Comment on the Article by Hart et al. Entitled ‘Combined Intracranial Pressure Monitoring and Cerebrospinal Fluid Infusion Study to Guide Management of Slit Ventricle Syndrome'

AbstractBACKGROUNDMany clinical phenomena related to cerebrospinal fluid(CSF) and intracranial pressure (ICP) are often contrary to common sense and difficult to explain by classical theory. Such as slit ventricle syndrome, normal intracranial pressure hydrocephalus / low pressure hydrocephalus, paradoxical herniation, and so on. Many authors have different theories about them but can’t have an unified explanation.OBJECTIVEWe try to simulate the above CSF disorders and ICP conduction with a mathematical method, and make theoretical interpretations to them.METHODSWe introduced a mathematical model based on several well-accepted hypothesesto simulate human CSF physiology and propose that ICP curve should be an U-shaped curve (especially, we introduce the hypothesis that CSF also play a role of decompression). Maple software was used to draw charts according to our formula. We use the theory and intuitive charts to explain those illnesses one by one.RESULTSThe formula: ICP = μ · MAP − δ · Vα · μ · MAP + θ · Vβ · μ · MAP + C, and corresponding diagrams was conducted.CONCLUSIONThis mathematical model is a supplement to the classical Monro-Kellie’s theory, the curve and coordinate system can be used to analyze different pathophysiological states and give a reasonable unified explanation to them.

Download Full-text

Slit-ventricle Syndrome Secondary to Shunt-induced Suture Ossification

Neurosurgery ◽

10.1097/00006123-200104000-00013 ◽

2001 ◽

Vol 48 (4) ◽

pp. 764-770 ◽

Cited By ~ 4

Author(s):

A. Leland Albright ◽

Elizabeth Tyler-Kabara

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Fibrous Tissue ◽

Cranial Sutures ◽

Normal Brain ◽

Increased Intracranial Pressure ◽

Slit Ventricle Syndrome ◽

Computed Tomographic ◽

Slit Ventricle ◽

Cranial Expansion

Abstract OBJECTIVE To report five children with slit-ventricle syndrome who were found to have increased intracranial pressure despite functioning cerebrospinal fluid shunts. METHODS Computed tomographic scans demonstrated erosion of the inner table of the cranium and sclerosis of the cranial sutures, particularly the coronal suture. Magnetic resonance imaging scans demonstrated no cerebrospinal fluid over the convexities. The patients were treated with cranial expansion operations that included removal of the sclerotic sutures, which were examined histologically. RESULTS Postoperatively, symptoms resolved for all children. Sutures were abnormal and contained foci of cartilage and bone within abnormally arranged fibrous tissue. CONCLUSION We postulate that chronic overdrainage of cerebrospinal fluid via shunts dampens the normal cerebral pressure waves; growth of the calvarium is thus understimulated, and this leads to ossification of the sutures, which become unable to expand to allow normal brain growth. Shunt-induced craniostenosis should be considered for children with symptoms of slit-ventricle syndrome for whom shunts are functional but intracranial pressure is increased. Cranial expansion operations may be more appropriate treatments than subtemporal decompressions for such children, given the diffuseness of the suture pathological features.

Download Full-text