Paradigm shift in hydrocephalus research in legacy of Dandy’s pioneering work: rationale for third ventriculostomy in communicating hydrocephalus |
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Authors: | Dan Greitz |
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Institution: | (1) Department of Neuroradiology, MR Research Center, Karolinska University Hospital, Bldg N8, 171 76 Stockholm, Sweden |
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Abstract: | Objective This study aims to question the generally accepted cerebrospinal fluid (CSF) bulk flow theory suggesting that the CSF is exclusively
absorbed by the arachnoid villi and that the cause of hydrocephalus is a CSF absorption deficit. In addition, this study aims
to briefly describe the new hydrodynamic concept of hydrocephalus and the rationale for endoscopic third ventriculostomy (ETV)
in communicating hydrocephalus.
Critique The bulk flow theory has proven incapable of explaining the pivotal mechanisms behind communicating hydrocephalus. Thus, the
theory is unable to explain why the ventricles enlarge, why the CSF pressure remains normal and why some patients improve
after ETV.
Hydrodynamic concept of hydrocephalus Communicating hydrocephalus is caused by decreased intracranial compliance increasing the systolic pressure transmission into
the brain parenchyma. The increased systolic pressure in the brain distends the brain towards the skull and simultaneously
compresses the periventricular region of the brain against the ventricles. The final result is the predominant enlargement
of the ventricles and narrowing of the subarachnoid space. The ETV reduces the increased systolic pressure in the brain simply
by venting ventricular CSF through the stoma. The patent aqueduct in communicating hydrocephalus is too narrow to vent the
CSF sufficiently. |
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Keywords: | Cerebrospinal fluid Compliance ETV Hydrocephalus Normal-pressure hydrocephalus Pathophysiology Pulse pressure |
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