Intracranial pressure accommodation is impaired by blocking pathways leading to extracranial lymphatics

2001 ◽  
Vol 280 (5) ◽  
pp. R1573-R1581 ◽  
Author(s):  
R. Mollanji ◽  
R. Bozanovic-Sosic ◽  
I. Silver ◽  
B. Li ◽  
C. Kim ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Cribriform Plate ◽  
Transport Pathways ◽  
Conventional View ◽  
Arachnoid Villi ◽  
Before And After ◽  
Intracranial Pressures ◽  
Flow Through ◽  
Mucosal Side ◽  
Lymphatic Pathways

Tracer studies indicate that cerebrospinal fluid (CSF) transport can occur through the cribriform plate into the nasal submucosa, where it is absorbed by cervical lymphatics. We tested the hypothesis that sealing the cribriform plate extracranially would impair the ability of the CSF pressure-regulating systems to compensate for volume infusions. Sheep were challenged with constant flow or constant pressure infusions of artificial CSF into the CSF compartment before and after the nasal mucosal side of the cribriform plate was sealed. With both infusion protocols, the intracranial pressure (ICP) vs. flow rate relationships were shifted significantly to the left when the cribriform plate was blocked. This indicated that obstruction of the cribriform plate reduced CSF clearance. Sham surgical procedures had no significant effects. Estimates of the proportional flow through cribriform and noncribriform routes suggested that cranial CSF absorption occurred primarily through the cribriform plate at low ICPs. Additional drainage sites (arachnoid villi or other lymphatic pathways) appeared to be recruited only when intracranial pressures were elevated. These data challenge the conventional view that CSF is absorbed principally via arachnoid villi and provide further support for the existence of several anatomically distinct cranial CSF transport pathways.

Blocking cerebrospinal fluid absorption through the cribriform plate increases resting intracranial pressure

2002 ◽  
Vol 282 (6) ◽  
pp. R1593-R1599 ◽  
Author(s):  
R. Mollanji ◽  
R. Bozanovic-Sosic ◽  
A. Zakharov ◽  
L. Makarian ◽  
M. G. Johnston
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Cribriform Plate ◽  
Olfactory Pathway ◽  
Major Site ◽  
Tissue Glue ◽  
Adjacent Mucosa ◽  
Before And After ◽  
Cerebrospinal Fluid Absorption ◽  
Experimental Group

Cerebrospinal fluid (CSF) drains through the cribriform plate (CP) in association with the olfactory nerves. From this location, CSF is absorbed into nasal mucosal lymphatics. Recent data suggest that this pathway plays an important role in global CSF transport in sheep. In this report, we tested the hypothesis that blocking CSF transport through this pathway would elevate resting intracranial pressure (ICP). ICP was measured continuously from the cisterna magna of sheep before and after CP obstruction in the same animal. To block CSF transport through the CP, an external ethmoidectomy was performed. The olfactory and adjacent mucosa were removed, and the bone surface was sealed with tissue glue. To restrict our analysis to the cranial CSF system, CSF transport into the spinal subarachnoid compartment was prevented with a ligature tightened around the thecal sac between C1 and C2. Sham surgical procedures had no significant effects, but in the experimental group CP obstruction elevated ICP significantly. Mean postobstruction steady-state pressures (18.0 ± 3.8 cmH2O) were approximately double the preobstruction values (9.2 ± 0.9 cmH2O). These data support the concept that the olfactory pathway represents a major site for CSF drainage.

Does neonatal cerebrospinal fluid absorption occur via arachnoid projections or extracranial lymphatics?

2002 ◽  
Vol 283 (4) ◽  
pp. R869-R876 ◽  
Author(s):  
C. Papaiconomou ◽  
R. Bozanovic-Sosic ◽  
A. Zakharov ◽  
M. Johnston
Keyword(s):  
Cerebrospinal Fluid ◽  
Constant Pressure ◽  
Cribriform Plate ◽  
Outflow Resistance ◽  
Arachnoid Villi ◽  
Relative Paucity ◽  
Stage Of Development ◽  
Cerebrospinal Fluid Absorption ◽  
Essential Function ◽  
Lymphatic Pathways

