Coupling of CSF and sagittal sinus pressure in adult patients with pseudotumour cerebri

Afroditi-Despina Lalou , Marek Czosnyka , Z Czosnyka , Deepa Krishnakumar , John D. Pickard , Nick J. Higgins


Objective: Pseudotumour cerebri syndrome (PTCS including idiopathic intracranial hypertension) is characterised by the symptoms and signs of raised cerebrospinal fluid pressure (CSFp) in the absence of ventricular dilatation or an intracranial mass lesion. Its aetiology is unknown in the majority of cases but there is much evidence for impaired CSF absorption. Traditionally, sagittal sinus pressure has been considered to be independent of CSF pressure in adults. However, the discovery of stenoses of intracranial venous sinuses and introduction of venous sinus stenting has highlighted the importance of the venous drainage in PTCS. In this study, we have explored the relationship between CSFp and SSp before and during a CSF infusion test and during CSF drainage. Materials and methods: Ten patients (9 females:1 male) with PTCS underwent infusion studies in parallel with direct retrograde cerebral venography. Both SSp and CSFp were recorded at a baseline and during CSFp elevation in a course of a CSF infusion test. The drainage of CSF after the CSF infusion was performed in 7 patients. In 5 cases, jugular venous pressure was also measured. Results: CSFp and SSp including their amplitudes correlated significantly and strongly both at baseline (R = 0.96; p = 0.001) and during infusion (R = 0.92; p = 0.0026). During drainage, this correlation was maintained until SSp reached a stable value, whereas CSFp continued to decrease. Conclusions: In this series of ten patients with PTCS, CSFp and SSp were coupled, both at baseline and during infusion. The implications of such coupling for the calculation of CSF outflow resistance are discussed.
Publication categoriesElectronic article/chapter
Author Afroditi-Despina Lalou - [University of Cambridge]
Afroditi-Despina Lalou,,
, Marek Czosnyka (FEIT / PE)
Marek Czosnyka,,
- The Institute of Electronic Systems
, Z Czosnyka - [University of Cambridge]
Z Czosnyka,,
, Deepa Krishnakumar - [University of Cambridge]
Deepa Krishnakumar,,
, John D. Pickard - [University of Cambridge]
John D. Pickard,,
, Nick J. Higgins - [University of Cambridge]
Nick J. Higgins,,
Journal seriesActa Neurochirurgica, ISSN 0001-6268, e-ISSN 0942-0940
Issue year2020
Pages1001 - 1009
Publication size in sheets0.5
Keywords in EnglishCSF pressure; Intracranial pressure; Idiopathic intracranial hypertension; Pseudotumour cerebri; Sagittal sinus pressure; CSF outflow resistance
ASJC Classification2728 Clinical Neurology; 2746 Surgery
Languageen angielski
Score (nominal)100
Score sourcejournalList
ScoreMinisterial score = 100.0, 17-06-2020, ArticleFromJournal
Publication indicators Scopus Citations = 2; Scopus SNIP (Source Normalised Impact per Paper): 2018 = 1.081; WoS Impact Factor: 2018 = 1.834 (2) - 2018=2.097 (5)
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