Dependency of cerebrospinal fluid outflow resistance on intracranial pressure.
OBJECTIVE
The outflow resistance (Rout) of the cerebrospinal fluid (CSF) system has generally been accepted by most investigators as independent of intracranial pressure (ICP), but there are also those claiming that it is not. The general belief is that this question has been investigated numerous times in the past, but few studies have actually been specifically aimed at looking at this relationship, and no study has been able to provide scientific evidence to elucidate fully this fundamental and important issue. The objective of this study was to investigate the relationship between ICP and CSF outflow in 30 patients investigated for idiopathic normal-pressure hydrocephalus.


METHODS
Lumbar infusion tests with constant pressure levels were performed, and ICP and corresponding flow were measured on 6 pressure levels for each patient. All data were standardized for comparison.


RESULTS
In the range of moderate increases from baseline pressure (approximately 5-12 mm Hg, mean baseline pressure 11.7 mm Hg), the assumption of a pressure-independent Rout was confirmed (p = 0.5). However, when the pressure increment from baseline pressure was larger (approximately 15-22 mm Hg), the relationship had a nonlinear tendency (p < 0.05).


CONCLUSIONS
The results of this study support the classic textbook theory of a pressure-independent Rout in the normal ICP range, where the CSF system is commonly operating. However, the theory might have to be questioned in regions where ICP exceeds baseline pressure by too much.
Andersson
Nina
N
Department of Biomedical Engineering and Informatics, Umeå University Hospital, Umeå, Sweden. nina.andersson@vll.se
Malm
Jan
J
Eklund
Anders
A
D000368:Aged; D000369:Aged, 80 and over; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000503:physiopathology*; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological