Negative-pressure hydrocephalus

1995 ◽  
Vol 83 (3) ◽  
pp. 486-490 ◽  
Author(s):  
Michael Vassilyadi ◽  
Jean-Pierre Farmer ◽  
José L. Montes
Keyword(s):  
Intracranial Pressure ◽  
Pressure Gradient ◽  
Negative Pressure ◽  
Subarachnoid Space ◽  
Ventricular Dilation ◽  
Content Type ◽  
Arnold Chiari Malformation ◽  
System A ◽  
Subarachnoid Spaces ◽  
Fine Print

✓ Two cases of children with closed myelodysplasia, Arnold-Chiari malformation, and shunted hydrocephalus who underwent spinal arachnoid cystopleural shunting are presented. Postoperatively, both patients developed craniovertebral symptomatology accompanied by radiologically documented ventricular dilation in spite of negative intracranial pressure and functional ventriculoperitoneal (VP) shunts. Both patients recovered after the cystopleural shunts were revised to increase the resistance to flow within the system. The authors believe that some communication between the arachnoid cyst and the subarachnoid space existed in both cases and that the negative pleural pressure was transmitted preferentially to the spinal and cerebral convexity subarachnoid spaces with relative sparing of the ventricular system. A transmantle pressure gradient was thereby established, leading to ventricular dilation. The authors further suggest that a craniospinal gradient was possibly established as well, leading to craniovertebral symptomatology in the patients. Return of flow in the VP shunts was obtained by correcting this iatrogenic transmantle pressure gradient.

Intraventricular fat from a ruptured sacral dermoid cyst: clinical, radiographic, and pathological correlation

1993 ◽  
Vol 78 (4) ◽  
pp. 666-668 ◽  
Author(s):  
Tim A. Scearce ◽  
Cheng-Mei Shaw ◽  
Andrew D. Bronstein ◽  
Phillip D. Swanson
Keyword(s):  
Dermoid Cyst ◽  
Subarachnoid Space ◽  
Unique Case ◽  
Content Type ◽  
Pathological Correlation ◽  
Subarachnoid Spaces ◽  
Fine Print

✓ The authors report a unique case of a dermoid cyst that ruptured into the lumbosacral subarachnoid space following trauma, resulting in dissemination of cyst contents into the ventricles and cerebrospinal subarachnoid spaces. An intraspinous source should be considered when intraventricular fat is identified without a clear intracranial source.

A subarachnoid screw for monitoring intracranial pressure

1973 ◽  
Vol 39 (3) ◽  
pp. 416-419 ◽  
Author(s):  
John K. Vries ◽  
Donald P. Becker ◽  
Harold F. Young
Keyword(s):  
Intracranial Pressure ◽  
Local Anesthesia ◽  
Subarachnoid Space ◽  
New Technique ◽  
Content Type ◽  
A New Technique ◽  
Fine Print

✓ A new technique for monitoring intracranial pressure is presented. It is based on a hollow screw in the skull whose tip projects through the dura into the subarachnoid space. The screw can be easily inserted under local anesthesia. Pressure is monitored isovolumetrically by connecting the screw to a transducer. The system can be calibrated in situ and has been successfully used in 56 patients during a 6-month period.

Experimental syringomyelia

1980 ◽  
Vol 52 (6) ◽  
pp. 812-817 ◽  
Author(s):  
Peter Hall ◽  
Michael Turner ◽  
Steven Aichinger ◽  
Phillip Bendick ◽  
Robert Campbell
Keyword(s):  
Intracranial Pressure ◽  
Subarachnoid Space ◽  
Ventricular Pressure ◽  
Arterial Pulse ◽  
Content Type ◽  
Spinal Subarachnoid Space ◽  
Valve Effect ◽  
Experimental Canine ◽  
Pressure Changes ◽  
Fine Print

✓ The influence of ventricular pressure changes on syrinx pressure was investigated in this study of experimental canine kaolin-induced syringomyelia. The pressures of the ventricles, syrinx, and cervical subarachnoid space were measured. A complete ventriculosubarachnoid block occurred in the animals with syringomyelia. The baseline syringeal pressures exceeded those of both the ventricles and the subarachnoid space. Raising ventricular pressure elevated the syringeal pressure, but aspiration of ventricular fluid did not acutely lower the pressure. These findings suggest a ventriculosyrinx valve effect that may inflate the syrinx during transient rises of intracranial pressure. A respiratory pressure pattern was found in the syrinx similar to that of the ventricles and subarachnoid space. This wave was reduced but not abolished by ligating the subarachnoid space distal to the syrinx. The arterial pulse was much diminished within the syrinx at rest. These findings indirectly support the possibility that transmission of thoracic pressures to the spinal subarachnoid space with compression of the syrinx is a principal force that enlarges the syrinx.

