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      The value of CSF flow studies in the management of CSF disorders in children: a pictorial review

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          Abstract

          CSF flow disorders are frequently encountered in children. The advent of MR technology with the emergence of new pulse sequences allowed better understanding of CSF flow dynamics. In this pictorial review, we aim to conduct a comprehensive review of the MR protocol used to study CSF flow disorders and to discuss the utility of each pulse sequence in the adopted protocol. We will focus on the key anatomical structures that should be examined to differentiate hydrocephalus form ventricular dilatation ex-vacuo. The MR features of obstructive and communicating hydrocephalus will be discussed, in addition to the manifestations of CSF disorders associated with posterior fossa malformations (Dandy-Walker malformation, Chiari, and Blake’s pouch cyst). Moreover, the value of MRI in the assessment of patients following interventional procedures (ventriculoperitoneal shunt and third ventriculostomy) will be addressed.

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          The online version of this article (10.1186/s13244-019-0686-x) contains supplementary material, which is available to authorized users.

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          The definition and classification of hydrocephalus: a personal recommendation to stimulate debate

          The aim of this review is to refine the definition and classification of hydrocephalus as a preview to developing an international consensus on the nomenclature of this complex condition. This proposed definition and classification is based on my own work in this area and is intended to promote a debate on the concepts presented. A literature review of contemporary definitions and classifications of hydrocephalus, and of the historic context in which these concepts developed, is presented. Based on new technology and understanding of hydrocephalus, the rationale for nomenclature is also discussed. Currently, there is no recognized definition of hydrocephalus. The failure to agree on a working definition impedes progress in understanding the pathophysiology and treatment of hydrocephalus. There are many proposed classifications, each with its own starting point in terms of the definition of the condition. This author recommends that the following definition be used as a starting point to develop a consensus statement defining hydrocephalus: "Hydrocephalus is an active distension of the ventricular system of the brain resulting from inadequate passage of cerebrospinal fluid from its point of production within the cerebral ventricles to its point of absorption into the systemic circulation." Such a definition can be used to develop a rational classification consistent with observations from contemporary neuroimaging and can lead to testable hypotheses. It is concluded that hydrocephalus is a complicated neurologic disorder with many causes and methods of treatment. Clinicians and basic scientists must agree on a working definition of the condition to be able to interpret results from different investigators. Reaching a consensus on a working definition and functional classification should be a high priority for researchers in this field.
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            Current and emerging MR imaging techniques for the diagnosis and management of CSF flow disorders: a review of phase-contrast and time-spatial labeling inversion pulse.

            This article provides an overview of phase-contrast and time-spatial labeling inversion pulse MR imaging techniques to assess CSF movement in the CNS under normal and pathophysiologic situations. Phase-contrast can quantitatively measure stroke volume in selected regions, notably the aqueduct of Sylvius, synchronized to the heartbeat. Judicious fine-tuning of the technique is needed to achieve maximal temporal resolution, and it has limited visualization of CSF motion in many CNS regions. Phase-contrast is frequently used to evaluate those patients with suspected normal pressure hydrocephalus and a Chiari I malformation. Correlation with successful treatment outcome has been problematic. Time-spatial labeling inversion pulse, with a high signal-to-noise ratio, assesses linear and turbulent motion of CSF anywhere in the CNS. Time-spatial labeling inversion pulse can qualitatively visualize whether CSF flows between 2 compartments and determine whether there is flow through the aqueduct of Sylvius or a new surgically created stoma. Cine images reveal CSF linear and turbulent flow patterns.
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              A consensus on the classification of hydrocephalus: its utility in the assessment of abnormalities of cerebrospinal fluid dynamics

              Background Between 2009 and 2011 an attempt has been made to develop a consensus on the classification of hydrocephalus. Clinicians and basic scientists who are recognized internationally for their work in hydrocephalus attended working meetings in which the concepts of classification of hydrocephalus were discussed at length. Purpose This review attempts to explain the relevance of a classification scheme based on the point of obstruction to the flow of cerebrospinal fluid to basic science research into the pathophysiology and effects of hydrocephalus. The review is designed to give examples of the value of this classification in analyzing research utilizing animal models. The development of hydrocephalus in the absence of a point of obstruction (true communicating hydrocephalus) is analyzed. Conclusion Contemporary neuroimaging techniques are now available that can identify the actual point of obstruction to the flow of CSF, if any, which results in the development of hydrocephalus. Such identification may lead to improved ability to analyze animal models used in hydrocephalus research as well as deciding among various treatment options.
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                Author and article information

                Contributors
                +20 01005777307 , shaimaa96@hotmail.com
                Journal
                Insights Imaging
                Insights Imaging
                Insights into Imaging
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1869-4101
                28 January 2019
                28 January 2019
                December 2019
                : 10
                : 1
                : 3
                Affiliations
                ISNI 0000 0004 0621 1570, GRID grid.7269.a, Department of Radiodiagnosis, Pediatric Radiology section, Faculty of Medicine, , Ain-Shams University, ; Abbasia, Cairo, 11657 Egypt
                Author information
                http://orcid.org/0000-0003-4401-9814
                Article
                686
                10.1186/s13244-019-0686-x
                6352391
                30689061
                3969b73d-17d4-4eaf-8919-fdb76feaa725
                © The Author(s). 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 13 July 2018
                : 3 January 2019
                Categories
                Pictorial Review
                Custom metadata
                © The Author(s) 2019

                Radiology & Imaging
                pediatric hydrocephalus,ventricular dilatation ex-vacuo,phase contrast,blake’s pouch and arachnoid cyst,dandy-walker malformation

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