A NEW VIEW ON THE CSF-CIRCULATION WITH THE POTENTIAL FOR PHARMACOLOGICAL TREATMENT OF CHILDHOOD HYDROCEPHALUS

A new model of the cerebrospinal fluid (CSF) circulation is proposed, implying that the main absorption of CSF occurs through the brain capi llaries. This model is based on recent observations of CSF dynamics us ing radionuclide cisternography and cardiac gated magnetic resonance i maging. Magnetic resonance imaging of communicating hydrocephalus has demonstrated a highly significant decrease of CSF Row through the fora men magnum, which is explained by decreased expansion of the intracran ial arteries. This invariable finding in combination with the new view of the CSF-circulation makes a hemodynamic pathogenesis of hydrocepha lus very probable. Communicating hydrocephalus may be caused by any pr ocess that restricts the arterial pulsations and is therefore termed r estricted arterial pulsation hydrocephalus. In obstructive hydrocephal us, the ventricular dilatation leads to a compression of the cortical veins and consequently is termed Venous congestion hydrocephalus. Base d on these considerations, a new concept of pharmacological treatment of hydrocephalus is proposed by using a selective venous constrictor.