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01-04-2016 | Review Paper

The cerebral venous system and the postural regulation of intracranial pressure: implications in the management of patients with cerebrospinal fluid diversion

Authors: Kaveh Barami, Sandeep Sood

Published in: Child's Nervous System | Issue 4/2016

Abstract

Loss of cerebrospinal fluid (CSF) occurs commonly in daily neurosurgical practice. Understanding the altered physiology following CSF loss is important for optimization of patient care and avoidance of complications. There is overwhelming evidence now that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. The CSF and cerebral venous compartments are tightly coupled in two important ways. CSF is resorbed into the venous system, and there is also an evolved mechanism that prevents overdrainage of venous blood with upright positioning known as the Starling resistor. With loss of CSF pressure, this protective mechanism could become nonfunctional which may result in posture-related venous overdrainage through the cranial venous outflow tracts leading to pathologic states. This review article summarizes the relevant anatomic and physiologic basis of the relationship between the craniospinal venous and CSF compartments in the setting of CSF diversion. It is hoped that this article improves our understanding of ICP dynamics after CSF loss, adds a new dimension to our therapeutic methods, stimulates further research into this field, and ultimately improves our care of these patients.

Akins PT, Guppy KH, Axelrod YV, Chakrabarti I, Silverthorn J, Williams AR (2011) The genesis of low pressure hydrocephalus. Neurocrit Care 15(3):461–468CrossRefPubMed

Andresen M, Juhler M (2014) Intracranial pressure following complete removal of a small demarcated brain tumor: a model for normal intracranial pressure in humans. J Neurosurg 121(4):797–801CrossRefPubMed

Arnautović KI, al-Mefty O, Pait TG, Krisht AF, Husain MM (1997) The suboccipital cavernous sinus. J Neurosurg 86(2):252–262CrossRefPubMed

Barami K, Sood S, Ham SD, Canady AI (2000) Postural changes in intracranial pressure in chronically shunted patients. Pediatr Neurosurg 33(2):64–69CrossRefPubMed

Batson OV (1995) The function of the vertebral veins and their role in the spread of metastases. 1940. Clin Orthop Relat Res 312:4–9PubMed

Benvenuti D, Maiuri F, Lavano A, Volpentesta G, Giamundo A, Tecame S (1987) Postoperative intracerebral haemorrhages remote from the site of the initial operation. Br J Neurosurg 1(3):377–384CrossRefPubMed

Bergsneider M, Yang I, Hu X, McArthur DL, Cook SW, Boscardin WJ (2004) Relationship between valve opening pressure, body position, and intracranial pressure in normal pressure hydrocephalus: paradigm for selection of programmable valve pressure setting. Neurosurgery 55(4):851–858CrossRefPubMed

Bernal-García LM, Cabezudo-Artero JM, Ortega-Martínez M, et al. (2008) Remote cerebellar hemorrhage after lumbar spinal fluid drainage. Report of two cases and literature review. Neurocirugia (Astur) 19(5):440–445CrossRef

Borkar SA, Lakshmiprasad G, Sharma BS, Mahapatra AK (2013) Remote site intracranial haemorrhage: a clinical series of five patients with review of literature. Br J Neurosurg 27(6):735–738CrossRefPubMed

10.

Brinker T, Stopa E, Morrison J, Klinge P (2014) A new look at cerebrospinal fluid circulation. Fluids and Barriers of the CNS 11:10. doi:10.1186/2045-8118-11-10. eCollection 2014 CrossRefPubMedPubMedCentral

11.

Brisman MH, Bederson JB, Sen CN, Germano IM, Moore F, Post KD (1996) Intracerebral hemorrhage occurring remote from the craniotomy site. Neurosurgery 39(6):1114–1121CrossRefPubMed

12.

Brockmann MA, Groden C (2006) Remote cerebellar hemorrhage: a review. Cerebellum 5(1):64–68CrossRefPubMed

13.

Chapman PH, Cosman ER, Arnold MA (1990) The relationship between ventricular fluid pressure and body position in normal subjects and subjects with shunts: a telemetric study. Neurosurgery 26(2):181–189CrossRefPubMed

14.

