Mori Etsuro, Yamada Shinya
Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University, Graduate School of Medicine.
Rinsho Shinkeigaku. 2014;54(12):1190-2. doi: 10.5692/clinicalneurol.54.1190.
The morphological features of disproportionately enlarged subarachnoid-space hydrocephalus (DESH), the core type of idiopathic normal pressure hydrocephalus, can not be explained by the classical theory of CSF absorption at the arachnoid villi and the hypothesis of CSF flow blocking at the convexity subarachnoid spaces. By using MRI Time-SLIP CSF flow imaging, we demonstrated that CSF freely move in the subarachnoid spaces below and in the Sylvian fissures. CSF does not move in the convexity subarachnoid spaces in healthy individuals and patients with DESH, indicating the presence of flow obstacles in the convexity subarachnoid spaces by nature. If so, CSF absorption must take place below the Sylvian fissures. CSF would retain in the ventral subarachnoid spaces and ventricles, once the absorption below the Sylvian fissures is impaired. This hypothesis enables to explain the morphological features of DESH. We proposed an alternative hypothesis of CSF circulation and absorption including absorption from the cranial and spinal nerve roots to the lymphatic system.
特发性正常压力脑积水的核心类型——蛛网膜下腔不成比例扩大性脑积水(DESH)的形态学特征,无法用蛛网膜绒毛处脑脊液吸收的经典理论以及凸面蛛网膜下腔脑脊液流动受阻的假说来解释。通过使用MRI时间飞跃法脑脊液流动成像,我们证明脑脊液可在下方蛛网膜下腔和外侧裂内自由流动。在健康个体和DESH患者中,脑脊液在凸面蛛网膜下腔并不流动,这表明凸面蛛网膜下腔天然存在流动障碍。如果是这样,脑脊液吸收必定发生在外侧裂下方。一旦外侧裂下方的吸收功能受损,脑脊液就会潴留在腹侧蛛网膜下腔和脑室内。这一假说能够解释DESH的形态学特征。我们提出了一种关于脑脊液循环和吸收的替代假说,包括从颅神经和脊神经根向淋巴系统的吸收。