{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T17:13:40Z","timestamp":1793466820888,"version":"4.5.0"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,7]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The dynamics of fluid flow in normal pressure hydrocephalus (NPH) are poorly understood. Normally, CSF flows out of the brain through the ventricles. However, ventricular enlargement during NPH may be caused by CSF backflow into the brain through the ventricles. A previous study showed this reversal of flow; in the present study, the authors provide additional clinical data obtained in patients with NPH and supplement these data with computer simulations to better understand the CSF flow and ventricular wall displacement and emphasize its clinical implications.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Three NPH patients and 1 patient with aqueductal stenosis underwent cine phase-contrast MR imaging (cine MR imaging) for measurement of CSF flow and ventricle wall movement during the cardiac cycle. These data were compared to data previously obtained in 8 healthy volunteers.<\/jats:p>\n<jats:p>The CSF flow measurements were obtained at the outlet of the aqueduct of Sylvius. Calculation of the ventricular wall movement was determined from the complete set of cine MR images obtained axially at the middle of the lateral ventricle. The data were obtained before and after CSF removal with a ventriculoperitoneal shunt with an adjustable valve. To supplement the clinical data, a computational model was used to predict the transmural pressure and flow.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In healthy volunteers, net CSF aqueductal flow was 1.2 ml\/minute in the craniocaudal direction. In patients with NPH, the net CSF flow was in the opposite direction\u2014the caudocranial direction\u2014before shunt placement. After shunting, the magnitude of the abnormal fluid flow decreased or reversed, with the flow resembling the normal flow patterns observed in healthy volunteers.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The authors' MR imaging\u2013based measurements of the CSF flow direction and lateral ventricle volume size change and the results of computer modeling of fluid dynamics lead them to conclude that the directional pattern and magnitude of CSF flow in patients with NPH may be an indication of the disease state. This has practical implications for shunt design and understanding the mechanisms that produce hydrocephalus.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.12.jns10926","type":"journal-article","created":{"date-parts":[[2011,1,28]],"date-time":"2011-01-28T15:10:13Z","timestamp":1296227413000},"page":"159-164","source":"Crossref","is-referenced-by-count":65,"title":["Ventricle wall movements and cerebrospinal fluid flow in hydrocephalus"],"prefix":"10.3171","volume":"115","author":[{"given":"Richard D.","family":"Penn","sequence":"first","affiliation":[{"name":"Department of Bioengineering, University of Illinois at Chicago; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukhraaj","family":"Basati","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of Illinois at Chicago; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Sweetman","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of Illinois at Chicago; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Guo","sequence":"additional","affiliation":[{"name":"3T MR Imaging Research Center, University of Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Linninger","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of Illinois at Chicago; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns10926","series-title":"Neurochem Int","first-page":"545","article-title":"Evidence for bulk flow of brain interstitial fluid: significance for physiology and pathology","volume":"45","author":"Abbott","year":"2004"},{"key":"b2-jns10926","series-title":"Invest Radiol","first-page":"192","article-title":"Relationship between ventricular morphology and aqueductal cerebrospinal fluid flow in healthy and communicating hydrocephalus","volume":"44","author":"Chiang","year":"2009"},{"key":"b3-jns10926","series-title":"Physiol Meas","first-page":"R51","article-title":"Cerebrospinal fluid dynamics","volume":"25","author":"Czosnyka","year":"2004"},{"key":"b4-jns10926","series-title":"Med Biol Eng Comput","first-page":"71","article-title":"Hydrocephalus shunts and waves of intracranial pressure","volume":"43","author":"Czosnyka","year":"2005"},{"key":"b5-jns10926","series-title":"Physiology of the CSF and Blood-Brain Barriers","first-page":"822","author":"Davson","year":"1996"},{"key":"b6-jns10926","series-title":"Pediatr Neurosurg","first-page":"281","article-title":"A model of pulsations in communicating hydrocephalus","volume":"36","author":"Egnor","year":"2002"},{"key":"b7-jns10926","series-title":"J Neurosurg","first-page":"912","article-title":"Demonstration of uneven distribution of intracranial pulsatility in hydrocephalus patients. Clinical article","volume":"109","author":"Eide","year":"2008"},{"key":"b8-jns10926","series-title":"Acta Radiol","first-page":"321","article-title":"On the pulsatile nature of intracranial and spinal CSF-circulation demonstrated by MR imaging","volume":"34","author":"Greitz","year":"1993"},{"key":"b9-jns10926","series-title":"Radiology","first-page":"603","article-title":"Supratentorial cerebrospinal fluid production rate in healthy adults: quantification with two-dimensional cine phase-contrast MR imaging with high temporal and spatial resolution","volume":"233","author":"Huang","year":"2004"},{"key":"b10-jns10926","series-title":"Childs Nerv Syst","first-page":"461","article-title":"Quantitative assessment of cerebrospinal fluid hydrodynamics using a phasecontrast cine MR image in hydrocephalus","volume":"15","author":"Kim","year":"1999"},{"key":"b11-jns10926","series-title":"J Neurol Sci","first-page":"1","article-title":"Intracranial pressure and ventricular expansion in hydrocephalus: have we been asking the wrong question?","volume":"269","author":"Levine","year":"2008"},{"key":"b12-jns10926","series-title":"Ann Biomed Eng","first-page":"1434","article-title":"Normal and hydrocephalic brain dynamics: the role of reduced cerebrospinal fluid reabsorption in ventricular enlargement","volume":"37","author":"Linninger","year":"2009"},{"key":"b13-jns10926","series-title":"IEEE Trans Biomed Eng","first-page":"557","article-title":"Pulsatile cerebrospinal fluid dynamics in the human brain","volume":"52","author":"Linninger","year":"2005"},{"key":"b14-jns10926","series-title":"J Math Biol","first-page":"729","article-title":"A mathematical model of blood, cerebrospinal fluid and brain dynamics","volume":"59","author":"Linninger","year":"2009"},{"key":"b15-jns10926","series-title":"Neurosurgery","first-page":"107","article-title":"Effects of brain ventricular shape on periventricular biomechanics: a finite-element analysis","volume":"45","author":"Pe\u00f1a","year":"1999"},{"key":"b16-jns10926","series-title":"Pediatr Neurosurg","first-page":"161","article-title":"The physics of hydrocephalus","volume":"45","author":"Penn","year":"2009"},{"key":"b17-jns10926","series-title":"J Biomech","first-page":"1263","article-title":"Reassessment of brain elasticity for analysis of biomechanisms of hydrocephalus","volume":"37","author":"Taylor","year":"2004"},{"key":"b18-jns10926","series-title":"Appl Math Comput","first-page":"3181","article-title":"A theoretical study of the effect of intraventricular pulsations on the pathogenesis of hydrocephalus","volume":"215","author":"Wilkie","year":"2010"},{"key":"b19-jns10926","series-title":"J Magn Reson Imaging","first-page":"756","article-title":"Dynamics of lateral ventricle and cerebrospinal fluid in normal and hydrocephalic brains","volume":"24","author":"Zhu","year":"2006"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/1\/article-p159.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/1\/article-p159.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/1\/article-p159.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T03:03:57Z","timestamp":1679886237000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/1\/article-p159.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,7]]},"references-count":19,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2010.12.jns10926","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,7]]}}}