Arachnoid villi and granulations are thought to represent the primary sites where cerebrospinal fluid (CSF) is absorbed. However, these structures do not appear to exist in the fetus but begin to develop around the time of birth and increase in number with age. With the use of a constant pressure-perfusion system in 2- to 6-day-old lambs, we observed that global CSF transport (0.012 ± 0.003 ml · min−1 · cmH2O−1) and CSF outflow resistance (96.5 ± 17.8 cmH2O · ml−1 · min) were very similar to comparable measures in adult animals despite the relative paucity of arachnoid villi at this stage of development. In the neonate, the recovery patterns of a radioactive protein CSF tracer in various lymph nodes and tissues indicated that CSF transport occurred through multiple lymphatic pathways. An especially important route was transport through the cribriform plate into extracranial lymphatics located in the nasal submucosa. To investigate the importance of the cribriform route in cranial CSF clearance, the cranial CSF compartment was isolated surgically from its spinal counterpart. When the cribriform plate was sealed extracranially under these conditions, CSF transport was impaired significantly. These data demonstrate an essential function for lymphatics in neonatal CSF transport and imply that arachnoid projections may play a limited role earlier in development.

scholarly journals Evaluation of cerebrovascular hemodynamics in patients with idiopathic intracranial hypertension using transcranial Doppler

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Mahmoud M. Allam ◽  
Hatem A. Almasry ◽  
Sandra M. Ahmed ◽  
Youssuf G. Taha ◽  
Mohammed I. Oraby
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Transcranial Doppler ◽  
Idiopathic Intracranial Hypertension ◽  
Pulsatility Index ◽  
Research Work ◽  
Increased Intracranial Pressure ◽  
Significant Relation ◽  
Before And After

Abstract Background Idiopathic intracranial hypertension (IIH) is a disorder of increased intracranial pressure without a clear cause and can have serious visual effects. Previous research work suggests that transcranial Doppler measurements of pulsatility index correlate accurately with elevated intracranial pressure. Objective To assess the cerebrovascular hemodynamic changes in patients with IIH using transcranial Doppler before and after lumbar puncture and CSF withdrawal. Methods An interventional study conducted on 40 patients (31 females and 9 males) fulfilling the modified Dandy criteria for diagnosis of idiopathic intracranial hypertension, MRI brain, and MRV was done to the patients. Lumbar puncture was done for all included patients to measure intracranial pressure and CSF withdrawal. Transcranial Doppler was performed for all included before and after lumbar puncture and CSF withdrawal and the following parameters were measured: peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI), and pulsatility index (PI). Results Significant relation was found between grades of papilledema and PSV, RI, and PI (p value 0.012, 0.025, 0.016) but no significant relation was found between grades of papilledema and EDV (0.102). Significant changes occurred in parameters of TCD pre- and post-CSF withdrawal including PSV, EDV, and PI (p value 0.001, 0.015, 0.019) denoting a significant change in cerebral hemodynamics after CSF withdrawal which denotes a decrease in intracranial pressure. Conclusion Increased intracranial pressure significantly affects cerebral blood flow. A normalization of transcranial Doppler parameters occurs following lowering of intracranial pressure through lumbar puncture and CSF withdrawal.

The effects of mass-induced intracranial pressures on arterial hypertension and survival in awake cats

1972 ◽  
Vol 37 (5) ◽  
pp. 514-527 ◽  
Author(s):  
Stanley J. Goodman ◽  
Donald P. Becker ◽  
John Seelig
Keyword(s):  
Intracranial Pressure ◽  
Systemic Hypertension ◽  
Content Type ◽  
Arterial Blood ◽  
Mass Size ◽  
Intracranial Pressures ◽  
Relationship Of ◽  
The Relationship ◽  
Awake Cats ◽  
Supratentorial Mass

✓ Intracranial pressures above and below the tentorium, arterial blood pressure, heart rate, and respiratory rate were recorded continuously before, during, and after expansion of a supratentorial mass in awake unsedated cats. In general, as the mass enlarged, the intracranial pressure rose; however, considerable variation was observed among animals with respect to specific mass size and associated intracranial pressures. There was considerable variation in the relationship of supratentorial pressure to infratentorial pressure. No animal survived that had sustained a mass-induced pressure exceeding 1100 mm H2O, and survival was shorter with greater pressures. Systemic hypertension occurred always and only when the infratentorial pressure exceeded 600 mm H2O, regardless of the magnitude of the associated supratentorial intracranial pressure. The methodological limitations of previous studies of mass-induced intracranial hypertension appear to have been substantially reduced by the technique described.

