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Published on: February 29, 2020
Pre- and postoperative cerebrospinal fluid absorption studies in patients with myelomeningocele shunted for
Insights
Ventriculoperitoneal shunts in infants with myelomeningocele and hydrocephalus may normalize cerebrospinal fluid (CSF) pressure. This stabilization potentially improves CSF absorption by reducing elevated sagittal sinus pressure.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Biomedical Engineering
Background:
- Myelomeningocele and hydrocephalus frequently coexist in infants.
- Elevated intracranial pressure is a common complication, impacting cerebrospinal fluid (CSF) dynamics.
- Ventriculoperitoneal shunts are a standard treatment for hydrocephalus.
Purpose of the Study:
- To investigate the impact of ventriculoperitoneal shunts on CSF formation and absorption in infants.
- To quantify changes in CSF conductance (Ccsf) and shunt conductance (Cs) postoperatively.
- To elucidate the mechanism by which shunts may normalize CSF pressure and absorption.
Main Methods:
- Cerebrospinal fluid formation and absorption studies were conducted on nine infants before and six after ventriculoperitoneal shunt insertion.
- CSF formation rates and CSF conductance (Ccsf) were measured preoperatively.
- Postoperative CSF conductance (Ct) was calculated as the sum of Ccsf and shunt conductance (Cs).
- The relationship between Ccsf and Cs was determined using the method of least-squares.
Main Results:
- Preoperative CSF formation rates ranged from 0.21-0.42 ml/min.
- Preoperative CSF conductance (Ccsf) varied from 0.008 to 0.031 ml/min/mm Hg.
- Postoperative CSF formation rates ranged from 0.21 to 0.39 ml/min.
- Data suggests shunts establish a new resting pressure, potentially by stabilizing sagittal sinus pressure.
Conclusions:
- Ventriculoperitoneal shunts may normalize CSF pressure in infants with myelomeningocele and hydrocephalus.
- Shunt placement can indirectly improve CSF absorption by mitigating elevated sagittal sinus pressure.
- This stabilization addresses a pre-existing absorption deficit exacerbated by increased CSF pressure.
Abstract:
Nine infants with myelomeningocele and hydrocephalus had cerebrospinal fluid formation and absorption studies before insertion of a ventriculoperitoneal shunt. Six were also tested postoperatively. The preshunt formation rate varied from 0.21-0.42 ml.min-1 and the cerebrospinal fluid absorption rate or CSF conductance (Ccsf) varied from 0.008 to 0.031 ml.min-1.mm Hg-1. The postoperative formation rate varied from 0.21 to 0.39 ml.min-1. The postoperative CSF conductance (Ct) was calculated as the sum of Ccsf and the shunt conductance (Cs). The relationship between the Ccsf and Cs curves was determined by matching the sum of these curves to the postoperative data points using the method of least-squares. The data suggests that the shunt may work directly or indirectly to establish a new resting pressure; the latter by stabilizing the sagittal sinus pressure which preoperatively increased concomitantly with the CSF pressure and thus enhanced an already-existing absorption deficit.
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