Brain Turgor (Kb): Intrinsic Property of the Brain to Resist Distortion

Rekate, Harold L.

doi:10.1159/000120672

Cited by 53 publications

(39 citation statements)

References 8 publications

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“…1,9,12,13,28,31,33,39,40 Some surgeons suggest that cerebellar tonsillar herniation may result from increased venous turgor. 9,28 Venous abnormalities are more often associated with complex and syndromic forms of craniosynostosis. 33,39 Abnormal venous anatomy must be accounted for when considering surgical treatment of CM associated with complex craniofacial syndromes.…”

Section: Discussionmentioning

confidence: 99%

Chiari malformation associated with craniosynostosis

Strahle

Muraszko

Buchman

et al. 2011

FOC

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Object Chiari malformation (CM) Type I is frequently associated with craniosynostosis. Optimal management of CM in patients with craniosynostosis is not well-established. The goal of this study was to report on a series of pediatric patients with both craniosynostosis and CM and discuss their management. Methods The authors searched the medical records of 383 consecutive patients treated for craniosynostosis at a single institution over a 15-year period to identify those with CM. They recorded demographic data as well as surgical treatment and outcomes for these patients. When MR imaging was performed, cerebellar tonsillar descent was recorded and any other associated findings, such as hydrocephalus or spinal syringes, were noted. Results A total of 29 patients with both CM and craniosynostosis were identified. Of these cases, 28% had associated occipital venous abnormalities, 45% were syndromic, and 52% also had hydrocephalus. Chiari malformation was more likely to be present in those patients with isolated lambdoid synostosis (55%), multisuture synostosis (35%), and pansynostosis (80%), compared with patients with coronal synostosis (6%) or sagittal synostosis (3%). All patients underwent surgical repair of craniosynostosis: 16 had craniosynostosis repair as well as CM decompression, and 13 patients did not undergo CM decompression. Of the 7 patients in whom craniosynostosis repair alone was performed, 5 had decreased tonsillar ectopia postoperatively and 5 had improved CSF flow studies postoperatively. Both patients with a spinal syrinx had imaging-documented syrinx regression after craniosynostosis repair. In 12 patients in whom CM was diagnosed after primary craniosynostosis repair, 5 had multiple cranial vault expansions and evidence of elevated intracranial pressure. In 5 cases, de novo CM development was documented following craniosynostosis repair at a mean of 3.5 years after surgery. Conclusions Chiari malformation is frequently seen in patients with both multi- and single-suture lambdoid craniosynostosis. Chiari malformation, and even a spinal cord syrinx, will occasionally resolve following craniofacial repair. De novo development of CM after craniosynostosis repair is not unusual.

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Section: Discussionmentioning

confidence: 99%

Chiari malformation associated with craniosynostosis

Strahle

Muraszko

Buchman

et al. 2011

FOC

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“…Simplistically, given an elevation in CSF pressure, those in whom the ventricles dilate must have higher brain compliance than those in whom the ventricles do not dilate. Rekate 16 has suggested that the reduced brain compliance may be due to an elevation in venous outflow pressure analogous to idiopathic intracranial hypertension (IIH) or pseudotumor cerebri. He mentions 5 children with "normal volume hydrocephalus" or Type 3 SVS who underwent retrograde manometry and venography and showed elevated dural sinus pressure, but these cases were not further documented.…”

Section: ©Aans 2013mentioning

confidence: 99%

Hypertensive slit ventricle syndrome: pseudotumor cerebri with a malfunctioning shunt?

Bateman¹

2013

JNS

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Symptomatic shunt malfunction without ventricular enlargement is known as slit ventricle syndrome (SVS).Patients presenting with this syndrome are not a homogeneous group. Of the 5 different types classified by Rekate, Type 1 is caused by CSF overdrainage and is associated with low pressures; Types 2 and 3 are associated with shunt blockage and elevated CSF pressures; Type 4 is cephalocranial disproportion that increases brain parenchymal pressure but not CSF pressure; and Type 5 is headache unrelated to shunt function. The low and normal CSF pressure types are relatively well understood, but the high-pressure forms are more problematic. In the high-pressure forms of SVS it is said that the lack of ventricular dilation is related to a reduction in brain compliance analogous to idiopathic intracranial hypertension or pseudotumor cerebri. Despite this, there is little evidence in the literature to support this conjecture. With this in mind, 3 cases of SVS associated with elevated CSF pressure are presented. The MR venogram findings and hemodynamics of these 3 cases are shown to be identical to those of pseudotumor cerebri. A literature review indicates that an underlying venous impairment may be functioning in the patients who re-present with small ventricles following shunt malfunction.

