The relationship of pulsatile cerebrospinal fluid flow to cerebral blood flow and intracranial pressure: a new theoretical model.
An electrical-equivalent circuit model of the cerebrovascular system is proposed, components of which directly relate to cerebrospinal fluid (CSF) compartment compliance and the determination of intracranial pressure (ICP). The model is based on three premises: 1) Under normal, physiologic conditions, the conversion of pulsatile arterial to nonpulsatile venous flow occurs primarily as a result of arterial compliance. Nonpulsatile venous flow is advantageous because less energy is required to maintain constant flow through the venous system, which comprises 75-80% of total blood volume. 2) Dynamic CSF movement across the foramen magnum is the primary facilitator by which intracranial arterial expansion occurs. Interference of the displacement of CSF during systole results in pulsatile venous flow and increased venous flow impedance. 3) Tissue hydrostatic pressure (here defined as ICP) is a dependent variable which is a function of capillary hydrostatic pressure and the osmotic/oncotic pressure gradient created by the blood-brain-barrier (BBB). An interference of transcranial CSF movement results in a decrease in cerebral blood flow (CBF) due to inertial effects impeding pulsatile venous flow. Feedback regulation in response to this decreased CBF leads to arteriolar vasodilatation (decreased resistance), thereby lowering the pressure difference between internal carotid and capillary pressures. Assuming no changes in the BBB potential, ICP increases linearly as capillary pressure increases.
Division of Neurosurgery, UCLA School of Medicine, USA.
M
M
Bergsneider
A A
AA
Alwan
L
L
Falkson
E H
EH
Rubinstein
D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001812:Blood-Brain Barrier / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D001929:Brain Edema / Q000503:physiopathology; D002199:Capillary Permeability / Q000502:physiology; D002555:Cerebrospinal Fluid / Q000502:physiology*; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D019586:Intracranial Hypertension / Q000503:physiopathology*; D007427:Intracranial Pressure / Q000502:physiology; D008959:Models, Neurological; D011673:Pulsatile Flow / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology