Cerebrospinal Fluid and its Abnormalities

Abstract

Cerebrospinal fluid bathes the central nervous system, providing mechanical support and maintaining a stable environment. Alterations in its production, circulation or absorption result in a pathological condition termed hydrocephalus, characterized by an accumulation of fluid within the cranium, usually in the ventricles of the brain. Similarly, aberrations in the circulation or absorption of cerebrospinal fluid around the spinal cord can create a condition termed syringomyelia. Hydrocephalus can be life‚Äźthreatening due to increased intracranial pressure. The most common causes of hydrocephalus are related to obstruction of cerebrospinal fluid flow. In the pediatric population, causes of hydrocephalus include developmental abnormalities, infectious aetiologies, mass lesions, and haemorrhage. Causes of high pressure hydrocephalus in adulthood are primarily related to haemorrhage and tumour, although idiopathic normal pressure hydrocephalus (NPH) is also encountered. The management of hydrocephalus and syringomyelia relies primarily on neurosurgical interventions such as insertion of shunt devices.

Key Concepts

  • CSF provides a mechanical support for the brain and spinal cord.

  • Overproduction of CSF, obstruction to CSF flow or impaired absorption of CSF may lead to disease states such as hydrocephalus or syringomyelia.

  • CSF diversion by means of shunting with catheter implantation or fenestration of anatomic barriers is the primary treatment for diseases of CSF disturbances.

Keywords: central nervous system; cerebrospinal fluid; hydrocephalus; ventricles; syringomyelia

Figure 1.

Pathways of cerebrospinal fluid (CSF) circulation: CSF is formed in the ventricles, circulates to the subarachnoid space and is absorbed into the venous system by the arachnoid villi. Only approximately 25 mL of the 130 mL around the brain and spinal cord is contained within the ventricles; the rest is housed within the subarachnoid space.

Figure 2.

Transport across the choroid epithelium: cerebrospinal fluid (CSF) formation involves both capillary filtration and active epithelial secretion within the choroid plexus. Both active and passive transport processes are demonstrated within the epithelial cells of the plexus, resulting in regulation of CSF composition. With permission from Spector and Johansen .

Figure 3.

T1 weighted axial and sagittal magnetic resonance images of the brain in patients with ((b) and (d)) and without ((a) and (c)) hydrocephalus. The ventricles are markedly enlarged compared to normal. The cerebral aqueduct (arrow) is patent and there is no evidence of obstruction within the ventricular system. This is a case of communicating hydrocephalus.

Figure 4.

Ventriculoperitoneal shunt.

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References

Albright AL, Pollack IF and Adelson PD (2008) Principles and Practice of Pediatric Neurosurgery, 2nd edn. New York: Thieme.

Amacher AI and Wellington J (1984) Infantile hydrocephalus: long term results of surgical therapy. Childs Brain 11: 217–229.

Cushing H (1926) Studies in Intracranial Physiology and Surgery. London: Oxford University Press.

Dandy WE and Blackfan KD (1914) Internal hydrocephalus: an experimental, clinical and pathological study. American Journal of Diseases of Children 8: 406.

Fishman RA (1992) Cerebrospinal Fluid in Diseases of the Nervous System, 2nd edn. Philadelphia: WB Saunders.

Green AL, Pereira EA, Kelly D, Richards PG and Pike MG (2007) The changing face of paediatric hydrocephalus: a decade's experience. Journal of Clinical Neuroscience 14(11): 1049–1054.

Hakim S and Adams RD (1965) The special clinical problem of symptomatic hydrocephalus with normal CSF pressure. Journal of Neurological Sciences 2: 307–327.

Jones HC and Kinge PM (2008) Hydrocephalus 2008, 17–20th September, Hannover Germany: a conference report. Cerebrospinal Fluid Research 5: 19.

Spector R and Johansen CE (1989) The mammalian choroid plexus. Scientific American 261: 68–74.

Further Reading

McComb JG (1983) Recent research into the nature of cerebrospinal fluid formation and absorption. Journal of Neurosurgery 59: 369–383.

Spector R and Johansen CE (1989) The mammalian choroid plexus. Scientific American 261: 68–74.

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How to Cite close
Chan, Michael, and Amin‐Hanjani, Sepideh(Jan 2010) Cerebrospinal Fluid and its Abnormalities. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0002191.pub2]