Sato O, Takei F, Yamada S
Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan.
Childs Nerv Syst. 1994 Apr;10(3):151-5. doi: 10.1007/BF00301080.
Hydrocephalus is a complex disease of the brain as a whole, and imbalance between cerebrospinal fluid (CSF) formation and absorption is not the sole mechanism involved in its pathophysiology. In the absence of a lymphatic system in the central nervous system, open communication between CSF and interstitial fluid (ISF) of the brain may contribute to maintaining homeostasis of the brain, keeping the microchemical environment in good balance. Membranes or cell layers separating CSF from ISF of the brain do not provide impermeability, so the CSF communicates with ISF across the ependymal layer and the pial surface of the brain. In contradiction of the classical theory, the CSF one may obtain at the cisterna magna, for instance, is different from the newly formed CSF out of the choroid plexus, because it has been modified by the free communication between CSF and ISF spaces as the CSF descends along the neural axis. Free flow of water and some smaller molecules provides a bidirectional movement of water and other materials, and this must play an important role in brain volume control. The significance of this role should not be overlooked in regard to the pathophysiology of hydrocephalus.
脑积水是一种影响整个大脑的复杂疾病，脑脊液（CSF）生成与吸收之间的失衡并非其病理生理学的唯一机制。由于中枢神经系统缺乏淋巴系统，脑脊液与脑间质液（ISF）之间的开放交流可能有助于维持大脑的内环境稳定，使微化学环境保持良好平衡。分隔脑脊液与脑间质液的膜或细胞层并非完全不可渗透，因此脑脊液通过室管膜层和脑软膜表面与间质液进行交流。与经典理论相悖的是，例如在枕大池中获取的脑脊液与脉络丛新生成的脑脊液不同，因为当脑脊液沿神经轴下降时，它已通过脑脊液与间质液空间之间的自由交流而发生了改变。水和一些较小分子的自由流动提供了水和其他物质的双向移动，这在脑容量控制中必定起着重要作用。就脑积水的病理生理学而言，这一作用的重要性不容小觑。
