The Sonographic Motion Quantification of the Third Ventricle Wall in Occlusive Hydrocephalus: A Dynamic Diagnostic Method

This study aimed to devise a dynamic method to diagnose occlusive hydrocephalus by transcranial ultrasound. By using transcranial B-mode ultrasound and speckle tracking software, we registered cardiac-related pulsations of the lateral walls of the third ventricle. We determined the measurement location with the least variance in 24 participants using a mixed-effect model. In six patients, we used this optimized measuring procedure to obtain deformation curves before and after surgical therapy of occlusive (i.e., obstructive) internal hydrocephalus. Speckle tracking points at the lateral change of contrast delineating the wall of the third ventricle at the level of the thalami accounted for the least variance in normal subjects. Using this refined method, all normal participants showed transient lateral distension of the third ventricle. In all patients, the deformation curves before surgery clearly differed from the normal collective and showed mostly a transient reduction of ventricle diameter. In two hydrocephalus patients with operative restoration of normal cerebrospinal fluid (CSF) pathways, the curves after surgery resembled the normal collective. The complete remission of those changes in some patients suggested restoration of near-normal CSF dynamics.