Table of Contents:
During external ventricular drainage (EVD) weaning, repeated cranial computed tomographies (cCT) and cranial computed ventriculographies are necessary to evaluate ventricle width. Affiliated with these diagnostic procedures are risks for the patients, caused by intrahospital transfer (Beckmann et al., 2004; Bercault et al., 2005) and radiation doses due to the CT-examination (Moskowitz et al., 2010). Furthemore intrahospital transportation of a critically ill patient is a time and labour consuming procedure (Waydhas, 1999). Hence it is advantageous to develop a bedside diagnostic method. In the department of neurosurgery at the university hospital of Marburg the contrast enhanced ultrasound (CEUS) ventriculography was developed. One milliliter of an ultrasound contrast agent (UCA) SonoVue® was administered via EVD line and visualized using tissue harmonig imaging showing the ventricles and the circulation of liquor cerebrospinalis. The paper at hand deals with the question whether visualization of ventricles and circulation of liquor cerebrospinalis can be achieved using CEUS-Ventriculography without being hazardous to the patients.
13 patients were examined by an experienced investigator in 16 cases. First a transcranial ultrasound was performed followed by CEUS-Ventriculography. Using CEUS-Ventriculography we observed the circulation of liquor cerebrospinalis. Ventricle widths gained in transcranial ultrasound were compared to ventricle widths gained in native cCT, which was performed after CEUS-Ventriculography. In a period of 30 minutes after CEUS-Ventriculography we examined intraventricular pressure, blood pressure, ECG and oxygen saturation. In a period of 5 days before and after application of SonoVue® we analyzed composition of liquor cerebrospinalis and serum regarding changes (Leukocytes, CRP, PCT, LZZ, LPrt, LLak, LGlc/ BGlc) and monitored daily measured maximal body temperature.
We found no statistical differences in the ventricle widths in cCT and Ultrasound (III.Ventricle p-Value: 0,267; IV. Ventricle p-Value: 0,075; right anterior horn p-Value: 0,256; left anterior horn p-Value: 0,716; right lateral ventricle p-Value: 0,481; left lateral ventricle p-Value: 0,603). We were able to show the circulation of liquor cerebrospinalis in all 16 cases, in 15 cases we detected the craniospinal passage of the UCA. The Injection of the UCA was well tolerated without changes in intraventricular and arterial blood pressure, oxygen saturation and ECG. We neither found evidence for Ventriculitis after the Injection of the UCA in the follow-up examinations. For a cCT-Ventriculography a total sum of 148,39 € to 156,79 € is to be expected and takes around 40-50 minutes, whereas a CEUS-Ventriculography will only come to 93,85 € consuming about 6 minutes.
The significance of our results is limited by its comparatively small sample. Nevertheless we were able to present distinct results that show great potential for visualization of ventricles and circulation of liquor cerebrospinalis. We could not completely perform diagnostic of liquor and serum in all patients, since after CEUS-Ventriculography the EVD was often removed and patients were discharged. Antibiotic therapy and infections are confounder, that may influence the registered parameters in liquor and serum. However the graphic presentation of these parameters shows no indication that intraventricular application of SonoVue® caused Ventriculitis. In order to achieve more precise results, further investigations with higher population are necessary.