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Jurjević I, Orešković D, Radoš M, Brgić K, Klarica M. Changes of cerebrospinal fluid pressure gradient in different body positions under experimental impairment of cerebrospinal fluid pathway: new insight into hydrocephalus development. Front Mol Neurosci 2024; 17:1397808. [PMID: 38947218 PMCID: PMC11212498 DOI: 10.3389/fnmol.2024.1397808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/24/2024] [Indexed: 07/02/2024] Open
Abstract
It is generally accepted that hydrocephalus is a consequence of the disbalance between cerebrospinal fluid (CSF) secretion and absorption which should in turn lead to CSF pressure gradient development and ventricular enlargement. To test CSF pressure gradient role in hydrocephalus development, we experimentally caused CSF system impairment at two sites in cats. In the first group of animals, we caused Sylvian aqueduct obstruction and recorded CSF pressure changes pre and post obstruction at three measuring sites (lateral ventricle -LV, cortical-CSS and lumbar subarachnoid space -LSS) during 15 min periods and in different body positions over 360 degrees. In the second group of experiments, we caused cervical stenosis by epidural plastic semiring implantation and monitored CSF pressure changes pre and post stenosis implantation at two measuring sites (lateral ventricle and lumbar subarachnoid space) during 15 min periods in different body positions over 360 degrees. Both groups of experimental animals had similar CSF pressures before stenosis or obstruction at all measuring points in the horizontal position. During head-up verticalization, CSF pressures inside the cranium gradually became more subatmospheric with no significant difference between LV and CSS, as they are measured at the same hydrostatic level, while CSF pressure inside LSS became more positive, causing the development of a large hydrostatic gradient between the cranial and the spinal space. With cervical stenosis, CSF pressure inside the cranium is positive during head-up verticalization, while in cats with aqueductal obstruction CSF pressure inside the CSS remains negative, as it was during control period. Concomitantly, CSF pressure inside LV becomes less negative, thus creating a small hydrostatic gradient between LV and CSS. Since CSF pressure and gradient changes occur only by shifting body position from the horizontal plane, our results indicate that cervical stenosis in a head-up vertical position reduces blood perfusion of the whole brain, while aqueductal obstruction impairs only the perfusion of the local periventricular brain tissue. It seems that, for evolutionary important bipedal activity, free craniospinal communication and good spinal space compliance represent crucial biophysical parameters for adequate cerebral blood perfusion and prevention of pathophysiological changes leading to the development of hydrocephalus.
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Affiliation(s)
- Ivana Jurjević
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Neurology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darko Orešković
- Department of Molecular Biology, Ruđer Bošković Institute, Zagreb, Croatia
| | - Milan Radoš
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Klara Brgić
- Department of Neurosurgery, Univesity Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijan Klarica
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
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Parikh SK. Rebound Intracranial Hypertension. Curr Pain Headache Rep 2024; 28:395-401. [PMID: 38430310 PMCID: PMC11126494 DOI: 10.1007/s11916-024-01231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW Rebound intracranial hypertension (RIH) is a post-procedural treatment complication in patients with spontaneous intracranial hypotension (SIH) characterized by transient high-pressure headache symptoms. This article reviews the epidemiology, clinical features, risk factors, and treatment options for RIH. RECENT FINDINGS This article discusses how changes in underlying venous pressure and craniospinal elastance can explain symptoms of RIH, idiopathic intracranial hypertension (IIH), and SIH. The pathophysiology of RIH provides a clue for how high and low intracranial pressure disorders, such as IIH and SIH, are connected on a shared spectrum.
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Affiliation(s)
- Simy K Parikh
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
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Luchtmann M, Klammer A, Iova MA, Roth A, Chanamolu VK, Mawrin C, Warnke JP. Thecaloscopy Reduces the Risk of Recurrent Perineural (Tarlov) Cysts after Microsurgical Resection. Neurol Int 2024; 16:450-458. [PMID: 38668130 PMCID: PMC11054917 DOI: 10.3390/neurolint16020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
Sacral Tarlov cysts (TCs), often asymptomatic, can cause significant pain and severe neurological dysfunction. Conventional treatments are generally associated with high recurrence and complication rates. Specifically, the substantial recurrence rates, which can reach as high as 50%, significantly impact long-term outcomes. Recent evidence increasingly supports the hypothesis that the formation of Tarlov cysts (TCs) may be associated with inflammatory processes within the nerve root sheath, further exacerbated by elevated cerebrospinal fluid (CSF) pressure. This retrospective study explores thecaloscopy, combined with surgical techniques, as a more effective alternative. We observed a total of 78 patients, 48 of whom underwent endoscopic fenestration of the arachnoid sheath in addition to microsurgical resection of the TC. We found that the fenestration of the arachnoid sheath at the level of lumbosacral spinal nerve root entry led to a significantly decreased risk of developing recurrent TCs (5/48 vs. 9/30). Only one of the patients suffered from a persistent new bladder dysfunction after microsurgical resection. This presented technique provides a promising treatment path for the future management of TCs, offering a safe and more effective treatment option compared to previous methods. Additionally, the advantages of the thecaloscopy provide pathophysiological implications regarding the development of perineural cysts.
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Affiliation(s)
- Michael Luchtmann
- Department of Neurosurgergy, Heinrich-Braun-Klinikum, 08060 Zwickau, Germany
- Department of Neurosurgery, Paracelsus-Klinikum, 08060 Zwickau, Germany
- Leupold Institute for Applied Natural Sciences, University of Applied Science, 08056 Zwickau, Germany
- Vigdis Thompson Foundation, 08412 Werdau, Germany
| | - Angelika Klammer
- Department of Neurosurgery, Paracelsus-Klinikum, 08060 Zwickau, Germany
- Vigdis Thompson Foundation, 08412 Werdau, Germany
| | - Mircea-Alin Iova
- Department of Neurosurgergy, Heinrich-Braun-Klinikum, 08060 Zwickau, Germany
- Department of Neurosurgery, Paracelsus-Klinikum, 08060 Zwickau, Germany
| | - André Roth
- Department of Neurosurgery, Paracelsus-Klinikum, 08060 Zwickau, Germany
| | - Vijay Kumar Chanamolu
- Department of Neurosurgergy, Heinrich-Braun-Klinikum, 08060 Zwickau, Germany
- Department of Neurosurgery, Paracelsus-Klinikum, 08060 Zwickau, Germany
| | - Christian Mawrin
- Vigdis Thompson Foundation, 08412 Werdau, Germany
- Department of Neuropathology, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Jan-Peter Warnke
- Department of Neurosurgery, Paracelsus-Klinikum, 08060 Zwickau, Germany
- Vigdis Thompson Foundation, 08412 Werdau, Germany
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Boraschi A, Hafner M, Spiegelberg A, Kurtcuoglu V. Influence of age on the relation between body position and noninvasively acquired intracranial pulse waves. Sci Rep 2024; 14:5493. [PMID: 38448614 PMCID: PMC10918064 DOI: 10.1038/s41598-024-55860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
The capacitive measurement of the head's dielectric properties has been recently proposed as a noninvasive method for deriving surrogates of craniospinal compliance (CC), a parameter used in the evaluation of space-occupying neurological disorders. With the higher prevalence of such disorders in the older compared to the younger population, data on the head's dielectric properties of older healthy individuals would be of particularly high value before assessing pathologic changes. However, so far only measurements on young volunteers (< 30 years) were reported. In the present study, we have investigated the capacitively obtained electric signal known as W in older healthy individuals. Thirteen healthy subjects aged > 60 years were included in the study. W was acquired in the resting state (supine horizontal position), and during head-up and head-down tilting. AMP, the peak-to-valley amplitude of W related to cardiac action, was extracted from W. AMP was higher in this older cohort compared to the previously investigated younger one (0°: 5965 ± 1677 arbitrary units (au)). During head-up tilting, AMP decreased (+ 60°: 4446 ± 1620 au, P < 0.001), whereas it increased during head-down tilting (- 30°: 7600 ± 2123 au, P < 0.001), as also observed in the younger cohort. Our observation that AMP, a metric potentially reflective of CC, is higher in the older compared to the younger cohort aligns with the expected decrease of CC with age. Furthermore, the robustness of AMP is reinforced by the consistent relative changes observed during tilt testing in both cohorts.
