engleski

SUBSTANCE DISTRIBUTION CHANGES AFTER CSF PATHWAY IMPAIREMENT IN DIFFERENT PARTS OF CRANIOSPINAL SPACE

Introduction: It is unclear how obstruction and stenosis in different parts of craniospinal space affect the CSF movement and distribution of substances within the CSF and interstitial fluid (ISF). Material and methods: In experimental animals with acute and subchronic blockage or stenosis of the aqueduct of Sylvii and/or cervical subarachnoid space, changes in dye distribution, size of ventricles and CSF pressure were examined. Contrast dynamics and changes in the CSF system anatomy were investigated in patients with obstruction or severe aqueductal stenosis. Results: According to the classic concept, obstruction or severe stenosis of unidirectional CSF circulation should lead to an increase in CSF pressure and dilation of ventricles proximal to the site of obstruction. Experimental acute aqueductal blockage showed lack of increase in the CSF pressure and ventricular dilatation. Long- term blockage and stenosis of the cervical space resulted in slight enlargement of ventricles. The obstructions within CSF system limited the distribution of the dye along the CSF system and increased its penetration into the tissue. MR studies in some patients showed the existence of aqueductal obstruction or stenosis, without development of clinical and radiological signs of the three-ventricular hypertensive hydrocephalus. Conclusion: Classical hypothesis of constant CSF secretion inside the ventricles, unidirectional circulation, and dominantly passive absorption through the arachnoid granulations of the dural sinuses cannot explain the described results, while they can be easily explained by a new concept of CSF/ISF physiology.

cerebrospinal fluid, acute aqueductal blockage

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