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Cerebrospinal fluid flow in adults.

William G Bradley1, Victor Haughton2, Kent-Andre Mardal3

  • 1Department of Radiology, University of California San Diego Health System, San Diego, CA, USA.

Handbook of Clinical Neurology
|July 20, 2016
PubMed
Summary

Magnetic resonance imaging can predict treatment response in normal-pressure hydrocephalus (NPH) and identify patients with Chiari I at risk for syringomyelia. Hyperdynamic cerebrospinal fluid (CSF) flow is a key indicator for both conditions.

Keywords:
Chiari INPH: etiologyNPH: prediction of shunt-responsivenesscomputational flow dynamicsphase-contrast CSF flowsyringomyelia

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Area of Science:

  • Neurosurgery
  • Neurology
  • Radiology

Background:

  • Normal-pressure hydrocephalus (NPH) and Chiari I malformation can lead to significant neurological deficits.
  • Predicting patient response to surgical intervention is crucial for effective treatment planning.
  • Cerebrospinal fluid (CSF) dynamics play a critical role in the pathophysiology of these conditions.

Purpose of the Study:

  • To investigate the utility of phase-contrast magnetic resonance imaging (PC-MRI) CSF flow measurements in predicting treatment outcomes for NPH.
  • To identify patients with Chiari I malformation who are at risk of developing syringomyelia.
  • To explore the role of hyperdynamic CSF flow in the pathogenesis of NPH and Chiari I.

Main Methods:

  • Phase-contrast MRI was used to measure aqueductal CSF stroke volume in NPH patients.
  • Computational fluid dynamics (CFD) was employed to model CSF flow at the foramen magnum and upper cervical spine.
  • CSF flow patterns were analyzed to identify correlations with clinical presentation and treatment response.

Main Results:

  • Symptomatic NPH patients with hyperdynamic aqueductal CSF stroke volume (twice normal) showed a high likelihood of responding to ventriculoperitoneal shunting.
  • Hyperdynamic CSF flow, resulting from normal systolic brain expansion, is associated with NPH treatment response.
  • Elevated CSF pressure pulses, predicted by CFD, may be an etiologic factor in syringomyelia development in Chiari I patients.

Conclusions:

  • PC-MRI CSF flow measurements, particularly hyperdynamic flow, are valuable predictors for shunting success in NPH.
  • Hyperdynamic CSF flow is implicated in the symptoms of Chiari I malformation, suggesting a potential indication for surgical decompression.
  • CFD modeling of CSF dynamics offers insights into the mechanisms underlying NPH and syringomyelia, aiding in surgical decision-making.