Clarke MJ, Maher CO, Nothdurft G, Meyer F (2006) Very low pressure hydrocephalus. Report of two cases. J Neurosurg 105(3):475–478CrossRefPubMed

15.

Cushing H (1926) The third circulation in studies in intracranial studies in physiology and surgery. Oxford University Press, London, pp. 1–51

16.

Daniel RT, Lee GY, Halcrow SJ (2002) Low-pressure hydrocephalic state complicating hemispherectomy: a case report. Epilepsia 43(5):563–565CrossRefPubMed

17.

Davson H (1984) Formation and drainage of the cerebrospinal fluid. In: Shapiro K, Marmarou A, Portnoy H (eds) Hydrocephalus. Raven, New York, pp. 3–40

18.

Davson H (1967) Physiology of the cerebrospinal fluid. Churchill, London, p. 445

19.

De Simone R, Raniere A, Montella S, Bilo L, Cautierio F (2014) The role of dural sinus stenosis in indiopathic intracranial hypertension pathogenesis: the self-limiting venous collapse feedback-loop model. Panminerva Med 56(3):201–209PubMed

20.

Dias MS, Li V, Pollina J (1999) Low-pressure shunt ‘malfunction’ following lumbar puncture in children with shunted obstructive hydrocephalus. Pediatr Neurosurg 30(3):146–150CrossRefPubMed

21.

Doepp F, Schreiber SJ, von Münster T, Rademacher J, Klingebiel R, Valdueza JM (2004) How does the blood leave the brain? A systematic ultrasound analysis of cerebral venous drainage patterns. Neuroradiology 46(7):565–570CrossRefPubMed

22.

Drake JM, Tenti G, Sivalsganathan S (1994) Computer modeling of siphoning for CSF shunt design evaluation. Pediatr Neurosurg 21(1):6–15CrossRefPubMed

23.

Evins AI, Boeris D, Burrell JC, Ducati A (2013) Postoperative intracranial hypotension-associated venous congestion: case report and literature review. Clin Neurol Neurosurg 115(10):2243–2246CrossRefPubMed

24.

Friedman JA, Ecker RD, Piepgras DG, Duke DA (2002) Cerebellar hemorrhage after spinal surgery: report of two cases and literature review. Neurosurgery 50(6):1361–1363PubMed

25.

Friedman JA, Piepgras DG, Duke DA, et al. (2001) Remote cerebellar hemorrhage after supratentorial surgery. Neurosurgery 49(6):1327–1340CrossRefPubMed

26.

Fry D, Thomas L, Greenfield J (1980) Flow in collapsible tubes. In: Patel D, Vaishnav R (eds) Basic hemodynamics and its role in disease processes. University Park, Baltimore, pp. 419–423

27.

Garg K, Tandon V, Sinha S, Suri A, Mahapatra AK, Sharma BS (2014) Remote site intracranial hemorrhage: our experience and review of literature. Neurol India 62(3):296–302CrossRefPubMed

28.

Gisolf J, van Lieshout JJ, van Heusden K, Pott F, Stok WJ, Karemaker JM (2004) Human cerebral venous outflow pathway depends on posture and central venous pressure. J Physiol 560(Pt 1):317–327CrossRefPubMedPubMedCentral

29.

Grady MS, Bedford RF, Park TS (1986) Changes in superior sagittal sinus pressure in children with head elevation, jugular venous compression, and PEEP. J Neurosurg 65(2):199–202CrossRefPubMed

30.

Grant R, Condon B, Hart I, Teasdale GM (1991) Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry 54(5):440–442CrossRefPubMedPubMedCentral

31.

Greenfield Jr JC, Tindall GT (1965) Effect of acute increase in intracranial pressure on blood flow in the internal carotid artery of man. J Clin Invest 44:1343–1351CrossRefPubMedPubMedCentral

32.

Higashi S, Futami K, Matsuda H, et al. (1994) Effects of head elevation on intracranial hemodynamics in patients with ventriculoperitoneal shunts. J Neurosurg 81(6):829–836CrossRefPubMed

33.

Iwabuchi T, Sobata E, Ebina K, Tsubakisaka H, Takiguchi M (1986) Dural sinus pressure: various aspects in human brain surgery in children and adults. Am J Physiol. 250(3 Pt 2):H389–H396PubMed

34.

