According to the CSF bulk flow theory, hydrocephalus is caused by an imbalance between CSF formation and absorption, or a block at various locations in the major CSF pathway. New theories, however, have been proposed in which minor CSF pathways may play a significant role in the development of congenital hydrocephalus. The authors review major contributions to the literature and analyze the evolution of theories of CSF dynamics in relation to hydrocephalus, dividing their development into 4 stages on the basis of historical trends.
In Stage I (prior to 1950), 2 systems of classifying hydrocephalus were proposed, namely Dandy's classifications of communicating and noncommunicating hydrocephalus and Russell's nonobstructive and obstructive hydrocephalus. In Stage II (1950–1974), based on these theories of major CSF pathway dynamics, treatment focused on ventriculostomy as an alternative to reduction of CSF production by choroid plexus coagulation. In Stage III (1975–1999), some of the specific forms of hydrocephalus, especially in premature infants, were found to be unsuitable for ventriculostomy. In Stage IV (2000–2008), selection of treatment modalities evolved further, with a focus on analysis of the chronological changes in CSF dynamics and the differences in absorption pathways in the developing and mature brains. The authors focus on “minor pathway hydrocephalus” in the immature brain, differentiating it from the conventional classification of obstructive and nonobstructive “major pathway hydrocephalus.”
Abbreviations used in this paper:HCA = hydrocephalus chronology in adults; ICP = intracranial pressure; NPH = normal pressure hydrocephalus.
Address correspondence to: Shizuo Oi, M.D., Ph.D. Division of Pediatric Neurosurgery, Jikei Women's and Children's Medical Center, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo, Japan 105-8461. email: email@example.com
Please include this information when citing this paper: published online December 7, 2012; DOI: 10.3171/2012.3.PEDS0934.
Di RoccoCPettorossiVECaldarelliMMancinelliRVelardiF: Communicating hydrocephalus induced by mechanically increased amplitude of the intraventricular cerebrospinal fluid pressure: experimental studies. Exp Neurol59:40–521978
DottNMGillinghamFJMechanical aspects of the cerebrospinal fluid circulation—physiological, pathological, surgical. WolstenholmeGEWO'ConnorCM: Ciba Foundation Symposium—The Cerebrospinal Fluid: Production Circulation and AbsorptionLondonCiba Foundation1958. 246–264
GreitzDWirestamRFranckANordellBThomsenCStåhlbergF: Pulsatile brain movement and associated hydrodynamics studied by magnetic resonance phase imaging. The Monro-Kellie doctrine revisited. Neuroradiology34:370–3801992