Measurement of Cerebrospinal Fluid Output through External Ventricular Drainage in One Hundred Infants and Children: Correlation with Cerebrospinal Fluid Production

Abstract

Objective: Cerebrospinal fluid (CSF) production rates influence shunt design and the care of children with hydrocephalus. Measurement of hourly CSF output through external ventricular drainage (EVD) reflects the CSF production. In the present study, hourly CSF outputs in children with hydrocephalus were measured while they were treated with EVD and correlated with the age, sex and body weight of the patients as well as other clinical parameters. Methods: One hundred children with hydrocephalus due to various causes had EVD treatment. Twenty-six had EVD on two or three separate occasions; thus, the CSF output measurements were observed and analyzed on the basis of 130 EVDs. The most common reason for EVD treatment was shunt infection (n = 75). The duration of EVDs ranged from 25 to 774 h (mean 269 h). The height of the drip chamber from the mid-head position ranged from 0 to 23 cm (mean 9.8 cm). The hourly CSF output was analyzed according to the patient’s age, sex and body weight as well as the presence of CSF infection. Results: The hourly CSF output rapidly increases during the first year of life. By the second year, it reaches 64% of the hourly CSF output of 15-year-old children. The mean hourly output ranged from 0.1 to 26.5 ml/h (mean 8.1 ml/h), with the standard deviation ranging from 0.4 to 10.8 ml/h (mean 5.2 ml/h). A regression analysis indicated that the age and body weight appeared to correlate with the hourly CSF output. Using the natural logarithm of age, body weight and sex, these predictors accounted for 50.9% of the variability in hourly CSF output. The regression equation is as follows: hourly CSF output = 2.78 – 2.23(male = 0, female = 1) + 0.97 log(age in years) + 2.26 log(body weight in kg). R sd = 3.36, R² = 0.509. The type of infecting organism and the height of EVD did not influence the overall CSF output. Conclusion: The hourly CSF output fluctuates, but the CSF output increases logarithmically with age and body weight. The gender also influences the CSF output, with males having a greater output than females. The data produced by the present study will help us to understand CSF production rates in developing children. They will also help us in the care of children receiving EVD treatment, as well as in selecting and designing shunt systems.

Intracerebroventricular drug administration

“…The following pharmacokinetic parameters were calculated from the authors' results: elimination clearance: 0.03 mL/min, CSF volume: 56 mL, total distribution volume: 131 mL. The value for elimination clearance is consistent with estimates of CSF production rate in neonates [33] and the CSF volume estimate is within the range of 40-60 mL reported for neonates. [34] Reesor et al [35] used a one-compartment model to analyze CSF vancomycin concentrations as 3 daily ICV doses of the drug were given to an 82-year-old man with an infected ventriculoperitoneal shunt.…”

Vision in children with hydrocephalus

“…The production is approximately 10 ml per hour, corresponding to 200-250 ml a day in a small child, and it increases to about 20 ml an hour or 400-500 ml a day in adolescents (Yasuda and Tomita 2002). The total CSF volume depends on the age of the person and is about five ml in a newborn child and reaches the "adult" volume of 80-150 ml at the age of about five years.…”

Phase-contrast MR Studies of CSF Flow Rate in the Cerebral Aqueduct and Cervical Subarachnoid Space with Correlation-based Segmentation

“…CSF is known to be associated with intracranial homeostatic balance, 1 so clinical evaluation of rates of CSF ‰ow and/or production rate may aid understanding of pathophysiological changes in the physiologic environment, such as brain atrophy and/or degeneration. 2 Recent studies 3,4 have shown increased CSF ‰ow rate in patients with hydrocephalus.…”

“…CSF ‰ow has been measured by catheterization, external ventricular drainage, or lumbar puncture techniques, 2,3 all highly invasive approaches. Recently, cine phase-contrast magnetic resonance imaging (PC-MRI) has been used as a noninvasive tool for a variety of quantitative clinical assessments, especially for measuring blood ‰ow 5,6 and CSF ‰ow.…”