Experimental and clinical studies on the intracranial pressure, cerebral hemodynamics and cerebral energy metabolism in the disturbance of CSF dynamics

目的是通过实验和临床研究，确定脑脊液动力学紊乱对颅内压、脑血流动力学和脑能代谢的影响。本实验以家兔和犬为实验对象，通过池内注射高岭土引起脑积水。急性和亚急性期，脑灰质和脑室周围白质总含水量无明显变化。各发育阶段白质游离水含量均显著增加，而灰质游离水含量无显著增加。池内注射高岭土后第二周颅内压下降。MR谱显示，犬脑积水急性期和亚急性期PCr/Pi比值下降，但慢性脑积水（注射高岭土50 d）犬脑PCr/Pi比值无变化。在临床研究中，对正常压力型脑积水（NPH）患者进行了连续监测颅内压、CT脑池造影作为脑脊液动力学研究、MR成像和T1、T2测量、x -CT血流量测量以及分流前后详细的心理评估。典型NPH患者mri T1、T2值延长，提示脑室周围白质游离含水量增加，脑脊液动力学明显紊乱，B波发生率高，脑血流紊乱。这些与脑脊液动力学紊乱相关的因素在分流术后均有所改善，提示脑脊液动力学紊乱可能是内源性脑积水病理生理中最基本的致病因素。

The purpose is to determine influence of the disturbance of CSF dynamics on the intracranial pressure, the cerebral hemodynamics, and the cerebral energy metabolism by experimental and clinical studies. In the experimental study internal hydrocephalus was produced by the cisternal injection of the kaolin using rabbits and dogs. In acute and subacute stages, there was no significant change in total water content in the gray matter and periventricular white matter. There was, however, significant increase in free water contents in the white matter in all stages, but not in the gray matter. The intracranial pressure decreased at the second week following cisternal injection of kaolin. MR spectroscopy revealed that the ratio PCr/Pi decreased in acute and subacute stage of the canine hydrocephalus, but there was no change in PCr/Pi ratio of the hydrocephalic dog brain of the chronic stage (50 days of Kaolin injections).In the clinical study the patients with normal pressure hydrocephalus (NPH) underwent continuous monitoring of the intracranial pressure, CT cisternography as a study of CSF dynamics, MR imaging and T1, T2 measurements, Xe-CT blood flow measurements, and detailed mental evaluations before and after shunting. In typical NPH patients there were prolongation of T1, T2 values in MR imaging suggesting the increase in free water content in the periventricular white matter, marked disturbance of CSF dynamics high incidence of B waves, and derangement of cerebral blood flow. All these factors relative to the disturbance of CSF dynamics improved after shunting procedure suggesting that the disturbance of CSF dynamics may be the most basic causative factor in the pathophysiology of internal hydrocephalus.