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Affiliation(s)
- Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Matthias Hafner
- The Interface Group, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Andreas Spiegelberg
- The Interface Group, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Vartan Kurtcuoglu
- The Interface Group, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
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Yu DY, Cringle SJ, Darcey D, Tien LYH, Vukmirovic AJ, Yu PK, Mehnert A, Morgan WH. Posture-Induced Changes in Intraocular, Orbital, Cranial, Jugular Vein, and Arterial Pressures in a Porcine Model. Invest Ophthalmol Vis Sci 2023; 64:22. [PMID: 38108688 PMCID: PMC10732089 DOI: 10.1167/iovs.64.15.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose The purpose of this study was to determine posture-induced changes in arterial blood pressure (ABP), intraocular pressure (IOP), orbital pressure (Porb), intracranial pressure (ICP), and jugular vein pressure (JVP) at various tilt angles in an in vivo pig. Methods Anesthetized and ventilated pigs (n = 8) were placed prone on a tiltable operating table. ABP, IOP, Porb, ICP, and JVP were monitored while the table was tilted at various angles between 15 degrees head up tilt (HUT) and 25 degrees head down tilt (HDT) either in stepwise changes (5 degrees per step) or continuously. The mean pressure was calculated from digitized pressure waveforms from each compartment. For stepwise changes in tilt angle the pressures were plotted as a function of tilt angle. For continuous tilt changes, the pressures were plotted as a function of time. Results In the case of stepwise changes, ABP remained relatively stable whilst IOP, Porb, ICP, and JVP demonstrated significant differences between most angles (typically P < 0.0001). The difference was greatest for IOP (P < 0.0001) where the average IOP increased from 13.1 ± 1.23 mm Hg at 15 degrees HUT to 46.3 ± 2.03 mm Hg at 25 degrees HDT. The relationship between pressure and tilt angle was almost linear for ICP and JVP, and sigmoidal for IOP and Porb. Interestingly, the effect of changes in tilt angle occurred very rapidly, within a few seconds. Conclusions Our results in a pig model demonstrate that changes in posture (tilt angle) induce rapid changes in IOP, Porb, ICP, and JVP, with IOP affected most severely.
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Affiliation(s)
- Dao-Yi Yu
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Stephen J. Cringle
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Dean Darcey
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Liam Y. H. Tien
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
| | - Aleksandar J. Vukmirovic
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Paula K. Yu
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Andrew Mehnert
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - William H. Morgan
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
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Podgoršak A, Trimmel NE, Oertel MF, Arras M, Weisskopf M, Schmid Daners M. The influence of upright posture on craniospinal, arteriovenous, and abdominal pressures in a chronic ovine in-vivo trial. Fluids Barriers CNS 2023; 20:83. [PMID: 37946223 PMCID: PMC10634040 DOI: 10.1186/s12987-023-00485-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Most investigations into postural influences on craniospinal and adjacent physiology have been performed in anesthetized animals. A comprehensive study evaluating these physiologies while awake has yet been completed. METHODS Six awake sheep had telemetric pressure sensors (100 Hz) implanted to measure intracranial, intrathecal, arterial, central venous, cranial, caudal, dorsal, and ventral intra-abdominal pressure (ICP, ITP, ABP, CVP, IAPcr, IAPcd, IAPds, IAPve, respectively). They were maneuvered upright by placing in a chair for two minutes; repeated 25 times over one month. Changes in mean and pulse pressure were calculated by comparing pre-chair, P0, with three phases during the maneuver: P1, chair entrance; P2, chair halftime; P3, prior to chair exit. Statistical significance (p ≤ .05) was assessed using repeated measures ANOVA. RESULTS Significant mean pressure changes of (P1 - P0) and (P3 - P0) were measured at - 12.1 ± 3.1 and - 14.2 ± 3.0(p < .001), 40.8 ± 10.5 and 37.7 ± 3.5(p = .019), 9.7 ± 8.3 and 6.2 ± 5.3(p = .012), 22.3 ± 29.8 and 12.5 ± 12.1(p = .042), and 11.7 ± 3.9 and 9.0 ± 5.2(p = .014) mmHg, for ICP, ITP, IAPds, IAPcr, IAPca, respectively. For pulse pressures, significant changes of (P1 - P0) and (P3 - P0) were measured at - 1.3 ± 0.7 and - 2.0 ± 1.1(p < .001), 4.7 ± 2.3 and 1.4 ± 1.4(p < .001), 15.0 ± 10.2 and 7.3 ± 5.5(p < .001), - 0.7 ± 1.8 and - 1.7 ± 1.7(p < .001), - 1.3 ± 4.2 and - 1.4 ± 4.7(p = .006), and 0.3 ± 3.9 and - 1.0 ± 1.3(p < .001) mmHg, for ICP, ITP, ABP, IAPds, IAPcr, IAPca, respectively. CONCLUSIONS Pressures changed posture-dependently to differing extents. Changes were most pronounced immediately after entering upright posture (P1) and became less prominent over the chair duration (P2-to-P3), suggesting increased physiologic compensation. Dynamic changes in IAP varied across abdominal locations, motivating the abdominal cavity not to be considered as a unified entity, but sub-compartments with individual dynamics.
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Affiliation(s)
- Anthony Podgoršak
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Nina Eva Trimmel
- Center for Preclinical Development, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Markus Florian Oertel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Margarete Arras
- Center for Preclinical Development, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Miriam Weisskopf
- Center for Preclinical Development, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Kazimierska A, Manet R, Vallet A, Schmidt E, Czosnyka Z, Czosnyka M, Kasprowicz M. Analysis of intracranial pressure pulse waveform in studies on cerebrospinal compliance: a narrative review. Physiol Meas 2023; 44:10TR01. [PMID: 37793420 DOI: 10.1088/1361-6579/ad0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/04/2023] [Indexed: 10/06/2023]
Abstract
Continuous monitoring of mean intracranial pressure (ICP) has been an essential part of neurocritical care for more than half a century. Cerebrospinal pressure-volume compensation, i.e. the ability of the cerebrospinal system to buffer changes in volume without substantial increases in ICP, is considered an important factor in preventing adverse effects on the patient's condition that are associated with ICP elevation. However, existing assessment methods are poorly suited to the management of brain injured patients as they require external manipulation of intracranial volume. In the 1980s, studies suggested that spontaneous short-term variations in the ICP signal over a single cardiac cycle, called the ICP pulse waveform, may provide information on cerebrospinal compensatory reserve. In this review we discuss the approaches that have been proposed so far to derive this information, from pulse amplitude estimation and spectral techniques to most recent advances in morphological analysis based on artificial intelligence solutions. Each method is presented with focus on its clinical significance and the potential for application in standard clinical practice. Finally, we highlight the missing links that need to be addressed in future studies in order for ICP pulse waveform analysis to achieve widespread use in the neurocritical care setting.
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Affiliation(s)
- Agnieszka Kazimierska
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Romain Manet
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, Lyon, France
| | - Alexandra Vallet
- Department of Mathematics, University of Oslo, Oslo, Norway
- INSERM U1059 Sainbiose, Ecole des Mines Saint-Étienne, Saint-Étienne, France
| | - Eric Schmidt
- Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France
| | - Zofia Czosnyka
- Brain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Marek Czosnyka
- Brain Physics Laboratory, Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
- Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
| | - Magdalena Kasprowicz
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Wroclaw, Poland
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Kheram N, Boraschi A, Pfender N, Spiegelberg A, Kurtcuoglu V, Curt A, Schubert M, Zipser CM. Queckenstedt's test repurposed for the quantitative assessment of the cerebrospinal fluid pulsatility curve. Acta Neurochir (Wien) 2023; 165:1533-1543. [PMID: 37079108 DOI: 10.1007/s00701-023-05583-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/16/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Before the era of spinal imaging, presence of a spinal canal block was tested through gross changes in cerebrospinal fluid pressure (CSFP) provoked by manual compression of the jugular veins (referred to as Queckenstedt's test; QT). Beyond these provoked gross changes, cardiac-driven CSFP peak-to-valley amplitudes (CSFPp) can be recorded during CSFP registration. This is the first study to assess whether the QT can be repurposed to derive descriptors of the CSF pulsatility curve, focusing on feasibility and repeatability. METHOD Lumbar puncture was performed in lateral recumbent position in fourteen elderly patients (59.7±9.3 years, 6F) (NCT02170155) without stenosis of the spinal canal. CSFP was recorded during resting state and QT. A surrogate for the relative pulse pressure coefficient was computed from repeated QTs (i.e., RPPC-Q). RESULTS Resting state mean CSFP was 12.3 mmHg (IQR 3.2) and CSFPp was 1.0 mmHg (0.5). Mean CSFP rise during QT was 12.5 mmHg (7.3). CSFPp showed an average 3-fold increase at peak QT compared to the resting state. Median RPPC-Q was 0.18 (0.04). There was no systematic error in the computed metrics between the first and second QT. CONCLUSION This technical note describes a method to reliably derive, beyond gross CSFP increments, metrics related to cardiac-driven amplitudes during QT (i.e., RPPC-Q). A study comparing these metrics as obtained by established procedures (i.e., infusion testing) and by QT is warranted.
