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Assessment of cerebrospinal fluid outflow resistance

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Abstract

The brain and the spinal cord are contained in a cavity and are surrounded by cerebrospinal fluid (CSF), which provides physical support for the brain and a cushion against external pressure. Hydrocephalus is a disease, associated with disturbances in the CSF dynamics, which can be surgically treated by inserting a shunt or third ventriculostomy. This review describes the physiological background, modeling and mathematics, and the investigational methods for determining the CSF dynamic properties, with specific focus on the CSF outflow resistance, R out. A model of the cerebrospinal fluid dynamic system, with a pressure-independent R out, a pressure-dependent compliance and a constant formation rate of CSF is widely accepted. Using mathematical expressions calculated from the model, along with active infusion of artificial CSF and observation of corresponding change in ICP allows measurements of CSF dynamics. Distinction between normal pressure hydrocephalus and differential diagnoses, prediction of clinical response to shunting and the possibility of assessment of shunt function in vivo are the three most important applications of infusion studies in clinical practice.

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Acknowledgments

We thank Nina Andersson for assisting with the mathematical derivations. Dr. Czosnyka is on unpaid leave from Warsaw University of Technology, Warsaw, Poland. Dr. Eklund was supported by grant 621-2005-3047 from Swedish Research Council.

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Authors and Affiliations

  1. Department of Biomedical Engineering and Informatics, Umeå University Hospital, 90185, Umeå, Sweden

    Anders Eklund

  2. Academic Neurosurgical Unit, Department of Neuroscience, Addenbrooke’s Hospital, Cambridge, UK

    Peter Smielewski & Marek Czosnyka

  3. Regional Medical Physics Department, The James Cook University Hospital, Middlesbrough, UK

    Iain Chambers

  4. Department of Radiology, University of Illinois, Chicago, IL, USA

    Noam Alperin

  5. Department of Clinical Neuroscience, Umeå University, Umeå, Sweden

    Jan Malm

  6. Department of Neurosurgery, Medical College of Virginia Commonwealth University, Richmond, VA, USA

    Anthony Marmarou

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  1. Anders Eklund
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Correspondence to Anders Eklund.

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Eklund, A., Smielewski, P., Chambers, I. et al. Assessment of cerebrospinal fluid outflow resistance. Med Bio Eng Comput 45, 719–735 (2007). https://doi.org/10.1007/s11517-007-0199-5

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