Ventriculography

Ventriculography is a radiographic procedure that images the cerebral ventricular system by introducing a radiopaque contrast medium into the ventricular cavities. The technique allows visualization of ventricular anatomy, the cerebral aqueduct, the third and fourth ventricles, and the patency of CSF pathways. Historically it was used to delineate hydrocephalus and intraventricular lesions before the advent of cross-sectional imaging.

Traditionally, ventriculography required direct access to a lateral ventricle, obtained by a burr hole and placement of a ventricular catheter. Contrast material, usually an iodinated water-soluble agent, was injected under fluoroscopic or radiographic control, and serial X-ray images or CT imaging were obtained to map the ventricles and CSF flow. In some cases cisternographic or fourth-ventricle approaches were used.

Indications include evaluation of hydrocephalus and ventricular size, assessment of obstructive blocks such as aqueductal stenosis, differentiation between ventricular enlargement due to atrophy versus hydrocephalus, preoperative planning for shunt placement or endoscopic procedures, and localization of intraventricular tumors or clots. It can also be used to assess shunt patency.

With advances in computed tomography and magnetic resonance imaging, noninvasive ventriculography techniques—CT ventriculography and MR ventriculography—have largely supplanted conventional invasive ventriculography for many diagnostic purposes. Risks of invasive ventriculography include infection, bleeding, intracranial air or contrast reaction, seizures, and catheter-related complications. Nevertheless, ventriculography remains a historical cornerstone in the evolution of neuroimaging and is encountered primarily in specialized or historical contexts.