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Affiliation(s)
- Najmeh Kheram
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Nikolai Pfender
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
| | - Andreas Spiegelberg
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Vartan Kurtcuoglu
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
| | - Carl Moritz Zipser
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland.
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Sagirov AF, Sergeev TV, Shabrov AV, Yurov AY, Guseva NL, Agapova EA. Postural influence on intracranial fluid dynamics: an overview. J Physiol Anthropol 2023; 42:5. [PMID: 37055862 PMCID: PMC10100470 DOI: 10.1186/s40101-023-00323-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/01/2023] [Indexed: 04/15/2023] Open
Abstract
This review focuses on the effects of different body positions on intracranial fluid dynamics, including cerebral arterial and venous flow, cerebrospinal fluid (CSF) hydrodynamics, and intracranial pressure (ICP). It also discusses research methods used to quantify these effects. Specifically, the implications of three types of body positions (orthostatic, supine, and antiorthostatic) on cerebral blood flow, venous outflow, and CSF circulation are explored, with a particular emphasis on cerebrovascular autoregulation during microgravity and head-down tilt (HDT), as well as posture-dependent changes in cerebral venous and CSF flow, ICP, and intracranial compliance (ICC). The review aims to provide a comprehensive analysis of intracranial fluid dynamics during different body positions, with the potential to enhance our understanding of intracranial and craniospinal physiology.
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Affiliation(s)
- Arlan Faritovich Sagirov
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia.
| | - Timofey Vladimirovich Sergeev
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia
| | - Aleksandr Vladimirovich Shabrov
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia
| | - Andrey Yur'evich Yurov
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia
| | - Nadezhda Leonidovna Guseva
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia
| | - Elizaveta Aleksandrovna Agapova
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia
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Karimi F, Neufeld E, Fallahi A, Boraschi A, Zwanenburg JJM, Spiegelberg A, Kurtcuoglu V, Kuster N. Theory for a non-invasive diagnostic biomarker for craniospinal diseases. Neuroimage Clin 2022; 37:103280. [PMID: 36508887 PMCID: PMC9763738 DOI: 10.1016/j.nicl.2022.103280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Monitoring intracranial pressure (ICP) and craniospinal compliance (CC) is frequently required in the treatment of patients suffering from craniospinal diseases. However, current approaches are invasive and cannot provide continuous monitoring of CC. Dynamic exchange of blood and cerebrospinal fluid (CSF) between cranial and spinal compartments due to cardiac action transiently modulates the geometry and dielectric properties of the brain. The resulting impedance changes can be measured and might be usable as a non-invasive CC surrogate. A numerically robust and computationally efficient approach based on the reciprocity theorem was developed to compute dynamic impedance changes resulting from small geometry and material property changes. The approach was successfully verified against semi-analytical benchmarks, before being combined with experimental brain pulsation data to study the information content of the impedance variation. The results indicate that the measurable signal is dominated by the pulsatile displacement of the cortical brain surface, with minor contributions from the ventricular surfaces and from changes in brain perfusion. Different electrode setups result in complementary information. The information content from the investigated three electrode pairs was employed to successfully infer subject-specific brain pulsation and motion features. This suggests that non-invasive CC surrogates based on impedance monitoring could be established.
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Affiliation(s)
- Fariba Karimi
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland; Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland.
| | - Esra Neufeld
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Arya Fallahi
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland; Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Jaco J M Zwanenburg
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andreas Spiegelberg
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Vartan Kurtcuoglu
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Niels Kuster
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland; Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
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Trimmel NE, Podgoršak A, Oertel MF, Jucker S, Arras M, Schmid Daners M, Weisskopf M. Venous dynamics in anesthetized sheep govern postural-induced changes in cerebrospinal fluid pressure comparable to those in humans. Physiol Rep 2022; 10:e15525. [PMID: 36541216 PMCID: PMC9768641 DOI: 10.14814/phy2.15525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 06/17/2023] Open
Abstract
Sheep are popular large animals in which to model human disorders and to study physiological processes such as cerebrospinal fluid dynamics. However, little is known about vascular compensatory mechanisms affecting cerebrospinal fluid pressures during acute postural changes in sheep. Six female white Alpine sheep were anesthetized to investigate the interactions of the vascular and cerebrospinal fluid system by acquiring measurements of intracranial pressure and central and jugular venous pressure during passive postural changes induced by a tilt table. The cross-sectional area of the common jugular vein and venous blood flow velocity was recorded. Anesthetized sheep showed bi-phasic effects of postural changes on intracranial pressure during tilting. A marked collapse of the jugular vein was observed during head-over-body tilting; this is in accordance with findings in humans. Active regulatory effects of the arterial system on maintaining cerebral perfusion pressure were observed independent of tilting direction. Conclusion: Anesthetized sheep show venous dynamics in response to posture-induced changes in intracranial pressure that are comparable with those in humans.
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Affiliation(s)
- Nina Eva Trimmel
- Center for Surgical ResearchUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Anthony Podgoršak
- Department of Mechanical and Process Engineering, ETH ZurichZurichSwitzerland
| | - Markus Florian Oertel
- Department of NeurosurgeryUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Simone Jucker
- Center for Surgical ResearchUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Margarete Arras
- Center for Surgical ResearchUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | | | - Miriam Weisskopf
- Center for Surgical ResearchUniversity Hospital Zurich, University of ZurichZurichSwitzerland
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12
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Holmlund P, Støverud KH, Eklund A. Mathematical modelling of the CSF system: effects of microstructures and posture on optic nerve subarachnoid space dynamics. Fluids Barriers CNS 2022; 19:67. [PMID: 36042452 PMCID: PMC9426285 DOI: 10.1186/s12987-022-00366-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background The pressure difference between the eye and brain in upright postures may be affected by compartmentalization of the optic nerve subarachnoid space (ONSAS). Both pressure and deformation will depend on the microstructures of the ONSAS, and most likely also on ocular glymphatic clearance. Studying these factors could yield important knowledge regarding the translaminar pressure difference, which is suspected to play a role in normal-tension glaucoma. Methods A compartment model coupling the ONSAS with the craniospinal CSF system was used to investigate the effects of microstructures on the pressure transfer through the ONSAS during a posture change from supine to upright body postures. ONSAS distensibility was based on MRI measurements. We also included ocular glymphatic flow to investigate how local pressure gradients alter this flow with changes in posture. Results A compartmentalization of the ONSAS occurred in the upright posture, with ONSAS porosity (degree of microstructural content) affecting the ONSAS pressure (varying the supine/baseline porosity from 1.0 to 0.75 yielded pressures between − 5.3 and − 2 mmHg). Restricting the minimum computed porosity (occurring in upright postures) to 0.3 prevented compartmentalization, and the ONSAS pressure could equilibrate with subarachnoid space pressure (− 6.5 mmHg) in \documentclass[12pt]{minimal}
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\begin{document}$$\le$$\end{document}≤ 1 h. The ocular glymphatics analysis predicted that substantial intraocular-CSF flows could occur without substantial changes in the ONSAS pressure. The flow entering the ONSAS in supine position (both from the intraocular system and from the cranial subarachnoid space) exited the ONSAS through the optic nerve sheath, while in upright postures the flow through the ONSAS was redirected towards the cranial subarachnoid space. Conclusions Microstructures affect pressure transmission along the ONSAS, potentially contributing to ONSAS compartmentalization in upright postures. Different pathways for ocular glymphatic flow were predicted for different postures.
