Summary
The view of the intracranial system as a rigid and closed box has been criticised by many authors who take into account the possibility of a certain degree of elastic bulk accommodation, mainly in the spinal sac.
In nine patients, who underwent decompressive craniectomy for treatment of life-threatening intracranial hypertension, when the clinical conditions improved, just before cranioplasty, the blood flow velocities at middle cerebral artery (MCA) and at superior sagittal sinus (SSS) level were simultaneously recorded. The measurements were repeated after cranioplasty.
The blood flow velocity recorded from SSS in craniectomized patients appeared flat, without evident pulsation; after cranioplasty a clear-cut pulsatile wave became again evident.
The disappearance of a pulsatile shape in the blood flow velocity recorded from the SSS when the intracranial system was “open” and the reappearance of a pulsatile blood flow waveform after the “closure” of the skull confirm that the venous bed acts as a bulk compensatory system in order to maintain the intracranial volume absolutely constant.
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References
Avezaat CJJ, van Eijndhoven JHM, Wyper DJ (1979) Cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J Neurol Neurosurg Psych 42: 687–700
Marmarou A (1973) A theoretical model and experimental evaluation of the cerebrospinal system. Thesis, Drexel University
Miller JD, Pickard JD (1974) Intracranial volume-pressure studies in patients with head injury. Injury 5: 265–269
Portnoy HD, Chopp M, Branch C (1983) Hydraulic model of myogenic autoregulation and the cerebrovascular bed: the effects of altering systemic arterial pressure. Neurosurgery 13: 482–498
Shapiro K, Fried A, Takei F, Kohm I (1985) Effects of the dura opening on neural axis pressure-volume relationships and CSF dynamics. J Neurosurg 63: 76–81
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© 2002 Springer-Verlag
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Carmelo, A. et al. (2002). ICP and CBF Regulation: Effect of the Decompressive Craniectomy. In: Czosnyka, M., Pickard, J.D., Kirkpatrick, P.J., Smielewski, P., Hutchinson, P. (eds) Intracranial Pressure and Brain Biochemical Monitoring. Acta Neurochirurgica Supplements, vol 81. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6738-0_28
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DOI: https://doi.org/10.1007/978-3-7091-6738-0_28
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-7397-8
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