Iwabuchi T, Sobata E, Suzuki M, Suzuki S, Yamashita M (1983) Dural sinus pressure as related to neurosurgical positions. Neurosurgery 12(2):203–207CrossRefPubMed

35.

Johnston IH, Rowan JO (1974) Raised intracranial pressure and cerebral blood flow. 3. Venous outflow tract pressures and vascular resistances in experimental intracranial hypertension. J Neurol Neurosurg Psychiatry 37(4):392–402CrossRefPubMedPubMedCentral

36.

Kajimoto Y, Ohta T, Miyake H, et al. (2000) Posture-related changes in the pressure environment of the ventriculoperitoneal shunt system. J Neurosurg 93(4):614–617CrossRefPubMed

37.

Kerr EE, Prevedello DM, Jamshidi A, Ditzel Filho LF, Otto BA, Carrau RL (2014) Immediate complications associated with high-flow cerebrospinal fluid egress during endoscopic endonasal skull base surgery. Neurosurg Focus 37(4):E3CrossRefPubMed

38.

Kety SS, Shenkin HA, Schmidt CF (1948) The effects of increased intracranial pressure on cerebral circulatory functions in man. J Clin Invest 27(4):493–499CrossRefPubMedCentral

39.

Knowlton FP, Starling EH (1912) The influence of variations in temperature and blood-pressure on the performance of the isolated mammalian heart. J Physiol 44(3):206–219CrossRefPubMedPubMedCentral

40.

Lesniak MS, Clatterbuck RE, Rigamonti D, Williams MA (2002) Low pressure hydrocephalus and ventriculomegaly: hysteresis, non-linear dynamics, and the benefits of CSF diversion. Br J Neurosurg 16(6):555–561CrossRefPubMed

41.

Luce JM, Huseby JS, Kirk W, Butler J (1982) A Starling resistor regulates cerebral venous outflow in dogs. J Appl Physiol Respir Environ Exerc Physiol 53(6):1496–1503PubMed

42.

Magnaes B (1976) Body position and cerebrospinal fluid pressure. Part 2: clinical studies on orthostatic pressure and the hydrostatic indifferent point. J Neurosurg 44(6):698–705CrossRefPubMed

43.

Magnaes B (1989) Clinical studies of cranial and spinal compliance and the craniospinal flow of cerebrospinal fluid. Br J Neurosurg 3(6):659–668CrossRefPubMed

44.

Magnaes B (1978) Movement of cerebrospinal fluid within the craniospinal space when sitting up and lying down. Surg Neurol 10(1):45–49PubMed

45.

Marmarou A, Shulman K, LaMorgese J (1975) Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43(5):523–534CrossRefPubMed

46.

Marquardt G, Setzer M, Schick U, Seifert V (2002) Cerebellar hemorrhage after supratentorial craniotomy. Surg Neurol 57(4):241–251CrossRefPubMed

47.

Martínez-Lage JF, Alarcón F, Alfaro R, Ruíz-Espejo A, López-Guerrero AL, Hernández-Abenza J (2009) Cervical extramedullary mass lesion due to chronic CSF overshunting: case report and literature review. Childs Nerv Syst 25(7):895–898CrossRefPubMed

48.

McCullough DC (1986) Symptomatic progressive ventriculomegaly in hydrocephalics with patent shunts and antisiphon devices. Neurosurgery 19(4):617–621CrossRefPubMed

49.

Moayeri NN, Henson JW, Schaefer PW, Zervas NT (1998) Spinal Dural enhancement on magnetic resonance imaging associated with spontaneous intracranial hypotension. Report of three cases and review of the literature. J Neurosurg 88(5):912–918CrossRefPubMed

50.

Mokri B (2001) The monro-kellie hypothesis: applications in CSF volume depletion. Neurology 56(12):1746–1748CrossRefPubMed

51.

Müller LO, Toro EF (2014) Enhanced global mathematical model for studying cerebral venous blood flow. J Biomech 47(13):3361–3372CrossRefPubMed

52.

Nakagawa Y, Tsuru M, Yada K (1974) Site and mechanism for compression of the venous system during experimental intracranial hypertension. J Neurosurg 41(4):427–434CrossRefPubMed

53.