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Affiliation(s)
- Petter Holmlund
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, 901 87, Umeå, Sweden.
| | - Karen-Helene Støverud
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, 901 87, Umeå, Sweden.,Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Anders Eklund
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, 901 87, Umeå, Sweden.,Umeå Center for Functional Brain Imaging, Umeå University, 901 87, Umeå, Sweden
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13
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D'Antona L, Craven CL, Bremner F, Matharu MS, Thorne L, Watkins LD, Toma AK. Effect of position on intracranial pressure and compliance: a cross-sectional study including 101 patients. J Neurosurg 2021:1-9. [PMID: 34715658 DOI: 10.3171/2021.6.jns203573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 06/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A better understanding of the effect of position on intracranial pressure (ICP) and compliance is important for the development of treatment strategies that can restore normal cerebrospinal fluid (CSF) dynamics. There is limited knowledge on the effect of position on intracranial compliance. In this cross-sectional study the authors tested the association of pulse amplitude (PA) with position and the day/night cycle. Additionally, they describe the postural ICP and PA changes of patients with "normal" ICP dynamics. METHODS This single-center retrospective study included patients with suspected and/or confirmed CSF dynamics abnormalities who had been examined with elective 24-hour ICP monitoring between October 2017 and September 2019. Patients had been enrolled in a short exercise battery including four positions: supine, lumbar puncture position in the left lateral decubitus position, sitting, and standing. Each position was maintained for 2 minutes, and mean ICP and PA were calculated for each position. The 24-hour day and night median ICP and PA data were also collected. Linear regression models were used to test the correlation of PA with position and day/night cycle. All linear regressions were corrected for confounders. The postural ICP monitoring results of patients without obvious ICP dynamics abnormality were summarized. RESULTS One hundred one patients (24 males and 77 females) with a mean age of 39 ± 13years (mean ± standard deviation) were included in the study. The adjusted linear regression models demonstrated a significant association of ICP with position and day/night cycle, with upright (sitting and standing) and day ICP values lower than supine and night ICP values. The adjusted linear regression model was also significant for the association of PA with position and day/night cycle, with upright and day PA values higher than supine and night PA results. These associations were confirmed for patients with and without shunts. Patients without clear ICP dynamics abnormality had tighter control of their postural ICP changes than the other patients; however, the difference among groups was not statistically significant. CONCLUSIONS This is the largest study investigating the effect of postural changes on intracranial compliance. The results of this study suggest that PA, as well as ICP, is significantly associated with posture, increasing in upright positions compared to that while supine. Further studies will be needed to investigate the mechanism behind this association.
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Affiliation(s)
- Linda D'Antona
- 1Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square.,2UCL Queen Square Institute of Neurology
| | - Claudia Louise Craven
- 1Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square
| | - Fion Bremner
- 2UCL Queen Square Institute of Neurology.,3Department of Neuro-Ophthalmology, The National Hospital for Neurology and Neurosurgery; and
| | - Manjit Singh Matharu
- 4Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Lewis Thorne
- 1Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square
| | - Laurence Dale Watkins
- 1Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square
| | - Ahmed Kassem Toma
- 1Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square.,2UCL Queen Square Institute of Neurology
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14
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Cheng SJ, Hakkinen I, Zhang P, Roychowdhury S. Paradoxical headache in a case of chronic spontaneous intracranial hypotension and multiple perineural cysts. Headache 2021; 61:1291-1294. [PMID: 34510443 DOI: 10.1111/head.14188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Samantha J Cheng
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ian Hakkinen
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Pengfei Zhang
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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15
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Gergelé L, Manet R. Postural Regulation of Intracranial Pressure: A Critical Review of the Literature. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 131:339-342. [PMID: 33839871 DOI: 10.1007/978-3-030-59436-7_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mechanisms underlying postural regulation of ICP remain unclear. METHOD Literature review in Medline 1900-2019 with search terms "Intracranial pressure," "Posture," "Jugular vein," "Collapse," "Regulation," "Physiology," resulting in 40 selected papers. RESULTS Postural transition from supine to sitting position results in a biphasic decrease of ICP: a fast decrease during phase 1 (low tilt) followed by a stabilization during phase 2 (higher tilt/erect). Two main factors have been proposed to explain this decrease: (a) Fast CSF transfers from the non-distensible cranial compartment to the distensible spinal compartment during phase 1; the maximal spinal expansion corresponds to phase 2; (b) The gravitational effect within the venous system is transferred to the CSF system according to Davson's equation, modulated by jugular collapse that would be responsible for the stabilization of ICP decrease in phase 2. DISCUSSION The impact of CSF transfers, from the cranial to spinal compartment, on postural regulation of ICP, has been well documented. Although they are sophisticated, models that support the major influence of jugular collapse likely underestimate the role of the vertebral venous plexus in cerebral venous outflow in the upright position. Moreover, Davson's equation supports slow CSF transfer from subarachnoid spaces to the venous system (a few mL/min) and thus cannot explain fast postural modulation of ICP (in a few seconds). Further data are thus needed to better understand postural regulation of ICP.
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Affiliation(s)
- Laurent Gergelé
- Department of Intensive Care, Ramsay Générale de Santé, Hôpital Privé de la Loire, Saint Etienne, France
| | - Romain Manet
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, Lyon, France.
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16
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Holmlund P, Støverud KH, Wåhlin A, Wiklund U, Malm J, Jóhannesson G, Eklund A. Posture-Dependent Collapse of the Optic Nerve Subarachnoid Space: A Combined MRI and Modeling Study. Invest Ophthalmol Vis Sci 2021; 62:26. [PMID: 33877263 PMCID: PMC8083083 DOI: 10.1167/iovs.62.4.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We hypothesize that a collapse of the optic nerve subarachnoid space (ONSAS) in the upright posture may protect the eyes from large translamina cribrosa pressure differences (TLCPD) believed to play a role in various optic nerve diseases (e.g., glaucoma). In this study, we combined magnetic resonance imaging (MRI) and mathematical modeling to investigate this potential ONSAS collapse and its effects on the TLCPD. Methods First, we performed MRI on six healthy volunteers in 6° head-down tilt (HDT) and 13° head-up tilt (HUT) to assess changes in ONSAS volume (measured from the eye to the optic canal) with changes in posture. The volume change reflects optic nerve sheath (ONS) distensibility. Second, we used the MRI data and mathematical modeling to simulate ONSAS pressure and the potential ONSAS collapse in a 90° upright posture. Results The MRI showed a 33% decrease in ONSAS volume from the HDT to HUT (P < 0.001). In the upright posture, the simulations predicted an ONSAS collapse 25 mm behind lamina cribrosa, disrupting the pressure communication between the ONSAS and the intracranial subarachnoid space. The collapse reduced the simulated postural increase in TLCPD by roughly 1 mm Hg, although this reduction was highly sensitive to ONS distensibility, varying between 0 and 4.8 mm Hg when varying the distensibility by ± 1 SD. Conclusions The ONSAS volume along the optic nerve is posture dependent. The simulations supported the hypothesized ONSAS collapse in the upright posture and showed that even small changes in ONS stiffness/distensibility may affect the TLCPD.
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Affiliation(s)
- Petter Holmlund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | | | - Anders Wåhlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - Urban Wiklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Gauti Jóhannesson
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
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17
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Young BA, Adams J, Beary JM, Mardal KA, Schneider R, Kondrashova T. Variations in the cerebrospinal fluid dynamics of the American alligator (Alligator mississippiensis). Fluids Barriers CNS 2021; 18:11. [PMID: 33712028 PMCID: PMC7953579 DOI: 10.1186/s12987-021-00248-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Studies of mammalian CSF dynamics have been focused on three things: paravascular flow, pressure and pulsatility, and "bulk" flow; and three (respective) potential motive forces have been identified: vasomotor, cardiac, and ventilatory. There are unresolved questions in each area, and few links between the different areas. The American alligator (Alligator mississippiensis) has pronounced plasticity in its ventilatory and cardiovascular systems. This study was designed to test the hypothesis that the greater cardiovascular and ventilatory plasticity of A. mississippiensis would result in more variation within the CSF dynamics of this species. METHODS Pressure transducers were surgically implanted into the cranial subarachnoid space of 12 sub-adult alligators; CSF pressure and pulsatility were monitored along with EKG and the exhalatory gases. In four of the alligators a second pressure transducer was implanted into the spinal subarachnoid space. In five of the alligators the CSF was labeled with artificial microspheres and Doppler ultrasonography used to quantify aspects of the spinal CSF flow. RESULTS Both temporal and frequency analyses of the CSF pulsations showed highly variable contributions of both the cardiac and ventilatory cycles. Unlike the mammalian condition, the CSF pressure pulsations in the alligator are often of long (~ 3 s) duration, and similar duration CSF unidirectional flow pulses were recorded along the spinal cord. Reduction of the duration of the CSF pulsations, as during tachycardia, can lead to a "summation" of the pulsations. There appears to be a minimum duration (~ 1 s) of isolated CSF pulsations. Simultaneous recordings of cranial and spinal CSF pressures reveal a 200 ms delay in the propagation of the pressure pulse from the cranium to the vertebral canal. CONCLUSIONS Most of the CSF flow dynamics recorded from the alligators, are similar to what has been reported from studies of the human CSF. It is hypothesized that the link between ventilatory mechanics and CSF pulsations in the alligator is mediated by displacement of the spinal dura. The results of the study suggest that understanding the CSF dynamics of Alligator may provide unique insights into the evolutionary origins and functional regulation of the human CSF dynamics.
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Affiliation(s)
- Bruce A Young
- Department of Anatomy, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO, 63501, USA.
| | - James Adams
- Department of Anatomy, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO, 63501, USA
| | - Jonathan M Beary
- Behavioral Neuroscience, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO, 63501, USA
| | | | - Robert Schneider
- Family Medicine, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO, 63501, USA
| | - Tatyana Kondrashova
- Family Medicine, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO, 63501, USA
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18
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Alperin N, Burman R, Lee SH. Role of the spinal canal compliance in regulating posture-related cerebrospinal fluid hydrodynamics in humans. J Magn Reson Imaging 2021; 54:206-214. [PMID: 33491833 DOI: 10.1002/jmri.27505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022] Open
Abstract
Mechanical compliance of a compartment is defined by the change in its volume with respect to a change in the inside pressure. The compliance of the spinal canal regulates the intracranial pressure (ICP) under postural changes. Understanding how gravity affects ICP is beneficial for poorly understood cerebrospinal fluid (CSF)-related disorders. The aim of this study was to evaluate postural effects on cranial hemo- and hydrodynamics. This was a prospective study, which included 10 healthy volunteers (three males, seven females, mean ± standard deviation age: 29 ± 7 years). Cine gradient-echo phase-contrast sequence acquired at 0.5 T, "GE double-doughnut" scanner was used. Spinal contribution to overall craniospinal compliance (CSC), craniospinal CSF stroke volume (SV), magnetic resonance (MR)-derived ICP (MR-ICP), and total cerebral blood flow (TCBF) were measured in supine and upright postures using automated blood and CSF flows quantification. Statistical tests performed were two-sided Student's t-test, Cohen's d, and Pearson correlation coefficient. MR-ICP and the craniospinal CSF SV were significantly correlated with the spinal contribution to the overall CSC (r = 0.83, p < 0.05) and (r = 0.62, p < 0.05), respectively. Cranial contribution to CSC increased from 44.5% ± 16% in supine to 74.9% ± 8.4% in upright posture. The average MR-ICP dropped from 9.9 ± 3.4 mmHg in supine to -3.5 ± 1.5 mmHg. The CSF SV was over 2.5 times higher in the supine position (0.55 ± 0.14 ml) than in the upright position (0.21 ± 0.13 ml). In contrast, TCBF was slightly higher in the supine posture (822 ± 152 ml/min) than in the upright posture (761 ± 139 ml/min), although not statistically significant (p = 0.16). The spinal-canal compliance contribution to CSC is larger than the cranial contribution in the supine posture and smaller in the upright posture. Thereby, the spinal canal plays a role in modulating ICP upon postural changes. The lower pressure craniospinal CSF system was more affected by postural changes than the higher-pressure cerebral vascular system. Craniospinal hydrodynamics is affected by gravity and is likely to be altered by its absence in space. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Noam Alperin
- Radiology Department, University of Miami, Miami, Florida, USA.,Biomedical Engineering Department, University of Miami, Miami, Florida, USA
| | - Ritambhar Burman
- Radiology Department, University of Miami, Miami, Florida, USA.,Biomedical Engineering Department, University of Miami, Miami, Florida, USA
| | - Sang H Lee
- Radiology Department, University of Miami, Miami, Florida, USA
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19
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Young BA, Adams J, Beary JM, Mardal KA, Schneider R, Kondrashova T. The myodural bridge of the American alligator ( Alligator mississippiensis) alters CSF flow. J Exp Biol 2020; 223:jeb230896. [PMID: 33077640 DOI: 10.1242/jeb.230896] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/11/2020] [Indexed: 12/19/2022]
Abstract
Disorders of the volume, pressure or circulation of the cerebrospinal fluid (CSF) lead to disease states in both newborns and adults; despite this significance, there is uncertainty regarding the basic mechanics of the CSF. The suboccipital muscles connect to the dura surrounding the spinal cord, forming a complex termed the 'myodural bridge'. This study tests the hypothesis that the myodural bridge functions to alter the CSF circulation. The suboccipital muscles of American alligators were surgically exposed and electrically stimulated simultaneously with direct recordings of CSF pressure and flow. Contraction of the suboccipital muscles significantly changed both CSF flow and pressure. By demonstrating another influence on CSF circulation and pulsatility, the present study increases our understanding of the mechanics underlying the movement of the CSF.
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Affiliation(s)
- Bruce A Young
- Department of Anatomy, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO 63501, USA
| | - James Adams
- Department of Anatomy, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO 63501, USA
| | - Jonathan M Beary
- Department of Behavioral Neuroscience, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO 63501, USA
| | | | - Robert Schneider
- Department of Family Medicine, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO 63501, USA
| | - Tatyana Kondrashova
- Department of Family Medicine, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO 63501, USA
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20
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Vinje V, Eklund A, Mardal KA, Rognes ME, Støverud KH. Intracranial pressure elevation alters CSF clearance pathways. Fluids Barriers CNS 2020; 17:29. [PMID: 32299464 PMCID: PMC7161287 DOI: 10.1186/s12987-020-00189-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/28/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Infusion testing is a common procedure to determine whether shunting will be beneficial in patients with normal pressure hydrocephalus. The method has a well-developed theoretical foundation and corresponding mathematical models that describe the CSF circulation from the choroid plexus to the arachnoid granulations. Here, we investigate to what extent the proposed glymphatic or paravascular pathway (or similar pathways) modifies the results of the traditional mathematical models. METHODS We used a compartment model to estimate pressure in the subarachnoid space and the paravascular spaces. For the arachnoid granulations, the cribriform plate and the glymphatic circulation, resistances were calculated and used to estimate pressure and flow before and during an infusion test. Finally, different variations to the model were tested to evaluate the sensitivity of selected parameters. RESULTS At baseline intracranial pressure (ICP), we found a very small paravascular flow directed into the subarachnoid space, while 60% of the fluid left through the arachnoid granulations and 40% left through the cribriform plate. However, during the infusion, 80% of the fluid left through the arachnoid granulations, 20% through the cribriform plate and flow in the PVS was stagnant. Resistance through the glymphatic system was computed to be 2.73 mmHg/(mL/min), considerably lower than other fluid pathways, giving non-realistic ICP during infusion if combined with a lymphatic drainage route. CONCLUSIONS The relative distribution of CSF flow to different clearance pathways depends on ICP, with the arachnoid granulations as the main contributor to outflow. As such, ICP increase is an important factor that should be addressed when determining the pathways of injected substances in the subarachnoid space. Our results suggest that the glymphatic resistance is too high to allow for pressure driven flow by arterial pulsations and at the same time too small to allow for a direct drainage route from PVS to cervical lymphatics.
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Affiliation(s)
- Vegard Vinje
- Department of Scientific Computing and Numerical Analysis, Simula Research Laboratory, Lysaker, Norway.
