PMC6265407_01
Brain MRI (A: T1 axial slice; B: T1 sagittal slice; C: T2 axial slice). (A) There is marked ventriculomegaly. The maximum width of the frontal horns of the lateral ventricles is 5.8 cm; the maximal internal diameter of the skull at the same level is 13.9 cm; the calculated Evans index is 0.42 (normal value: < 0.3). (B) The anterior commissure- posterior commissure line is drawn, and its length is 4.0 cm; this line is an important landmark for stereotactic targeting in GPi-DBS. (C) The third ventricle is also dilated, and there is prominent flow void artifact (white straight arrows); this artifact means that CSF flow velocity is high and there is no obstruction. Magnetic susceptibility artifacts due to ventriculoperitoneal catheter and valve (white stars).
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F1
A brain MRI revealed marked ventriculomegaly (calculated Evans index = 0.42) (Figure 1). INPH was diagnosed and a ventriculoperitoneal (VP) shunt was placed (Figure 1).
Postoperative GPi-DBS exams (A: skull radiography frontal view; B and C: brain CT coronal slices). The lead tracts (white curved arrows) avoid the right ventriculoperitoneal shunt catheter (white arrowheads) and the enlarged frontal horns of the lateral ventricles. Superimposed fused images between preoperative T2 MRI and postoperative CT (D: axial; E: coronal) confirmed the lead placement on the GPi bilaterally (white straight arrows).
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F2
The GPi-DBS lead placement was confirmed on a postoperative CT scan (Figure 2).