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Cerebrospinal Fluid Volumetric Net Flow Rate and Direction in Idiopathic Normal Pressure Hydrocephalus

61 Pages Posted: 4 Sep 2018 First Look: Under Review

See all articles by Per K. Eide

Per K. Eide

University of Oslo - Oslo University Hospital

Kent Andre Mardal

University of Oslo - Oslo University Hospital

Erika K. Lindstrom

University of Oslo - Oslo University Hospital

Geir Ringstad

University of Oslo - Oslo University Hospital

Abstract

The aim of the present study was to examine cerebrospinal fluid (CSF) volumetric net flow rate and direction at the cranio-cervical junction (CCJ) and cerebral aqueduct in individuals with idiopathic normal pressure hydrocephalus (iNPH) using cardiac-gated phase-contrast magnetic resonance imaging (PC-MRI). An in-depth, pixel-by-pixel analysis of regions of interest from the CCJ and cerebral aqueduct, respectively, was done in 26 iNPH individuals, and in 4 healthy subjects for validation purposes. Results from patients were compared with over-night measurements of static and pulsatile intracranial pressure (ICP). In iNPH, CSF net flow at CCJ was cranially directed in 17/22 as well as in 4/4 healthy subjects. Estimated daily CSF volumetric net flow rate at CCJ was 6.9 ± 9.9 L/24 hours in iNPH patients and 4.5 ± 5.0 L/24 hours in healthy individuals. Within the cerebral aqueduct, the CSF net flow was antegrade in 7/21 iNPH patients and in 4/4 healthy subjects, while it was retrograde (i.e. towards ventricles) in 14/21 iNPH patients. Estimated daily CSF volumetric net flow rate in cerebral aqueduct was 1.1 ± 2.2 L/24 hours in iNPH while 295 ± 53 ml/24 hours in healthy individuals. Magnitude of cranially directed CSF net flow in cerebral aqueduct was highest in iNPH individuals with signs of impaired intracranial compliance. The study results indicate CSF flow volumes and direction that are profoundly different from previously assumed. We hypothesize that spinal CSF formation may serve to buffer increased demand for CSF flow through the glymphatic system during sleep and during deep inspiration to compensate for venous outflow.

Suggested Citation

Eide, Per K. and Mardal, Kent Andre and Lindstrom, Erika K. and Ringstad, Geir, Cerebrospinal Fluid Volumetric Net Flow Rate and Direction in Idiopathic Normal Pressure Hydrocephalus (September 1, 2018). NICL-18-827, Available at SSRN: https://ssrn.com/abstract=3242820 or http://dx.doi.org/10.2139/ssrn.3242820

Per K. Eide (Contact Author)

University of Oslo - Oslo University Hospital ( email )

Kirkeveien 166
Building 2H
Oslo, N-0450
Norway

Kent Andre Mardal

University of Oslo - Oslo University Hospital ( email )

Kirkeveien 166
Building 2H
Oslo, N-0450
Norway

Erika K. Lindstrom

University of Oslo - Oslo University Hospital ( email )

Kirkeveien 166
Building 2H
Oslo, N-0450
Norway

Geir Ringstad

University of Oslo - Oslo University Hospital ( email )

Kirkeveien 166
Building 2H
Oslo, N-0450
Norway

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