Hemodynamic Method to Predict Whether Hunterian Ligation of the Basilar Artery Will Lead to Thrombosis of Basilar Bifurcation Aneurysms

Neurosurgery ◽  
1987 ◽  
Vol 20 (2) ◽  
pp. 249-253 ◽  
Author(s):  
Jack Chang ◽  
Margot R. Roach
Keyword(s):  
Pressure Gradient ◽  
Basilar Artery ◽  
Diameter Ratio ◽  
Phase Lag ◽  
Maximal Width ◽  
Before And After ◽  
Simple Measurement ◽  
Flow Through ◽  
Stop Flow

Abstract In some cases, basilar artery aneurysms cannot be repaired surgically and the basilar artery is occluded near the neck of the aneurysm to stop flow into the aneurysm. After the operation, the aneurysm can fill only by flow through the posterior communicating arteries (PCoAs). Hemodynamically, if the flow were the same in both PCoAs and there were no phase lag in the pressures, there would be no pressure gradient for flow to go across the neck of the aneurysm and therefore the aneurysm would thrombose. We have assumed that the diameter of the artery is roughly proportional to the flow that goes through it chronically. We measured the diameters of the PCoAs in 25 patients who had hunterian ligation of the basilar artery. We also measured the maximal width, height, and depth of the aneurysms on angiograms obtained before and after operation. Eleven aneurysms thrombosed completely and had a diameter ratio of > 0.6; 10 aneurysms thrombosed partially and had a diameter ratio of 0.46 ˜ 1.0; 4 aneurysms did not change and had a diameter ratio of <0.45. The ratio of the sizes of the PCoAs pre- and postoperatively was comparable in most cases, so we believe that it is possible to predict reasonably accurately from this simple measurement whether the aneurysm is likely to thrombose if the basilar artery is ligated.

Abstract W P211: Investigating the Cause for “Collateral Failure” in Stroke-in-Progression: Intracranial Pressure Elevation Reduces Flow Through Collateral Vessels

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Daniel Beard ◽  
Damian McLeod ◽  
Neil J Spratt
Keyword(s):  
Intracranial Pressure ◽  
Flow Velocity ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Minor Stroke ◽  
Collateral Flow ◽  
Mca Occlusion ◽  
Intracranial Pressure Elevation ◽  
Flow Through ◽  
Collateral Vessels

Background: Adequacy of the collateral circulation is a major determinant of outcome in stroke patients. Recent human imaging data indicates that collateral failure, rather than reperfusion-reocclusion is the most common cause for early progression in minor stroke. Our previous experimental data shows that intracranial pressure (ICP) rises transiently 24 h after even minor stroke. Herein, we investigated the effect of ICP manipulation on blood flow through collateral vessels during MCA occlusion. Methods: We developed and validated a method to quantify flow velocity and vessel diameter of anterior-middle cerebral artery (ACA-MCA) leptomeningeal collaterals in rats during stroke, using fluorescent microspheres. BIood flow velocity and diameter was quantified in individual collateral vessels and used to calculate absolute flow during MCA occlusion and reperfusion (n = 6). In separate experiments, ICP was increased after MCA occlusion by fluid infusion into the lateral ventricles and effects on relative collateral flow were determined (n = 4). Results: In vitro validation indicated accurate flow quantification (R 2 = 0.99, P<0.0001). Collateral flow was seen to switch from bidirectional to unidirectional flow (toward occluded vessel) and increase by 595 ± 134 % within 10 min of vessel occlusion. Direction and flow changes were variable after MCA reperfusion, however there was a mean flow reduction of 52 ± 15 % by 5 mins. Artificially elevating ICP during MCA occlusion caused a reduction of cerebral perfusion pressure which was strongly correlated with collateral flow reduction (R 2 = 0.90, p<0.0001). Discussion: Our method permits real time quantification of flow through individual collateral vessels during stroke and reperfusion. Intracranial pressure elevation reduced collateral flow, proportional to its effect on cerebral perfusion pressure. Coupled with our previous data indicating significant ICP elevation after even minor stroke, this suggests that transient ICP elevation is the possible cause of the collateral failure recently described in patients with stroke-in-progression.

Serial Lumbar Punctures for at Least Temporary Amelioration of Neonatal Posthemorrhagic Hydrocephalus

PEDIATRICS ◽  
1985 ◽  
Vol 75 (4) ◽  
pp. 719-724
Author(s):  
Katherine L. Kreusser ◽  
Theodore J. Tarby ◽  
Edward Kovnar ◽  
Donald A. Taylor ◽  
Alan Hill ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Subarachnoid Space ◽  
Ventricular Size ◽  
Anterior Fontanel ◽  
Posthemorrhagic Hydrocephalus ◽  
Before And After ◽  
Cranial Ultrasonography ◽  
Lumbar Subarachnoid Space

