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

目的：通过实验和临床研究，探讨脑脊液动力学紊乱对颅内压、脑血流动力学和脑能量代谢的影响。在实验研究中，使用兔和狗通过脑池注射高岭土来产生内部脑积水。在急性期和亚急性期，灰质和脑室周围白色物质的总含水量无明显变化。然而，有，在白色物质中的自由水含量在所有阶段的显着增加，但不是在灰质。脑池注射高岭土后第2周颅内压下降。脑积水犬急性期和亚急性期脑组织PCr/Pi比值降低，而慢性期脑组织PCr/Pi比值无变化（高岭土注射50天）。在临床研究中，对正常压力脑积水（NPH）患者进行颅内压的连续监测，作为CSF动力学研究的CT脑池造影，分流前后的MR成像和T1、T2测量，Xe-CT血流测量，以及详细的精神评估。典型NPH患者MRI表现为T1、T2值延长，提示脑室周围白色物质自由水含量增加，脑脊液动力学明显紊乱，B波发生率高，脑血流紊乱。所有这些与脑脊液动力学紊乱相关的因素在分流术后均得到改善，提示脑脊液动力学紊乱可能是脑积水最基本的病理生理因素。

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.