Erika Kristina Lindstrøm1, Geir Ringstad2,3, Angelika Sorteberg3,4, Wilhelm Sorteberg4, Kent-Andre Mardal1,5, Per Kristian Eide6,7. 1. Department of Mathematics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway. 2. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 3. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. 4. Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Pb 4950 Nydalen, N-0424, Oslo, Norway. 5. Department of Numerical Analysis and Scientific Computing, Simula Research Laboratory, Fornebu, Norway. 6. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. peide@ous-hf.no. 7. Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Pb 4950 Nydalen, N-0424, Oslo, Norway. peide@ous-hf.no.
Abstract
BACKGROUND: Net cerebrospinal fluid (CSF) flow within the cerebral aqueduct is usually considered to be antegrade, i.e., from the third to the fourth ventricle with volumes ranging between 500 and 600 ml over 24 h. Knowledge of individual CSF flow dynamics, however, is hitherto scarcely investigated. In order to explore individual CSF flow rate and direction, we assessed net aqueductal CSF flow in individuals with intracranial aneurysms with or without a previous subarachnoid hemorrhage (SAH). METHODS: A prospective observational study was performed utilizing phase-contrast magnetic resonance imaging (PC-MRI) to determine the magnitude and direction of aqueductal CSF flow with an in-depth, pixel-by-pixel approach. Estimation of net flow was used to calculate CSF flow volumes over 24 h. PC-MRI provides positive values when flow is retrograde. RESULTS: The study included eight patients with intracranial aneurysms. Four were examined within days after their SAH; three were studied in the chronic stage after SAH while one patient had an unruptured intracranial aneurysm. There was a vast variation in magnitude and direction of aqueductal CSF flow between individuals. Net aqueductal CSF flow was retrograde, i.e., directed towards the third ventricle in 5/8 individuals. For the entire patient cohort, the estimated net aqueductal CSF volumetric flow rate (independent of direction) was median 898 ml/24 h (ranges 69 ml/24 h to 12.9 l/24 h). One of the two individuals who had a very high estimated net aqueductal CSF volumetric flow rate, 8.7 l/24 h retrograde, later needed a permanent CSF shunt. CONCLUSIONS: The magnitude and direction of net aqueductal CSF flow vary extensively in patients with intracranial aneurysms. Following SAH, PC-MRI may offer the possibility to perform individualized assessments of the CSF circulation.
BACKGROUND: Net cerebrospinal fluid (CSF) flow within the cerebral aqueduct is usually considered to be antegrade, i.e., from the third to the fourth ventricle with volumes ranging between 500 and 600 ml over 24 h. Knowledge of individual CSF flow dynamics, however, is hitherto scarcely investigated. In order to explore individual CSF flow rate and direction, we assessed net aqueductal CSF flow in individuals with intracranial aneurysms with or without a previous subarachnoid hemorrhage (SAH). METHODS: A prospective observational study was performed utilizing phase-contrast magnetic resonance imaging (PC-MRI) to determine the magnitude and direction of aqueductal CSF flow with an in-depth, pixel-by-pixel approach. Estimation of net flow was used to calculate CSF flow volumes over 24 h. PC-MRI provides positive values when flow is retrograde. RESULTS: The study included eight patients with intracranial aneurysms. Four were examined within days after their SAH; three were studied in the chronic stage after SAH while one patient had an unruptured intracranial aneurysm. There was a vast variation in magnitude and direction of aqueductal CSF flow between individuals. Net aqueductal CSF flow was retrograde, i.e., directed towards the third ventricle in 5/8 individuals. For the entire patient cohort, the estimated net aqueductal CSF volumetric flow rate (independent of direction) was median 898 ml/24 h (ranges 69 ml/24 h to 12.9 l/24 h). One of the two individuals who had a very high estimated net aqueductal CSF volumetric flow rate, 8.7 l/24 h retrograde, later needed a permanent CSF shunt. CONCLUSIONS: The magnitude and direction of net aqueductal CSF flow vary extensively in patients with intracranial aneurysms. Following SAH, PC-MRI may offer the possibility to perform individualized assessments of the CSF circulation.
Authors: Vegard Vinje; Geir Ringstad; Erika Kristina Lindstrøm; Lars Magnus Valnes; Marie E Rognes; Per Kristian Eide; Kent-Andre Mardal Journal: Sci Rep Date: 2019-07-05 Impact factor: 4.379
Authors: Martin Hornkjøl; Lars Magnus Valnes; Geir Ringstad; Marie E Rognes; Per-Kristian Eide; Kent-André Mardal; Vegard Vinje Journal: Front Bioeng Biotechnol Date: 2022-09-12