Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital, Cambridge, UK.
Department of Paediatric Neurology, Cambridge University Hospital, Cambridge, UK.
Acta Neurochir (Wien). 2020 May;162(5):1001-1009. doi: 10.1007/s00701-019-04095-w. Epub 2019 Dec 12.
Pseudotumour cerebri syndrome (PTCS including idiopathic intracranial hypertension) is characterised by the symptoms and signs of raised cerebrospinal fluid pressure (CSFp) in the absence of ventricular dilatation or an intracranial mass lesion. Its aetiology is unknown in the majority of cases but there is much evidence for impaired CSF absorption. Traditionally, sagittal sinus pressure has been considered to be independent of CSF pressure in adults. However, the discovery of stenoses of intracranial venous sinuses and introduction of venous sinus stenting has highlighted the importance of the venous drainage in PTCS. In this study, we have explored the relationship between CSFp and SSp before and during a CSF infusion test and during CSF drainage.
Ten patients (9 females:1 male) with PTCS underwent infusion studies in parallel with direct retrograde cerebral venography. Both SSp and CSFp were recorded at a baseline and during CSFp elevation in a course of a CSF infusion test. The drainage of CSF after the CSF infusion was performed in 7 patients. In 5 cases, jugular venous pressure was also measured.
CSFp and SSp including their amplitudes correlated significantly and strongly both at baseline (R = 0.96; p = 0.001) and during infusion (R = 0.92; p = 0.0026). During drainage, this correlation was maintained until SSp reached a stable value, whereas CSFp continued to decrease.
In this series of ten patients with PTCS, CSFp and SSp were coupled, both at baseline and during infusion. The implications of such coupling for the calculation of CSF outflow resistance are discussed.
假性脑瘤综合征(包括特发性颅内高压)的特征是脑脊液压力升高(CSFp)的症状和体征,但不存在脑室扩张或颅内肿块病变。大多数情况下,其病因不明,但有大量证据表明脑脊液吸收受损。传统上,成人的矢状窦压力被认为与 CSFp 无关。然而,颅内静脉窦狭窄的发现和静脉窦支架置入术的引入凸显了静脉引流在假性脑瘤综合征中的重要性。在这项研究中,我们探讨了 CSF 输注试验前后和 CSF 引流期间 CSFp 和 SSp 之间的关系。
10 例假性脑瘤综合征患者(9 名女性:1 名男性)同时进行了输注研究和逆行脑静脉造影。在 CSF 输注试验过程中,在基线和 CSFp 升高期间记录 SSp 和 CSFp。在 7 例患者中进行了 CSF 引流。在 5 例患者中,还测量了颈静脉压。
CSFp 和 SSp 及其振幅在基线时(R = 0.96;p = 0.001)和输注时(R = 0.92;p = 0.0026)均显著且强烈相关。在引流期间,这种相关性一直保持到 SSp 达到稳定值,而 CSFp 继续下降。
在这 10 例假性脑瘤综合征患者中,CSFp 和 SSp 在基线和输注时均相关。讨论了这种耦合对 CSF 流出阻力计算的影响。