The pressure-volume function of brain elasticity. Physiological considerations and clinical applications

The intracranial pressure-volume function as determined by brain elasticity is reported in normal dogs. Rapid subarachnoid infusions clearly define an exponential relationship between pressure and volume. An aliquot technique to measure elastance (dP/dV) at multiple intracranial pressures demonstrates a linear relationship between elastance and pressure. This follows mathematically from the exponential nature of the basic pressure-volume function. The clinical significance of brain elastance measurements is discussed. It is emphasized that the effects of pressure on CSF dynamics are superimposed on the pressure-volume function of brain elasticity and probably account for the process of spatial compensation for an expanding mass lesion. It is not apparent that elastance measurements can serve as indicators of impending decompensation, since the pressure-volume function of brain elasticity provides no direct information about CSF dynamics. Accordingly, the clinical usefullness of elastance measurements is seriously questioned.