Scinticisternography and scintiventriculography. A study of C.S.F. dynamics

The problem of C.S.F. flow and absorption has attracted many different disciplines in medicine. The normal physiology and the pathology, which declares itself mainly by hydrocephalus, have been intensively studied by neurophysiologists, neurologists and neurosurgeons. The possibility of treating hydrocephalus by some form of shunting of the C.S.F. flow has given these studies important therapeutic value. The advent of scinticisternography and scintiventriculography has made it possible to visualize both the C.S.F. spaces and the flow and absorption of C.S.F. The methods are similar to other neuroradiological studies which demonstrate various parts of the nervous system by X-rays. Scinticisternography and scintiventriculography are relatively new procedures, and there is still some confusion about the significance of the various phenomena seen in scintigrams. After reviewing the literature and in examining our own material we have tried to categorize the various observations and discover the theoretical and therapeutic implications. This study was initiated like all recent work on the subject, with the aim of recognizing hydrocephalus as a treatable cause of dementia in adults. The method was found to be very helpful in the diagnosis of cerebrospinal fluid fistulas and the study of infantile hydrocephalus as well. However, it was soon apparent that the method is not only useful for diagnosis but also provides a lot of information about the principles of normal and abnormal C.S.F. flow and absorption. The data collected could be used in conjunction with information gained by other methods. These observations considerably widened the scope of the study, and many sorts of patients have been investigated. The majority of them fall into three main groups: patients suspected clinically of having some disturbance of C.S.F. flow with resultant hydrocephalus; patients thought to have rhinorrhea; and infants suspected of hydrocephalus. In addition, investigations were performed on a large group of psychiatric patients whose clinical signs included dementia, and on patients after head injury, as part of a search for some treatable disturbance of C.S.F. dynamics. The different pathologies in these patients made it easier to understand C.S.F. flow even when no treatment could be instituted. Although it is closely related to neurology, neurosurgery and nuclear medicine it is not our purpose to elaborate upon the clinical or the nuclear physical aspect of the problem. The main aim is the interpretation of the scintigrams. As will be demonstrated the normal distribution of the radio- pharmaceuticals in the various C.S.F. compartments is characteristic, and its time of appearance is predictable. This means that normal standards can be established with which to compare the findings in doubtful cases. Although the studies are very useful, they are still at an early stage. Better scanning devices and radiopharmaceutical substances, and a critical analysis of a large number of studies will allow a better understanding and therapeutic application of the method.