How does CSF dynamics change after shunting?
OBJECTIVE
Hydrocephalus is much more complex than a simple disorder of cerebrospinal fluid (CSF) circulation. Shunting primarily corrects disturbed fluid flow which may have an impact on cerebral blood flow and metabolism. We studied hydrocephalic patients before and after shunting to characterize changes in their CSF compensatory parameters.


METHODS
We selected 25 patients and studied them retrospectively. All patients had ventriculomegaly and clinical symptoms of normal pressure hydrocephalus. After shunting, they were still presenting with some adverse symptoms, mainly headaches, slow improvement or no improvement of ventriculomegaly. Therefore, they underwent further infusion studies to assess shunt function. In all cases, the shunts were confirmed to be draining CSF adequately. Parameters of CSF dynamics: baseline intracranial pressure (ICP), resistance to CSF outflow, cerebrospinal elasticity, content of vasogenic pressure waves (pulse, respiratory and B waves) and compensatory reserve assessed as moving correlation coefficient between mean CSF pressure and pulse amplitude (RAP), were compared before and after shunting.


RESULTS
Mean ICP and resistance to CSF outflow decreased (P < 0.003) after shunting. All vasogenic pressure waves decreased (P < 0.005). Compensatory reserve (RAP) significantly improved (P < 0.005).


CONCLUSIONS
A functioning shunt has an important impact on CSF circulation and pressure-volume compensation. Infusion studies can demonstrate the return of disturbed CSF dynamics to normal values even if clinical or radiological changes are not dramatic.
Academic Neurosurgical Unit, Addenbrookes Hospital, Cambridge, UK.
G
G
Petrella
M
M
Czosnyka
N
N
Keong
J D
JD
Pickard
Z
Z
Czosnyka
D002555:Cerebrospinal Fluid / Q000502:physiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000601:surgery; D007427:Intracranial Pressure / Q000502:physiology; D012189:Retrospective Studies