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Kent-Andre Mardal
- Department of Scientific Computing and Numerical Analysis, Simula Research Laboratory, Lysaker, Norway.,Department of Mathematics, University of Oslo, Oslo, Norway
| | - Marie E Rognes
- Department of Scientific Computing and Numerical Analysis, Simula Research Laboratory, Lysaker, Norway
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21
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Jones HC, Keep RF, Drewes LR. CNS fluid and solute movement: physiology, modelling and imaging. Fluids Barriers CNS 2020; 17:12. [PMID: 32019555 PMCID: PMC6998813 DOI: 10.1186/s12987-020-0174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Hazel C Jones
- Gagle Brook House, Chesterton, Bicester, OX26 1UF, UK.
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, 48105, USA
| | - Lester R Drewes
- Department of Biomedical Sciences, University of Minnesota Medical School Duluth, Duluth, MN, 55812, USA
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22
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Sass LR, Khani M, Romm J, Schmid Daners M, McCain K, Freeman T, Carter GT, Weeks DL, Petersen B, Aldred J, Wingett D, Martin BA. Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients. Fluids Barriers CNS 2020; 17:4. [PMID: 31959193 PMCID: PMC6971921 DOI: 10.1186/s12987-019-0164-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background Developing novel therapeutic agents to treat amyotrophic lateral sclerosis (ALS) has been difficult due to multifactorial pathophysiologic processes at work. Intrathecal drug administration shows promise due to close proximity of cerebrospinal fluid (CSF) to affected tissues. Development of effective intrathecal pharmaceuticals will rely on accurate models of how drugs are dispersed in the CSF. Therefore, a method to quantify these dynamics and a characterization of differences across disease states is needed. Methods Complete intrathecal 3D CSF geometry and CSF flow velocities at six axial locations in the spinal canal were collected by T2-weighted and phase-contrast MRI, respectively. Scans were completed for eight people with ALS and ten healthy controls. Manual segmentation of the spinal subarachnoid space was performed and coupled with an interpolated model of CSF flow within the spinal canal. Geometric and hydrodynamic parameters were then generated at 1 mm slice intervals along the entire spine. Temporal analysis of the waveform spectral content and feature points was also completed. Results Comparison of ALS and control groups revealed a reduction in CSF flow magnitude and increased flow propagation velocities in the ALS cohort. Other differences in spectral harmonic content and geometric comparisons may support an overall decrease in intrathecal compliance in the ALS group. Notably, there was a high degree of variability between cases, with one ALS patient displaying nearly zero CSF flow along the entire spinal canal. Conclusion While our sample size limits statistical confidence about the differences observed in this study, it was possible to measure and quantify inter-individual and cohort variability in a non-invasive manner. Our study also shows the potential for MRI based measurements of CSF geometry and flow to provide information about the hydrodynamic environment of the spinal subarachnoid space. These dynamics may be studied further to understand the behavior of CSF solute transport in healthy and diseased states.
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Affiliation(s)
- Lucas R Sass
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Mohammadreza Khani
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Jacob Romm
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA.,University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Kyle McCain
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Tavara Freeman
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Gregory T Carter
- St. Luke's Rehabilitation Institute, 711 South Cowley St., Spokane, WA, 99202, USA
| | - Douglas L Weeks
- St. Luke's Rehabilitation Institute, 711 South Cowley St., Spokane, WA, 99202, USA
| | - Brian Petersen
- Inland Imaging PS and LLC, 801 South Stevens St., Spokane, WA, 99204, USA
| | - Jason Aldred
- Selkirk Neurology, 610 South Sherman St. #201, Spokane, WA, 99202, USA
| | - Dena Wingett
- Inland Imaging LLC, 801 South Stevens St., Spokane, WA, 99204, USA
| | - Bryn A Martin
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA. .,Biological Engineering, University of Idaho, 875 Perimeter Dr. MS0904, Moscow, ID, 83844-0904, USA.
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Hulens M, Rasschaert R, Bruyninckx F, Dankaerts W, Stalmans I, De Mulder P, Vansant G. Symptomatic Tarlov cysts are often overlooked: ten reasons why-a narrative review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2237-2248. [PMID: 31079249 DOI: 10.1007/s00586-019-05996-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/05/2019] [Accepted: 05/05/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Tarlov cysts (TCs) are dilations of nerve roots arising from pathologically increased hydrostatic pressure (HP) in the spinal canal. There is much controversy regarding whether these cysts are a rare source of pain or often produce symptoms. The aim of this review was to identify the reasons that symptomatic TCs (STCs) are easily overlooked. METHODS The literature was searched for data regarding pathogenesis and symptomatology. RESULTS TCs may be overlooked for the following reasons: (1) STCs are considered clinically irrelevant findings; (2) it is assumed that it is clinically difficult to ascertain that TCs are the cause of pain; (3) MRI or electromyography studies only focus on the L1 to S1 nerves; (4) TCs are usually not reported by radiologists; (5) degenerative alterations of the lumbosacral spine are almost always identified as the cause of a patient's pain; (6) it is not generally known that small TCs can be symptomatic; (7) examinations and treatments usually focus on the cysts as an underlying mechanism; however, essentially, increased HP is the main underlying mechanism for producing symptoms. Consequently, STCs may relapse after surgery; (8) bladder, bowel and sphincter dysfunction are not inquired about during history taking. (9) Unexplained pain is often attributed to depression, whereas depression is more likely the consequence of debilitating neuropathic pain. (10) The recognition of STCs is subject to gender bias, confirmation bias and cognitive dissonance and unconscious bias in publishing. CONCLUSION There are several reasons STCs are underdiagnosed, mostly due to persistent misconceptions and biases. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Mieke Hulens
- Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Tervuursevest 101, 3001, Heverlee, Belgium. .,, Sint-Joris-Weert, Belgium.
| | - Ricky Rasschaert
- Department of Neurosurgery, AZ Rivierenland, Kasteelstraat 23, 2880, Bornem, Belgium
| | - Frans Bruyninckx
- Clinical Electromyography Laboratory, University Hospitals UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Wim Dankaerts
- Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Ingeborg Stalmans
- Ophthalmology Research Group, Department of Neurosciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.,Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Peter De Mulder
- Department of Anesthesiology and Pain Therapy, Imelda Hospital, 2820 Bonheiden, Belgium
| | - Greet Vansant
- Department of Social and Primary Health Care, Public Health Nutrition, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
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24
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Depauw PRAM, Groen RJM, Van Loon J, Peul WC, Malbrain MLNG, De Waele JJ. The significance of intra-abdominal pressure in neurosurgery and neurological diseases: a narrative review and a conceptual proposal. Acta Neurochir (Wien) 2019; 161:855-864. [PMID: 30911831 PMCID: PMC6483957 DOI: 10.1007/s00701-019-03868-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/03/2019] [Indexed: 11/24/2022]
Abstract
Intra-abdominal pressure (IAP) is a physiological parameter that has gained considerable attention during the last few decades. The incidence of complications arising from increased IAP, known as intra-abdominal hypertension (IAH) or abdominal compartment syndrome in critically ill patients, is high and its impact is significant. The effects of IAP in neurological conditions and during surgical procedures are largely unexplored. IAP also appears to be relevant during neurosurgical procedures (spine and brain) in the prone position, and in selected cases, IAH may affect cerebrospinal fluid drainage after a ventriculoperitoneal shunt operation. Furthermore, raised IAP is one of the contributors to intracranial hypertension in patients with morbid obesity. In traumatic brain injury, case reports described how abdominal decompression lowers intracerebral pressure. The anatomical substrate for transmission of the IAP to the brain and venous system of the spine is the extradural neural axis compartment; the first reports of this phenomenon can be found in anatomical studies of the sixteenth century. In this review, we summarize the available knowledge on how IAP impacts the cerebrospinal venous system and the jugular venous system via two pathways, and we discuss the implications for neurosurgical procedures as well as the relevance of IAH in neurological disorders.
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Affiliation(s)
- Paul R A M Depauw
- Department of Neurosurgery, Elisabeth Tweesteden Hospital (ETZ), Tilburg, The Netherlands.
