Head-nodding: a driving force for the circulation of cerebrospinal fluid.
Head-nodding: a driving force for the circulation of cerebrospinal fluid.
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点头：脑脊液循环的动力
DOI：
10.1038/s41598-021-93767-8
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发表时间：
2021-07-09
影响因子：
4.6
通讯作者：
Sui HJ
中科院分区：
文献类型：
--
作者：
Xu Q;Shao CX;Zhang Y;Zhang Y;Liu C;Chen YX;Wang XM;Chi YY;Yu SB;Sui HJ
肌硬膜桥（MDB）是一种连接枕下肌和脊髓硬膜的致密结缔组织桥，已被证明是人类和哺乳动物中正常普遍存在的结构。一些学者认为，枕下肌可通过肌硬膜桥充当动态的脑脊液（CSF）泵，他们发现头部旋转促进人体脑脊液流动，这为该假说提供了证据。头部运动是一种复杂的运动，但其他形式的头部运动对脑脊液循环的影响知之甚少。本研究探讨了点头对脑脊液循环的影响。对60名健康志愿者在点头1分钟前后的枕颈交界处水平，通过电影相位对比磁共振成像分析其脑脊液流动情况。此外，对100名志愿者在手术准备麻醉期间，在点头5次前后通过腰椎穿刺测量其脑脊液压力。结果发现，在心室舒张期，寰椎上缘水平的脑脊液最大流速和平均流速分别从1.965±0.531显著降低至1.839±0.460毫升/秒和从0.702±0.253显著降低至0.606±0.228毫升/秒。同时，在点头1分钟后，净流量的头向和尾向比例变化有显著差异（p = 0.017）。另一方面，L3 - L4水平的脑脊液压力从116.03±26.13显著升高至124.64±26.18毫米水柱。总之，点头对脑脊液循环有明显影响，头部运动是脑脊液循环的重要驱动因素之一。我们提出，参与各种头部运动的枕下肌可能通过肌硬膜桥牵拉硬膜囊，从而头部运动为脑脊液循环提供动力。
The myodural bridge (MDB) is a dense connective tissue bridge connecting the suboccipital muscles to the spinal dura mater, and it has been proven to be a normal common existing structure in humans and mammals. Some scholars believe that the suboccipital muscles can serve as a dynamic cerebrospinal fluid (CSF) pump via the MDB, and they found head rotations promote the CSF flow in human body, which provided evidence for this hypothesis. Head movement is a complex motion, but the effects of other forms of head movement on CSF circulation are less known. The present study explored the effects of head-nodding on CSF circulation. The CSF flow of 60 healthy volunteers was analyzed via cine phase-contrast magnetic resonance imaging at the level of the occipitocervical junction before and after one-minute-head-nodding period. Furthermore, the CSF pressures of 100 volunteers were measured via lumbar puncture before and after 5 times head-nodding during their anesthetizing for surgical preparation. As a result, it was found that the maximum and average CSF flow rates at the level of the upper border of atlas during ventricular diastole were significantly decreased from 1.965 ± 0.531 to 1.839 ± 0.460 ml/s and from 0.702 ± 0.253 to 0.606 ± 0.228 ml/s respectively. In the meantime, the changes in the ratio of cranial and caudal orientation of the net flow volume were found differed significantly after the one-minute-head-nodding period (p = 0.017). And on the other hand, the CSF pressures at the L3–L4 level were markedly increased 116.03 ± 26.13 to 124.64 ± 26.18 mmH2O. In conclusion, the head-nodding has obvious effects on CSF circulation and head movement is one of the important drivers of cerebrospinal fluid circulation. We propose that the suboccipital muscles, participating in various head movements, might pull the dura sac via the myodural bridge, and thus, head movement provides power for the CSF circulation.
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