Effect of positional changes and jugular vein compression on the pressure gradient across the arachnoid villi and granulations of the dog

1973 ◽  
Vol 38 (6) ◽  
pp. 722-728 ◽  
Author(s):  
D. Gordon Potts ◽  
Vishnu Deonarine
Keyword(s):  
Cerebrospinal Fluid ◽  
Pressure Gradient ◽  
Subarachnoid Space ◽  
Superior Sagittal Sinus ◽  
Jugular Vein ◽  
Content Type ◽  
Sagittal Sinus ◽  
Venous Compression ◽  
Filtration System ◽  
Fine Print

✓ The pressure gradient between the distal subarachnoid space and the superior sagittal sinus was measured in dogs and the effects of positional changes and jugular venous compression investigated. This pressure gradient remained almost constant in the head-up, head-down, and horizontal positions. These findings would be consistent with a passive filtration system for the return of cerebrospinal fluid from the distal subarachnoid space to the superior sagittal sinus and adjacent veins. The pressure gradient rose with jugular venous compression.

Quantitative analysis of cerebrospinal fluid spaces in children with occipital plagiocephaly

1996 ◽  
Vol 85 (3) ◽  
pp. 428-434 ◽  
Author(s):  
Paul D. Sawin ◽  
Michael G. Muhonen ◽  
Arnold H. Menezes
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Space ◽  
Sylvian Fissure ◽  
Case Group ◽  
Ventricular Size ◽  
Content Type ◽  
External Hydrocephalus ◽  
Subarachnoid Spaces ◽  
Fine Print ◽  
Space Volume

✓ The etiology of occipital plagiocephaly (OP) is not fully understood. The authors have observed that many infants with this condition have external hydrocephalus. This study was undertaken to quantify cerebrospinal fluid (CSF) space caliber in children with OP and to compare these measurements to those derived from normal age-matched controls to further elucidate the pathogenesis of this condition. Thirty-one infants with isolated unilateral OP (mean age 6 months) were studied. Infants with multiple cranial suture abnormalities, impaired neurological function, developmental delay, and associated craniofacial anomalies were excluded. Twenty normal infants were evaluated as controls. The volumes of the sylvian fissures, frontal and occipital subarachnoid spaces, as well as the cross-sectional areas of the suprasellar and perimesencephalic cisterns, were calculated from computerized tomography (CT) studies. Ventricular size was also assessed. Generalized subarachnoid space dilation was observed in 29 (93.5%) of the 31 children with OP. Head circumference was significantly greater in the case group (71.4 vs. 50.8 percentile; p = 0.0002 by analysis of variance). The sylvian fissure volume was significantly larger in the case group (5.8 ml vs. 0.7 ml in controls, p < 0.0001). The volume of the contralateral sylvian fissure was greater than that ipsilateral to the side of OP (7.1 ml vs. 4.5 ml, p = 0.001). Frontal subarachnoid space volume was greater in infants with OP (27.5 ml vs. 0.6 ml in controls, p < 0.0001). Both the suprasellar and perimesencephalic cisterns were of greater caliber in the case group (p = 0.007 and p < 0.0001, respectively). No difference in ventricular size or occipital subarachnoid space volume was noted between groups. The extraventricular CSF spaces in neurologically unimpaired infants with OP are significantly larger than those in age-and sex-matched controls. Enlarged subarachnoid spaces may increase the compliance and malleability of the calvaria and sutures, predisposing to positional deformity. External hydrocephalus may be a fundamental etiological factor in OP.

Assessment of Leeds device for monitoring intracranial pressure

1984 ◽  
Vol 60 (1) ◽  
pp. 123-129 ◽  
Author(s):  
N. Mark Dearden ◽  
D. Gordon McDowall ◽  
Robert M. Gibson
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Subarachnoid Space ◽  
Severe Head Injury ◽  
Infusion Test ◽  
Free Communication ◽  
Content Type ◽  
Fine Print

✓ In Leeds a screw device is used to monitor surface subarachnoid pressure following severe head injury. The possibility that such measurements may under-read true intracranial pressure (ICP) has led to the development of an infusion test to confirm free communication with the surface subarachnoid space. The results of 69 infusion tests using 18 devices reveal that the device was reading accurately on 33 of 69 occasions. In 31 of the remaining 36, correction of the problem was possible. Particularly at ICP values exceeding 20 mm Hg the Leeds device may under-read, and possible causes for this are discussed. Reliable readings can usually be obtained using the infusion sequence described.