- Elisabeth Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes Van Loon
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center (LUMC) and The Hague Medical Center (HMC+), Leiden, The Netherlands
| | - Manu L N G Malbrain
- Intensive Care Unit, University Hospital Brussels (UZB), Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jan J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
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25
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Benninghaus A, Balédent O, Lokossou A, Castelar C, Leonhardt S, Radermacher K. Enhanced in vitro model of the CSF dynamics. Fluids Barriers CNS 2019; 16:11. [PMID: 31039805 PMCID: PMC6492379 DOI: 10.1186/s12987-019-0131-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Fluid dynamics of the craniospinal system are complex and still not completely understood. In vivo flow and pressure measurements of the cerebrospinal fluid (CSF) are limited. Whereas in silico modeling can be an adequate pathway for parameter studies, in vitro modeling of the craniospinal system is essential for testing and evaluation of therapeutic measures associated with innovative implants relating to, for example, normal pressure hydrocephalus and other fluid disorders. Previously-reported in vitro models focused on the investigation of only one hypothesis of the fluid dynamics rather than developing a modular set-up to allow changes in focus of the investigation. The aim of this study is to present an enhanced and validated in vitro model of the CSF system which enables the future embedding of implants, the validation of in silico models or phase-contrast magnetic resonance imaging (PC-MRI) measurements and a variety of sensitivity analyses regarding pathological behavior, such as reduced CSF compliances, higher resistances or altered blood dynamics. METHODS The in vitro model consists of a ventricular system which is connected via the aqueduct to the cranial and spinal subarachnoid spaces. Two compliance chambers are integrated to cushion the arteriovenous blood flow generated by a cam plate unit enabling the modeling of patient specific flow dynamics. The CSF dynamics are monitored using three cranial pressure sensors and a spinal ultrasound flow meter. Measurements of the in vitro spinal flow were compared to cervical flow data recorded with PC-MRI from nine healthy young volunteers, and pressure measurements were compared to the literature values reported for intracranial pressure (ICP) to validate the newly developed in vitro model. RESULTS The maximum spinal CSF flow recorded in the in vitro simulation was 133.60 ml/min in the caudal direction and 68.01 ml/min in the cranial direction, whereas the PC-MRI flow data of the subjects showed 122.82 ml/min in the caudal and 77.86 ml/min in the cranial direction. In addition, the mean ICP (in vitro) was 12.68 mmHg and the pressure wave amplitude, 4.86 mmHg, which is in the physiological range. CONCLUSIONS The in vitro pressure values were in the physiological range. The amplitudes of the flow results were in good agreement with PC-MRI data of young and healthy volunteers. However, the maximum cranial flow in the in vitro model occurred earlier than in the PC-MRI data, which might be due to a lack of an in vitro dynamic compliance. Implementing dynamic compliances and related sensitivity analyses are major aspects of our ongoing research.
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Affiliation(s)
- Anne Benninghaus
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany.
| | - Olivier Balédent
- Department of Image Processing, University Hospital, E.A 7516, CHIMERE, Jules Verne University of Picardy, 80054, Amiens cedex, France
| | - Armelle Lokossou
- Department of Image Processing, University Hospital, E.A 7516, CHIMERE, Jules Verne University of Picardy, 80054, Amiens cedex, France
| | - Carlos Castelar
- Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany
| | - Steffen Leonhardt
- Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany
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26
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Burman R, Shah AH, Benveniste R, Jimsheleishvili G, Lee SH, Loewenstein D, Alperin N. Comparing invasive with MRI-derived intracranial pressure measurements in healthy elderly and brain trauma cases: A pilot study. J Magn Reson Imaging 2019; 50:975-981. [PMID: 30801895 DOI: 10.1002/jmri.26695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Intracranial pressure (ICP) is an important physiological parameter in several neurological disorders. Considerable effort has been made to measure ICP noninvasively. MR-based ICP (MR-ICP) is a nonempirical method based on principles of cerebrospinal fluid (CSF) physiology, where ICP is obtained from measurements of blood and CSF flows to and from the cranium during the cardiac cycle. PURPOSE To compare MR-ICP with invasive ICP measurements obtained using lumbar puncture (LP) or external ventricular drainage (EVD). STUDY TYPE Prospective, cross-sectional, observational study. SUBJECTS Ten cognitively healthy elderly subjects (age 69.6 ± 6.6 years; seven females) and six brain trauma patients (age 36.8 ± 19.7 years; two females). FIELD STRENGTH Velocity encoding cine phase-contrast at 1.5 T and 3 T. ASSESSMENT MR-ICP and craniospinal compliance distribution were estimated from arterial inflow and venous outflow to and from cranium, and craniospinal CSF flow at the upper cervical region, measured using cine phase contrast MRI. LP (done 177 ± 163 days after scan) and EVD measurements (at the time of scan) were performed in lateral recumbent and supine positions, respectively. STATISTICAL TESTS Linear regression was used to assess the relationships of MR-ICP with invasive ICP, and the dependency of these measurements on age, weight, height, and BMI. A Shapiro-Wilks test and Bland-Altman plot were respectively used to evaluate the normality and agreement between these two pressure distributions. Student's t-test was used throughout the analysis to compare differences between the EVD and LP cohorts. RESULTS In the combined cohort, MR-ICP and invasive ICP were positively correlated (r = 0.95, P < 0.001), with invasive ICP being higher than MR-ICP by 2.2 mmHg on average. In the healthy cohort, the cranial contribution to total craniospinal compliance was negatively correlated with MR-ICP (r = -0.90, P < 0.001). DATA CONCLUSION MR-ICP provides a reliable estimate of ICP, with 14 out of 16 datapoints within the clinically acceptable error. Craniospinal compliance distribution plays a role in modulating ICP in supine position. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:975-981.
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Affiliation(s)
- Ritambhar Burman
- University of Miami, Biomedical Engineering Department, Coral Gables, Florida, USA
| | - Ashish H Shah
- University of Miami, Department of Neurological Surgery, Florida, USA
| | - Ronald Benveniste
- University of Miami, Department of Neurological Surgery, Florida, USA
| | | | - Sang H Lee
- University of Miami, Radiology Department, Miami, Florida, USA
| | - David Loewenstein
- University of Miami, Department of Psychiatry and Behavioral Sciences, Florida, USA
| | - Noam Alperin
- University of Miami, Biomedical Engineering Department, Coral Gables, Florida, USA.,University of Miami, Radiology Department, Miami, Florida, USA
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27
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Burman R, Alperin N, Lee SH, Ertl-Wagner B. Patient-specific cranio-spinal compliance distribution using lumped-parameter model: its relation with ICP over a wide age range. Fluids Barriers CNS 2018; 15:29. [PMID: 30428887 PMCID: PMC6236958 DOI: 10.1186/s12987-018-0115-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/01/2018] [Indexed: 12/23/2022] Open
Abstract
Background The distribution of cranio-spinal compliance (CSC) in the brain and spinal cord is a fundamental question, as it would determine the overall role of the compartments in modulating ICP in healthy and diseased states. Invasive methods for measurement of CSC using infusion-based techniques provide overall CSC estimate, but not the individual sub-compartmental contribution. Additionally, the outcome of the infusion-based method depends on the infusion site and dynamics. This article presents a method to determine compliance distribution between the cranium and spinal canal non-invasively using data obtained from patients. We hypothesize that this CSC distribution is indicative of the ICP. Methods We propose a lumped-parameter model representing the hydro and hemodynamics of the cranio-spinal system. The input and output to the model are phase-contrast MRI derived volumetric transcranial blood flow measured in vivo, and CSF flow at the spinal cervical level, respectively. The novelty of the method lies in the model mathematics that predicts CSC distribution (that obeys the physical laws) from the system dc gain of the discrete-domain transfer function. 104 healthy individuals (48 males, 56 females, age 25.4 ± 14.9 years, range 3–60 years) without any history of neurological diseases, were used in the study. Non-invasive MR assisted estimate of ICP was calculated and compared with the cranial compliance to prove our hypothesis. Results A significant negative correlation was found between model-predicted cranial contribution to CSC and MR-ICP. The spinal canal provided majority of the compliance in all the age groups up to 40 years. However, no single sub-compartment provided majority of the compliance in 41–60 years age group. The cranial contribution to CSC and MR-ICP were significantly correlated with age, with gender not affecting the compliance distribution. Spinal contribution to CSC significantly positively correlated with CSF stroke volume. Conclusions This paper describes MRI-based non-invasive way to determine the cranio-spinal compliance distribution in the brain and spinal canal sub-compartments. The proposed mathematics makes the model always stable and within the physiological range. The model-derived cranial compliance was strongly negatively correlated to non-invasive MR-ICP data from 104 patients, indicating that compliance distribution plays a major role in modulating ICP.