Owler BK, Jacobson EE, Johnston IH (2001) Low pressure hydrocephalus: issues of diagnosis and treatment in five cases. Br J Neurosurg 15(4):353–359CrossRefPubMed

54.

Pang D, Altschuler E (1994) Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery 35(4):643–655CrossRefPubMed

55.

Pang Q, Wang C, Hu Y, et al. (2001) Experimental study of the morphology of cerebral bridging vein. Chin Med Sci J 16(1):19–22PubMed

56.

Park JS, Hwang JH, Park J, Hamm IS, Park YM (2009) Remote cerebellar hemorrhage complicated after supratentorial surgery: retrospective study with review of articles. J Korean Neurosurg Soc 46(2):136–143CrossRefPubMedPubMedCentral

57.

Piechnik SK, Czosnyka M, Richards HK, Whitfield PC, Pickard JD (2001) Cerebral venous blood outflow: a theoretical model based on laboratory simulation. Neurosurgery 49(5):1214–1222PubMed

58.

Portnoy HD, Branch C, Castro ME (1994) The relationship of intracranial venous pressure to hydrocephalus. Childs Nerv Syst 10(1):29–35CrossRefPubMed

59.

Qvarlander S, Sundström N, Malm J, Eklund A (2013) Postural effects on intracranial pressure: modeling and clinical evaluation. J Appl Physiol (1985) 115(10):1474–1480CrossRef

60.

Schievink WI, Meyer FB, Atkinson JL, Mokri B (1996) Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 84(4):598–605CrossRefPubMed

61.

Seoane E, Rhoton AL Jr. (1999) Compression of the internal jugular vein by the transverse process of the atlas as the cause of cerebellar hemorrhage after supratentorial craniotomy Surg Neurol 51(5):500–5

62.

Si Z, Luan L, Kong D, et al. (2008) MRI-based investigation on outflow segment of cerebral venous system under increased ICP condition. Eur J Med Res 13(3):121–6

63.

Sood S, Kumar CR, Jamous M, Schuhmann MU, Ham SD, Canady AI (2004) Pathophysiological changes in cerebrovascular distensibility in patients undergoing chronic shunt therapy. J Neurosurg 100(5 Suppl Pediatrics):447–453PubMed

64.

Tobinick E, Vega CP (2006) The cerebrospinal venous system: anatomy, physiology, and clinical implications. MedGenMed 8(1):53PubMed

65.

Ulrich NH, Maier M, Bernays RL, Krayenbuhl N, Kollias S (2013) Cervical myelopathy due to chronic overshunting in a pediatric patient: case report and review of the literature. Turk Neurosurg 23(3):410–414PubMed

66.

Valdueza JM, von Münster T, Hoffman O, Schreiber S, Einhäupl KM (2000) Postural dependency of the cerebral venous outflow. Lancet 355(9199):200–201CrossRefPubMed

67.

Vassilyadi M, Farmer JP, Montes JL (1995) Negative-pressure hydrocephalus. J Neurosurg 83(3):486–490CrossRefPubMed

68.

Vignes JR, Dagain A, Guérin J, Liguoro D (2007) A hypothesis of cerebral venous system regulation based on a study of the junction between the cortical bridging veins and the superior sagittal sinus. Laboratory investigation. J Neurosurg 107(6):1205–1210CrossRefPubMed

69.

Vogels RL, Verstegen MJ, van Furth WR (2006) Cerebellar haemorrhage after non-traumatic evacuation of supratentorial chronic subdural haematoma: report of two cases. Acta Neurochir 148(9):993–996CrossRefPubMed

70.

Zamboni P, Sisini F, Menegatti E, et al. (2013) An ultrasound model to calculate the brain blood outflow through collateral vessels: a pilot study. BMC Neurol 13:81CrossRefPubMedPubMedCentral

Title: The cerebral venous system and the postural regulation of intracranial pressure: implications in the management of patients with cerebrospinal fluid diversion
Authors: Kaveh Barami
Sandeep Sood
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 4/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-015-3010-1

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The cerebral venous system and the postural regulation of intracranial pressure: implications in the management of patients with cerebrospinal fluid diversion

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