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“…26 In our initial concept, Kb was considered a constant for each individual but would be affected by age, stroke, head injury, or radiation therapy. This concept was only partially correct.…”

Section: Negative-pressure Hydrocephalusmentioning

confidence: 99%

“…In our report on this stratagem, we described a young woman with hydrocephalus related to a cerebellar hemangioblastoma whose negative-pressure hydrocephalus was managed by manipulating brain turgor through the application of a gentle cervical tourniquet. 26 Subsequently, we have had an opportunity to treat several more patients with such a tourniquet and have come to understand the important role of the CSAS in the pathophysiology of this condition.…”

Section: Negative-pressure Hydrocephalusmentioning

confidence: 99%

“…Instead, changes in the volume of the ventricles were explained by changes in the actual brain parenchyma itself. 26 Later we found that almost all patients with ventricles that did not expand at the time of shunt failure could be shown to have ventricular CSF in communication with the upper SSAS and CSAS. This finding led to the thought that we had underestimated the role played by the CSAS in the pathophysiology of various forms of hydrocephalus and other abnormalities of CSF dynamics.…”

mentioning

confidence: 91%

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The importance of the cortical subarachnoid space in understanding hydrocephalus

Rekate

Nadkarni

Wallace

2008

PED

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Object In this paper the authors define the role of the cortical subarachnoid space (CSAS) in poorly understood forms of hydrocephalus to cerebrospinal fluid (CSF) dynamics to improve understanding of the importance of the CSAS and its role in selecting patients for endoscopic third ventriculostomy (ETV). The secondary purpose of this work was to define testable hypotheses to explain enigmatic disorders of CSF dynamics and to suggest how these concepts could be tested. Methods The magnitude of the contribution of the CSAS is explored using the solid geometry of concentric spheres. With this starting point, clinical conditions in which CSF dynamics are not easily understood are explored regarding the potential role of the CSAS. Overall, problems of CSF dynamics are easily understood. Insights may be gained when the results of a pathological process or its treatment vary from what has been expected. Results Acute changes in ventricular volume at the time that hydrocephalus develops, the failure of shunts, and the changes in ventricular volume with shunt repair may occur very rapidly. Changes in the volume of water in the brain, especially in the brain substance itself, are unlikely to occur at this rapid rate and may be interpreted as a simple redistribution of the CSF between the ventricle and CSAS with no initial change in the actual volume of brain parenchyma. Problems such as pseudotumor cerebri, shunt failure with nonresponsive ventricles, and negative-pressure hydrocephalus can be explained by assessing the ability of ventricular CSF to flow to the CSAS and the ability of this fluid to exit this compartment. Ventricular enlargement at the time of shunt failure implies a failure of flow between the ventricles and CSAS, implying that all patients who show this phenomenon are potential candidates for ETV. Conclusions The important role of the CSAS in the pathophysiology of various forms of hydrocephalus has been largely ignored. Attention to the dynamics of the CSF in this compartment will improve understanding of enigmatic conditions of hydrocephalus and improve selection criteria for treatment paradigms such as ETV. These concepts lead to clearly defined problems that may be solved by the creation of a central database to address these issues.

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Brain Turgor (Kb): Intrinsic Property of the Brain to Resist Distortion

Cited by 53 publications

References 8 publications

Chiari malformation associated with craniosynostosis

Chiari malformation associated with craniosynostosis

Hypertensive slit ventricle syndrome: pseudotumor cerebri with a malfunctioning shunt?

The importance of the cortical subarachnoid space in understanding hydrocephalus

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