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Thursday, 21 January 2016
Wednesday, 6 January 2016
A new look at cerebrospinal fluid circulation
Response to Brinker T.
Fluids Barriers CNS. 2014. Andrew Tarnaris 2014 Sep 15 7:17 p.m.
Corresponding author:
Andrew Tarnaris University Hospitals Birmingham Foundation NHS Trust Department of Neurosurgery Queen Elizabeth Medical Centre, Birmingham B15 2TH, United Kingdom.
Email: andrewtarnaris@gmail.com
I have read with interest the review article by Brinker et al. titled "A new look at cerebrospinal fluid circulation" published in Fluids Barriers CNS, 2014 May. The authors discuss key developments regarding cerebral cerebrospinal fluid (CSF) circulation including of production and absorption touching particularly among others the Virchow-Robin space (VRS) circulation.
The significance of VRS in hydrocephalus in general has not been thus far well investigated [1]. Our group first attempted to examine the significance of VRS circulation in idiopathic normal pressure hydrocephalus (iNPH), and in particular investigate whether they could represent a surrogate imaging marker for coexisitng microvascular disease which is known to co-exist in a subset of patients with iNPH [2]. In that preliminary study we concluded that there may be a higher incidence of VRS in patients with iNPH, when compared with normal patients of similar age, however we could not prove with that initial study that there was any correlation with microvascular co-morbidities. We suggested that our data should be followed in a larger set of patients.
We thus followed with a second study that was first presented in Hydrocephalus 2012 in Kyoto Japan entitled “In vivo study of the relationship of CSF dynamics and Virchow-Robin spaces in idiopathic normal pressure hydrocephalus “ (1OS-A2-05). We presented data from 17 patients with a diagnosis of iNPH and correlated the frequency of VRS with physiological data from lumbar infusion studies. Lumbar infusion studies can give unique information about the state of CSF dynamics in an individual. In summary we noted a lower compensatory reserve being associated with more intense perivascular CSF absorption, that resulting in a decrease in global outflow resistance. In that larger study (data submitted elsewhere) we confirmed that the incidence of VRS does not differ in normal population with the same risk factors for microvascular disease and proposed that VRS in iNPH may have a different pathophysiological origin representing impaired CSF circulation [3].
We are glad that the concept of our previous work is now acknowledged in this excellent review and hope that other groups will investigate the role of VRS in iNPH or hydrocephalus in general with modern imaging or by employing other experimental models.
References
[1] Gideon P, Thomsen C, Gjerris F, Sørensen PS, Henriksen O. Increased self-diffusion of brain water in hydrocephalus measured by MR imaging. Acta Radiologica. 1994;35(6):514-9.
[2] Tarnaris A, Tamangani J, Fayeye O, Kombogiorgas D, Murphy H, Gan YC, et al. Virchow-Robin Spaces in Idiopathic Normal Pressure Hydrocephalus: A Surrogate Imaging Marker for Coexisting Microvascular Disease? Hydrocephalus.33-7.
[3] W.A. Mohamed, A. Tarnaris, H. Murphy, M. Csoznyka, Flint G. In vivo study of the relationship of CSF dynamics and Virchow – Robin spaces in idiopathic normal pressure hydrocephalus. Society of British Neurological Surgeons; 2012 October 2012; Leeds: British Journal of Neurosurgery; 2012. p. 596-629. PermalinkShare
Fluids Barriers CNS. 2014. Andrew Tarnaris 2014 Sep 15 7:17 p.m.
Corresponding author:
Andrew Tarnaris University Hospitals Birmingham Foundation NHS Trust Department of Neurosurgery Queen Elizabeth Medical Centre, Birmingham B15 2TH, United Kingdom.
Email: andrewtarnaris@gmail.com
I have read with interest the review article by Brinker et al. titled "A new look at cerebrospinal fluid circulation" published in Fluids Barriers CNS, 2014 May. The authors discuss key developments regarding cerebral cerebrospinal fluid (CSF) circulation including of production and absorption touching particularly among others the Virchow-Robin space (VRS) circulation.
The significance of VRS in hydrocephalus in general has not been thus far well investigated [1]. Our group first attempted to examine the significance of VRS circulation in idiopathic normal pressure hydrocephalus (iNPH), and in particular investigate whether they could represent a surrogate imaging marker for coexisitng microvascular disease which is known to co-exist in a subset of patients with iNPH [2]. In that preliminary study we concluded that there may be a higher incidence of VRS in patients with iNPH, when compared with normal patients of similar age, however we could not prove with that initial study that there was any correlation with microvascular co-morbidities. We suggested that our data should be followed in a larger set of patients.
We thus followed with a second study that was first presented in Hydrocephalus 2012 in Kyoto Japan entitled “In vivo study of the relationship of CSF dynamics and Virchow-Robin spaces in idiopathic normal pressure hydrocephalus “ (1OS-A2-05). We presented data from 17 patients with a diagnosis of iNPH and correlated the frequency of VRS with physiological data from lumbar infusion studies. Lumbar infusion studies can give unique information about the state of CSF dynamics in an individual. In summary we noted a lower compensatory reserve being associated with more intense perivascular CSF absorption, that resulting in a decrease in global outflow resistance. In that larger study (data submitted elsewhere) we confirmed that the incidence of VRS does not differ in normal population with the same risk factors for microvascular disease and proposed that VRS in iNPH may have a different pathophysiological origin representing impaired CSF circulation [3].
We are glad that the concept of our previous work is now acknowledged in this excellent review and hope that other groups will investigate the role of VRS in iNPH or hydrocephalus in general with modern imaging or by employing other experimental models.
References
[1] Gideon P, Thomsen C, Gjerris F, Sørensen PS, Henriksen O. Increased self-diffusion of brain water in hydrocephalus measured by MR imaging. Acta Radiologica. 1994;35(6):514-9.
[2] Tarnaris A, Tamangani J, Fayeye O, Kombogiorgas D, Murphy H, Gan YC, et al. Virchow-Robin Spaces in Idiopathic Normal Pressure Hydrocephalus: A Surrogate Imaging Marker for Coexisting Microvascular Disease? Hydrocephalus.33-7.
[3] W.A. Mohamed, A. Tarnaris, H. Murphy, M. Csoznyka, Flint G. In vivo study of the relationship of CSF dynamics and Virchow – Robin spaces in idiopathic normal pressure hydrocephalus. Society of British Neurological Surgeons; 2012 October 2012; Leeds: British Journal of Neurosurgery; 2012. p. 596-629. PermalinkShare
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