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Cerebrospinal fluid absorption mechanism based on measurement of cerebrospinal fluid flow rate in shunt tube


, : Cerebrospinal fluid absorption mechanism based on measurement of cerebrospinal fluid flow rate in shunt tube. Brain & Nerve (Tokyo) 37(4): 365-370

CSF absorption mechanisms in cases of hydrocephalus was investigated on the basis of measurements of CSF flow in a shunt tube after ventriculo-peritoneal shunt surgery, monitoring of intracranial pressure, CT findings, radioisotope cisternography, cerebral blood flow, EEG, PSP tests and changes in neurological findings. The subjects were 6 males and 7 females aged from 18-70 yr. CSF flow rates in the shunt tubes were between 0.01-1.93 ml/min. Calculating the daily volume of CSF flow, the subjects were divided into 2 groups: Group A (8 patients) with a volume of < 150 ml/day (0.01-0.25 ml/min), and Group B (5 patients) with between 150 and 500 ml/day (0.01-1.93 ml/min). Monitoring of intracranial pressure prior to the shunt operation was performed in 10 cases. These pressure values ranged between 4 and 25 mm Hg (mean: 7-8 mm Hg), and there was no difference between the 2 groups. The pre- and post-operative radioisotope cisternography findings indicated improvement of ventricular dilatation, periventricular lucency and ventricular reflux. After the shunt operations, there was neurological improvement in 6 of the 8 Group A cases but only in 2 of the 5 Group B cases. Considering the CSF flow volumes of the 2 groups, it appears that in Group A the shunt tube is not the main CSF circulation pathway. This could mean that resistance to CSF absorption in the cerebrospinal space has decreased after the shunt operation and there has been recovery of the physiological CSF absorption pathways, i.e., neurological improvement can be expected in this group A.

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