The cerebral venous system and the postural regulation of intracranial pressure: implications in the management of patients with cerebrospinal fluid diversion

Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery
Kaveh Barami, Sandeep Sood

Abstract

Loss of cerebrospinal fluid (CSF) occurs commonly in daily neurosurgical practice. Understanding the altered physiology following CSF loss is important for optimization of patient care and avoidance of complications. There is overwhelming evidence now that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. The CSF and cerebral venous compartments are tightly coupled in two important ways. CSF is resorbed into the venous system, and there is also an evolved mechanism that prevents overdrainage of venous blood with upright positioning known as the Starling resistor. With loss of CSF pressure, this protective mechanism could become nonfunctional which may result in posture-related venous overdrainage through the cranial venous outflow tracts leading to pathologic states. This review article summarizes the relevant anatomic and physiologic basis of the relationship between the craniospinal venous and CSF compartments in the setting of CSF diversion. It is hoped that this article improves our understanding of ICP dynamics after CSF loss, adds a new dimension...Continue Reading

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Citations

Apr 28, 2016·CNS Drugs·Edward Lewis Tobinick
Nov 1, 2016·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Riccardo CarusoVenceslao Wierzbicki
Sep 22, 2018·Journal of Neurosurgery. Pediatrics·Neena I MarupudiSandeep Sood
Nov 13, 2017·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Laura V SainzMartin U Schuhmann
Mar 7, 2019·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Roberto De SimoneVincenzo Bonavita
Feb 16, 2021·Acta neurochirurgica·Anna BjornsonShungu Ushewokunze
May 25, 2021·Progress in Retinal and Eye Research·Richard F SpaidePeter M Maloca
Aug 28, 2021·Journal of Clinical Medicine·Bienvenido RosMiguel Angel Arráez
May 19, 2018·World Neurosurgery·Anita KovácsErika Vörös
Mar 2, 2019·World Neurosurgery·Ramesh Sharanappa DoddamaniGurudatta Sathyarthee

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