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Magnitude and direction of aqueductal cerebrospinal fluid flow: large variations in patients with intracranial aneurysms with or without a previous subarachnoid hemorrhage

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Net cerebrospinal fluid (CSF) flow within the cerebral aqueduct is usually considered to be antegrade, i.e., from the third to the fourth ventricle with volumes ranging between 500 and 600 ml over 24 h. Knowledge of individual CSF flow dynamics, however, is hitherto scarcely investigated. In order to explore individual CSF flow rate and direction, we assessed net aqueductal CSF flow in individuals with intracranial aneurysms with or without a previous subarachnoid hemorrhage (SAH).

Methods

A prospective observational study was performed utilizing phase-contrast magnetic resonance imaging (PC-MRI) to determine the magnitude and direction of aqueductal CSF flow with an in-depth, pixel-by-pixel approach. Estimation of net flow was used to calculate CSF flow volumes over 24 h. PC-MRI provides positive values when flow is retrograde.

Results

The study included eight patients with intracranial aneurysms. Four were examined within days after their SAH; three were studied in the chronic stage after SAH while one patient had an unruptured intracranial aneurysm. There was a vast variation in magnitude and direction of aqueductal CSF flow between individuals. Net aqueductal CSF flow was retrograde, i.e., directed towards the third ventricle in 5/8 individuals. For the entire patient cohort, the estimated net aqueductal CSF volumetric flow rate (independent of direction) was median 898 ml/24 h (ranges 69 ml/24 h to 12.9 l/24 h). One of the two individuals who had a very high estimated net aqueductal CSF volumetric flow rate, 8.7 l/24 h retrograde, later needed a permanent CSF shunt.

Conclusions

The magnitude and direction of net aqueductal CSF flow vary extensively in patients with intracranial aneurysms. Following SAH, PC-MRI may offer the possibility to perform individualized assessments of the CSF circulation.

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Abbreviations

ACOM:

Anterior communicating artery

CSF:

Cerebrospinal fluid

EVT:

Endovascular treatment

ICA:

Internal carotid artery

iNPH:

Idiopathic normal pressure hydrocephalus

PC-MRI:

Phase-contrast magnetic resonance imaging

ROI:

Region of interest

SAH:

Subarachnoid hemorrhage

SNR:

Signal-to-noise ratio

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Funding

Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway

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Correspondence to Per Kristian Eide.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

For this type of study, formal consent is not required.

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Informed consent was obtained from all individual participants for whom identifying information is included in this article.

Additional information

This article is part of the Topical Collection on Vascular Neurosurgery – Aneurysm

Electronic supplementary material

Animation of aqueductal CSF flow in the individual patients: Movie 1 (patient 1), Movie 2 (patient 2), Movie 3 (patient 3), Movie 4 (patient 4), Movie 5 (patient 5), Movie 6 (patient 6), Movie 7 (patient 7), and Movie 8 (patient 8).

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Lindstrøm, E.K., Ringstad, G., Sorteberg, A. et al. Magnitude and direction of aqueductal cerebrospinal fluid flow: large variations in patients with intracranial aneurysms with or without a previous subarachnoid hemorrhage. Acta Neurochir 161, 247–256 (2019). https://doi.org/10.1007/s00701-018-3730-6

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  • DOI: https://doi.org/10.1007/s00701-018-3730-6

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