Ruđer Bošković Institute, Department of Molecular Biology, Bijenička 54, 10 000 Zagreb, Croatia.
Prog Neurobiol. 2011 Aug;94(3):238-58. doi: 10.1016/j.pneurobio.2011.05.005. Epub 2011 May 27.
According to the classical hypothesis of the cerebrospinal fluid (CSF) hydrodynamics, CSF is produced inside the brain ventricles, than it circulates like a slow river toward the cortical subarachnoid space, and finally it is absorbed into the venous sinuses. Some pathological conditions, primarily hydrocephalus, have also been interpreted based on this hypothesis. The development of hydrocephalus is explained as an imbalance between CSF formation and absorption, where more CSF is formed than is absorbed, which results in an abnormal increase in the CSF volume inside the cranial CSF spaces. It is believed that the reason for the imbalance is the obstruction of the CSF pathways between the site of CSF formation and the site of its absorption, which diminishes or prevents CSF outflow from the cranium. In spite of the general acceptance of the classical hypothesis, there are a considerable number of experimental results that do not support such a hypothesis and the generally accepted pathophysiology of hydrocephalus. A recently proposed new working hypothesis suggests that osmotic and hydrostatic forces at the central nervous system microvessels are crucial for the regulation of interstial fluid and CSF volume which constitute a functional unit. Based on that hypothesis, the generally accepted mechanisms of hydrocephalus development are not plausible. Therefore, the recent understanding of the correlation between CSF physiology and the development of hydrocephalus has been thoroughly presented, analyzed and evaluated, and new insights into hydrocephalus etiopathology have been proposed, which are in accordance with the experimental data and the new working hypothesis.
根据经典的脑脊液（CSF）流体动力学假说，脑脊液在脑室内产生，然后像缓慢的河流一样流向皮质下蛛网膜下腔，最终被吸收进入静脉窦。一些病理状况，主要是脑积水，也基于这一假说进行了解释。脑积水的发展被解释为脑脊液形成和吸收之间的失衡，即形成的脑脊液多于吸收的脑脊液，导致颅腔脑脊液空间内的脑脊液体积异常增加。人们认为失衡的原因是脑脊液形成部位和吸收部位之间的脑脊液通路受阻，阻碍或阻止了脑脊液从颅骨中流出。尽管经典假说被广泛接受，但仍有相当数量的实验结果不支持这一假说和普遍接受的脑积水病理生理学。最近提出的一个新的工作假说表明，中枢神经系统微血管的渗透和静水压力对于调节构成功能单位的间质液和脑脊液体积至关重要。基于该假说，普遍接受的脑积水发展机制是不合理的。因此，本文对 CSF 生理学与脑积水发展之间的相关性进行了全面的阐述、分析和评估，并提出了新的脑积水病因病理学见解，这些见解与实验数据和新的工作假说相符。
