculostomy (ETV) for hydrocephalus and examine their preventions., Methods: From September 2008 to September 2013, ETV was offered for obstructive hydrocephalus (n=15) and communicating hydrocephalus (n=5). And the prevention and treatment of common complications were analyzed., Results: All had achieved satisfactory outcomes. For 16 cases, their symptoms and signs disappeared, ventricle returned to normal and interstitial edema resolved; for another 4 cases, there were improvements of symptoms and (or) signs, ventricular shrinking and/or interstitial edema lessening. And the postoperative complications included fever (n=5), poor healing of incision (n=2), scalp hydrops (n=2) and intracranial infection (n=1)., Conclusion: The indications of ETV should be selected strictly according to the specific anatomical characteristics of bottom of third ventricle. And individualized methods of stoma are necessary. And early postoperative lumbar puncture and drainage may obviously reduce complications and improve surgical outcomes.

Objective: To explore the efficacies of endoscopic third ventriculostomy (ETV) and tumor biopsy in surgical treatment of obstructive hydrocephalus induced by pineal region tumors., Methods: For 65 patients of obstructive hydrocephalus induced by pineal region tumors, endoscopic third ventriculostomy (ETV) and tumor biopsy were performed from 2012 to 2014. Tumor specimens were harvested and analyzed histopathologically. According to pathological diagnosis, appropriate treatment strategies were followed., Results: Sixty-five patients underwent successfully ETV and pineal region tumor biopsy. And the histological diagnosis yield rate was 98.5% (64/65). PEB chemotherapy (cisplatin+etoposide+bleomycin) and radiotherapy were offered for germ cell tumors (n = 37) and pineal blastomas (n = 6). The therapy effective rate of germ cell tumors was 91.7% (33/36). A total of 56.9% (37/65) patients benefited without traditional craniotomy or shunt., Conclusion: For pineal region tumor induced non-communicating hydrocephalus, ETV and endoscopic tumor biopsy can relieve hydrocephalus while obtaining pathological diagnosis at a relative low risk. Most patients of germ cell tumors and pineoblastomas may avoid craniotomy and shunt. It will become a routine treatment for pineal region tumors with non-communicating hydrocephalus.

Objective: To evaluate and explore the optimal surgical strategy for the normalized treatment of pineal region tumors., Methods: From September 2007 to February 2012, 43 patients were treated in Chinese People's Liberation Army General Hospital, including 30 male and 14 female patients, with pineal region tumors and non-communicating hydrocephalus were enrolled, who were 1-52 years old, mean age was (27 ± 4) years. The clinical records, treatment strategy, and prognosis were retrospectively analyzed. All the patients routinely underwent endoscopic third ventriculostomy (ETV) and tumor biopsy as the initial treatment. Twenty-seven cases (62.8%, pure endoscopic group) with histological diagnosis of germinoma (23 cases) or pineoblastoma (4 cases) were treated with chemotherapy with/without radiation therapy after ETV. The rest 16 cases (37.2%, craniotomy group) with histological diagnosis of non-germinoma and non-pineoblastoma (5 astrocytomas, 4 pineocytomas, 4 teratomas, 2 ependymomas, and 1 pineopappiloma) had craniotomy and tumor resection after ETV. All the cases had routine follow-up at 1, 3, and 6 months after the final surgery. The clinical, imaging, and tumor markers analysis were routinely examined at follow-up., Results: In the pure endoscopic group, 1 case had intra-ventricular hemorrhage after ETV, followed by external ventricular drainage and recovered after 1 week. Endoscopic procedure related short-term ( < 3 months) complication rate was 2.3% (1/43), while long-term morbidity was 0. All cases in the pure endoscopic group had chemotherapy with/without radiation therapy. Long-term follow-up results showed that all cases were cured or had progression free survival (PFS). In the craniotomy group, 2 cases (2/16) developed intra-cranial hemorrhage after surgery, and had to be operated again for hematoma evacuation. In the craniotomy group, the short-term ( < 3 months) morbidity rate was 6/16. At 3 months follow-up, 1 case still had homonymous hemianopia, which made the long-term morbidity rate was 1/16., Conclusions: For pineal region tumors with non-communicating hydrocephalus, simultaneous ETV with tumor biopsy can be the most favorable initial diagnostic and therapeutic treatment. Second-stage treatment (chemotherapy, radiation therapy, or craniotomy with tumor resection) can be selected according to the histological diagnosis.

Objective: To explore the application of neuroendoscopic treatment for intracranial lesions., Methods: The clinic data of 372 patients with intracranial lesions, who underwent neuroendoscopic treatment at our department from May 1998 to May 2010, were reviewed retrospectively. Representative endoscopic treatments included endoscopic third ventriculostomy (ETV) (n = 198), ETV & endoscopic biopsy (n = 69), neuroendoscopic ostomy for septum pellucidum fenestration (n = 55) (for septum pellucidum cysts, n = 37) and endoscopic cystoventriculostomy for ventricular cysts (n = 50). Their surgical indications and clinical outcomes were summarized for analysis., Results: ETV was performed successfully in 369 cases. Among them, 2 failed cases underwent other operations and endoscopic biopsy failed in 1 case. Within a short post-operative period, the symptoms were resolved in 347 cases (93.3%), showed no improvement in 23 cases (6.2%) and 2 died (0.5%). At Month 6 post-operation, a failure of ETV was detected in 22 cases (9.5%), a failure of neuroendoscopic ostomy for septum pellucidum cysts in 23 (69.7%) and for ventricular cysts in 12 cases (26.7%)., Conclusion: ETV is effective in the treatment of obstructive hydrocephalus, but its indication should be strictly controlled for children. Effective rate of neuroendoscopic treatment for intracranial septum pellucidum cysts remains unsatisfactory so that its operative indication should be strictly controlled.

Objective: To evaluate the change of CSF dynamics using MR PC Cine for neuroendoscopic third ventriculostomy., Methods: 146 cases of hydrocephalus were treated by neuroendoscopic third ventriculostomy including 36 cases checked with MR PC Cine study randomly. The successful result was assessed by clinical symptom and imaging study. All the patients were given 3 months to 1 year follow-up., Results: The symptoms of 121 (83%) patients were recovered soon. CT, MRI and MR PC Cine demonstrated the CSF velocity, flow rate and dynamics change to the normal level compared with preoperative check. The effective rate of this group was 75.3% with one year follow-up., Conclusion: The method of MR PC Cine to evaluate the CSF dynamics result for neuroendoscopic third ventriculostomy is simple, fast and safe. It is worth the clinical application.