Mannitol-induced rebleeding from intracranial aneurysm

1983 ◽  
Vol 59 (3) ◽  
pp. 529-530 ◽  
Author(s):  
Jarl Rosenørn ◽  
Lars Westergaard ◽  
Peter H. Hansen
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Aneurysm ◽  
Pressure Gradient ◽  
Intravenous Administration ◽  
Elevated Intracranial Pressure ◽  
Content Type ◽  
Aneurysm Wall ◽  
The Relationship ◽  
Increased Pressure ◽  
Fine Print

✓ A case is presented in which rebleeding from an intracranial saccular aneurysm occurred a few minutes after intravenous administration of mannitol during surgery. The relationship between the reducing effect of mannitol on elevated intracranial pressure and the increased pressure gradient across the aneurysm wall, causing risk of rebleeding, is discussed. Procedures that can reduce this risk are summarized.

Modification of the Richmond subarachnoid screw for monitoring intracranial pressure

1984 ◽  
Vol 60 (5) ◽  
pp. 1102-1103 ◽  
Author(s):  
Karl W. Swann ◽  
Eric R. Cosman
Keyword(s):  
Intracranial Pressure ◽  
Subarachnoid Space ◽  
Content Type ◽  
Fine Print

✓ The authors describe a modification of a subarachnoid screw for monitoring intracranial pressure by hydrostatic coupling of the subarachnoid space to an external transducer. The device can be used in both children and adults, and features more assured placement of the distal tip, increased stability, and enhanced safety on insertion.

Flushing in relation to a possible rise in intracranial pressure: documentation of an unusual clinical sign

2000 ◽  
Vol 92 (6) ◽  
pp. 1040-1044 ◽  
Author(s):  
Gregory W. Hornig
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intraventricular Hemorrhage ◽  
Pneumococcal Meningitis ◽  
Clinical Importance ◽  
Neurological Deterioration ◽  
Content Type ◽  
Transient Nature ◽  
Fine Print

✓ This report documents clinical features in five children who developed transient reddening of the skin (epidermal flushing) in association with acute elevations in intracranial pressure (ICP). Four boys and one girl (ages 9–15 years) deteriorated acutely secondary to intracranial hypertension ranging from 30 to 80 mm Hg in the four documented cases. Two patients suffered from ventriculoperitoneal shunt malfunctions, one had diffuse cerebral edema secondary to traumatic brain injury, one was found to have pneumococcal meningitis and hydrocephalus, and one suffered an intraventricular hemorrhage and hydrocephalus intraoperatively. All patients were noted to have developed epidermal flushing involving either the upper chest, face, or arms during their period of neurological deterioration. The response was transient, typically lasting 5 to 15 minutes, and dissipated quickly. The flushing reaction is postulated to be a centrally mediated response to sudden elevations in ICP. Several potential mechanisms are discussed. Flushing has clinical importance because it may indicate significant elevations in ICP when it is associated with neurological deterioration. Because of its transient nature, the importance of epidermal flushing is often unrecognized; its presence confirms the need for urgent treatment.

Effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure

1987 ◽  
Vol 66 (4) ◽  
pp. 548-554 ◽  
Author(s):  
Seigo Nagao ◽  
Tsukasa Nishiura ◽  
Hideyuki Kuyama ◽  
Masakazu Suga ◽  
Takenobu Murota
Keyword(s):  
Intracranial Pressure ◽  
Reticular Formation ◽  
Cerebral Blood Volume ◽  
Systemic Arterial Pressure ◽  
Brain Swelling ◽  
Dorsomedial Nucleus ◽  
Medullary Reticular Formation ◽  
Content Type ◽  
Fine Print ◽  
Stimulation Of

✓ The authors report the results of a study to evaluate the effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure (ICP) after the hypothalamic dorsomedial nucleus and midbrain reticular formation were destroyed. Systemic arterial pressure (BP), ICP, and local cerebral blood volume (CBV) were continuously recorded in 32 cats. To assess the changes in the cerebral vasomotor tonus, the vasomotor index defined by the increase in ICP per unit change in BP was calculated. In 29 of the 32 animals, BP, ICP, and CBV increased simultaneously immediately after stimulation. The increase in ICP was not secondary to the increase in BP, because the vasomotor index during stimulation was significantly higher than the vasomotor index after administration of angiotensin II. The vasomotor index was high during stimulation of the area around the nucleus reticularis parvocellularis. In animals with the spinal cord transected at the C-2 vertebral level, ICP increased without a change in BP. These findings indicate that the areas stimulated in the medullary reticular formation play an important role in decreasing cerebral vasomotor tonus. This effect was not influenced by bilateral superior cervical ganglionectomy, indicating that there is an intrinsic neural pathway that regulates cerebral vasomotor tonus directly. In three animals, marked biphasic or progressive increases in ICP up to 100 mm Hg were evoked by stimulation. The reduction of cerebral vasomotor tonus and concomitant vasopressor response induced by stimulation of the medullary reticular formation may be one of the causes of acute brain swelling.

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