Serial lumbar punctures for the management of neonatal posthemorrhagic hydrocephalus without intracranial hypertension were evaluated in 16 infants. Cranial ultrasonography to evaluate ventricular size and the Ladd monitor at the anterior fontanel to measure intracranial pressure were utilized immediately before and after lumbar puncture. In 12 patients, a decrease in ventricular size and in anterior fontanel pressure could be effected with each lumbar puncture. In these infants, cessation of progression of the hydrocephalus and intermittent decreases in ventricular size were accomplished. In four patients, lumbar punctures were not successful in decreasing ventricular size or lowering intracranial pressure. Two criteria could be defined to determine whether lumbar puncture could provide at least temporary benefit for the treatment of posthemorrhagic hydrocephalus. The first of these is to establish the presence of communication between lateral ventricles and lumbar subarachnoid space by effecting a decrease in ventricular size and a decrease in intracranial pressure by removal of CSF. The second criterion is to ascertain a critical volume of CSF (usually relatively large) that must be removed in order to effect the above changes. Cranial ultrasonography and measurement of intracranial pressure by application of the Ladd monitor to the anterior fontanel are extremely valuable in the evaluation of lumbar punctures in the management of posthemorrhagic hydrocephalus.

scholarly journals Role of the nurse in preventing or reducing increase intracrani-al pressure following craniotomy

2017 ◽  
Vol 6 (2) ◽  
pp. 92
Author(s):  
Rasha Abdelmowla ◽  
Abdelhakeem Essa ◽  
Esmat Abdelmaged
Keyword(s):  
Intracranial Pressure ◽  
Educational Program ◽  
Demographic Data ◽  
Quality Care ◽  
Adult Patients ◽  
University Hospital ◽  
Control Group ◽  
Significant Difference ◽  
Before And After ◽  
Nurses Knowledge

Background: Increase intracranial pressure following craniotomy is common and different measures should be taken to prevent or treat it promptly. Aim: Preventing or reducing increase intracranial pressure following craniotomy. Research design: Quasi-experimental.Subjects and methods: All nurses (26) in neurosurgery department at Assiut Neurological, Psychiatric and Neurosurgery University Hospital, in addition to a sample of 124 patients after craniotomy. Control group (62 adult patients before implementing the nursing     educational program) and study group (62 adult patients after implementing the nursing educational program). Nurses’ knowledge and practice were assessed before and after implementation of the nursing educational program. Tools: Structured questionnaire to assess nurses` demographic data and knowledge about intracranial pressure, observation checklist for nurses` practice, patients’ assessment sheet, and teaching booklet for nurses about postoperative increase intracranial pressure. Results: Highly significant differences were found as regarding nurses` knowledge and nurses` practice pre and post implementing the nursing educational program. Significant difference was found between study and control groups as regarding increase intracranial pressure following craniotomy. Conclusion: Nursing educational program had a significant effect on preventing or reducing postoperative increase intracranial pressure.Recommendation: Nurses should have continuous education through programs, workshops, seminars and/or training courses to maintain high quality care.

Raised intracranial pressure increases CSF drainage through arachnoid villi and extracranial lymphatics

1998 ◽  
Vol 275 (3) ◽  
pp. R889-R896 ◽  
Author(s):  
M. Boulton ◽  
D. Armstrong ◽  
M. Flessner ◽  
J. Hay ◽  
J. P. Szalai ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Human Serum Albumin ◽  
Serum Albumin ◽  
Human Serum ◽  
Jugular Vein ◽  
Lymphatic Vessels ◽  
Lymphatic Drainage ◽  
Cisterna Magna ◽  
Arachnoid Villi ◽  
Ventriculocisternal Perfusion

We demonstrated previously that about one-half of cerebrospinal fluid (CSF) removed from the cranial vault was cleared by extracranial lymphatic vessels. In this report we test the hypothesis that lymphatic drainage of CSF increases as intracranial pressure (ICP) is elevated in anesthetized sheep. Catheters were inserted into both lateral ventricles, cisterna magna, cervical lymphatics, and jugular vein. A ventriculocisternal perfusion system was employed to regulate CSF pressures and to deliver a protein tracer (125I-labeled human serum albumin) into the CSF compartment.131I-labeled human serum albumin was injected intravenously to permit calculation of plasma tracer loss and tracer recirculation into lymphatics. ICP was controlled by adjusting the height of the inflow reservoir and the cisterna magna outflow catheter appropriately. The experimental design consisted of a 3-h period of lower pressure followed by a 3-h period of higher pressure in the same animal (10–20 or 20–30 cmH2O). We determined that incremental changes in ICP were associated with higher CSF transport through lymphatic and arachnoid villi routes in all eight animals tested ( P = 0.004).

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