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Affiliation(s)
- Ritambhar Burman
- Biomedical Engineering Department, University of Miami, Coral Gables, FL, 33146, USA
| | - Noam Alperin
- Radiology Department, University of Miami, Miami, FL, 33136, USA.
| | - Sang H Lee
- Radiology Department, University of Miami, Miami, FL, 33136, USA
| | - Brigit Ertl-Wagner
- Department of Radiology, Ludwig-Maximilians University, 80539, Munich, Germany
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28
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Gadda G, Majka M, Zieliński P, Gambaccini M, Taibi A. A multiscale model for the simulation of cerebral and extracerebral blood flows and pressures in humans. Eur J Appl Physiol 2018; 118:2443-2454. [DOI: 10.1007/s00421-018-3971-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/21/2018] [Indexed: 01/26/2023]
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29
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Tsai YH, Chen HC, Tung H, Wu YY, Chen HM, Pan KJ, Cheng DC, Chen JH, Chen CCC, Chai JW, Shen WC. Noninvasive assessment of intracranial elastance and pressure in spontaneous intracranial hypotension by MRI. J Magn Reson Imaging 2018; 48:1255-1263. [PMID: 29437266 DOI: 10.1002/jmri.25976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/24/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Spontaneous intracranial hypotension (SIH) is often misdiagnosed, and can lead to severe complications. Conventional MR sequences show a limited ability to aid in this diagnosis. MR-based intracranial pressure (MR-ICP) may be able to detect changes of intracranial elastance and pressure. PURPOSE To determine whether MR-ICP is able to differentiate SIH patients from normal subjects, improve diagnostic sensitivity, and provide an insight into the pathophysiology. STUDY TYPE Prospective. SUBJECTS Twenty-eight SIH cases with orthostatic headache and 20 healthy volunteers. FIELD STRENGTH/SEQUENCE Cine phase-contrast MRI on a 1.5T scanner. ASSESSMENT Intracranial elastance (IE) was derived from the ratio of the peak-to-peak cerebrospinal fluid (CSF) pressure gradient (PGcsf-pp ) and intracranial volume change, obtained by summing all flows before each sequential cardiac frame. STATISTICAL TESTS Student's t-test was used to compare the MR-ICP indexes and flow parameters between SIH patients and healthy volunteers (P < 0.01). RESULTS The SIH patients with cervical epidural venous dilatation (EVD) had an IE of 0.121 ± 0.027 mmHg/cm/ml, significantly higher than that of the normal volunteers (0.085 ± 0.027 mmHg/cm/ml; P = 0.002). In contradistinction, the EVD-negative SIH patients, including four with no sign of CSF leaks, had significantly lower IE (0.055 ± 0.012 mmHg/cm/ml) compared with the normal volunteers and the EVD-positive group (P = 0.001, P < 0.001). The EVD-negative patients had significantly lower PGcsf-pp (0.024 ± 0.007 mmHg/cm) compared with the normal volunteers and the EVD-positive group (0.035 ± 0.011 mmHg/cm, 0.040 ± 0.010 mmHg/cm; P = 0.003, P < 0.001). Additionally, the MRI flow study showed a significant decrease in transcranial inflow and outflow of SIH patients (P < 0.01). DATA CONCLUSION We found that the MR-ICP method is potentially more sensitive than morphological MRI in the early diagnosis of SIH. Also, contrary to common belief, our results suggest that an abnormal craniospinal elastance might be the cause of SIH, instead of CSF leak. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1255-1263.
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Affiliation(s)
- Yi-Hsin Tsai
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chieh Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin Tung
- Neurological Institute, Taichung Veterans General Hospital, Taiwan
| | - Yi-Ying Wu
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsian-Min Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Biomedical Engineering, Hung Kuang University, Taichung, Taiwan
| | - Kuan-Jung Pan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Da-Chuan Cheng
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Jeon-Hor Chen
- Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California, USA.,Department of Radiological Technology, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Clayton Chi-Chang Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Jyh-Wen Chai
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wu-Chung Shen
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Radiology, China Medical University Hospital, Taichung, Taiwan
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Gehlen M, Eklund A, Kurtcuoglu V, Malm J, Schmid Daners M. Comparison of anti-siphon devices-how do they affect CSF dynamics in supine and upright posture? Acta Neurochir (Wien) 2017; 159:1389-1397. [PMID: 28660395 DOI: 10.1007/s00701-017-3249-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Three different types of anti-siphon devices (ASDs) have been developed to counteract siphoning-induced overdrainage in upright posture. However, it is not known how the different ASDs affect CSF dynamics under the complex pressure environment seen in clinic due to postural changes. We investigated which ASDs can avoid overdrainage in upright posture best without leading to CSF accumulation. METHODS Three shunts each of the types Codman Hakim with SiphonGuard (flow-regulated), Miethke miniNAV with proSA (gravitational), and Medtronic Delta (membrane controlled) were tested. The shunts were compared on a novel in vitro setup that actively emulates the physiology of a shunted patient. This testing method allows determining the CSF drainage rates, resulting CSF volume, and intracranial pressure in the supine, sitting, and standing posture. RESULTS The flow-regulated ASDs avoided increased drainage by closing their primary flow path when drainage exceeded 1.39 ± 0.42 mL/min. However, with intraperitoneal pressure increased in standing posture, we observed reopening of the ASD in 3 out of 18 experiment repetitions. The adjustable gravitational ASDs allow independent opening pressures in horizontal and vertical orientation, but they did not provide constant drainage in upright posture (0.37 ± 0.03 mL/min and 0.26 ± 0.03 mL/min in sitting and standing posture, respectively). Consequently, adaptation to the individual patient is critical. The membrane-controlled ASDs stopped drainage in upright posture. This eliminates the risk of overdrainage, but leads to CSF accumulation up to the volume observed without shunting when the patient is upright. CONCLUSIONS While all tested ASDs reduced overdrainage, their actual performance will depend on a patient's specific needs because of the large variation in the way the ASDs influence CSF dynamics: while the flow-regulated shunts provide continuous drainage in upright posture, the gravitational ASDs allow and require additional adaptation, and the membrane-controlled ASDs show robust siphon prevention by a total stop of drainage.
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Affiliation(s)
- Manuel Gehlen
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Vartan Kurtcuoglu
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Jan Malm
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Tannenstrasse 3, CLA G 21.1, 8092, Zürich, Switzerland.
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31
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Human jugular vein collapse in the upright posture: implications for postural intracranial pressure regulation. Fluids Barriers CNS 2017. [PMID: 28623925 PMCID: PMC5473973 DOI: 10.1186/s12987-017-0065-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Intracranial pressure (ICP) is directly related to cranial dural venous pressure (Pdural). In the upright posture, Pdural is affected by the collapse of the internal jugular veins (IJVs) but this regulation of the venous pressure has not been fully understood. A potential biomechanical description of this regulation involves a transmission of surrounding atmospheric pressure to the internal venous pressure of the collapsed IJVs. This can be accomplished if hydrostatic effects are cancelled by the viscous losses in these collapsed veins, resulting in specific IJV cross-sectional areas that can be predicted from flow velocity and vessel inclination. Methods We evaluated this potential mechanism in vivo by comparing predicted area to measured IJV area in healthy subjects. Seventeen healthy volunteers (age 45 ± 9 years) were examined using ultrasound to assess IJV area and flow velocity. Ultrasound measurements were performed in supine and sitting positions. Results IJV area was 94.5 mm2 in supine and decreased to 6.5 ± 5.1 mm2 in sitting position, which agreed with the predicted IJV area of 8.7 ± 5.2 mm2 (equivalence limit ±5 mm2, one-sided t tests, p = 0.03, 33 IJVs). Conclusions The agreement between predicted and measured IJV area in sitting supports the occurrence of a hydrostatic-viscous pressure balance in the IJVs, which would result in a constant pressure segment in these collapsed veins, corresponding to a zero transmural pressure. This balance could thus serve as the mechanism by which collapse of the IJVs regulates Pdural and consequently ICP in the upright posture. Electronic supplementary material The online version of this article (doi:10.1186/s12987-017-0065-2) contains supplementary material, which is available to authorized users.
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