Age dependence of cerebrospinal pressure—volume compensation in patients with hydrocephalus

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Object. The dynamics of both drainage and storage capacity become altered during the sequential pathological processes that lead to hydrocephalus. Cerebrospinal fluid (CSF) formation and drainage rate have been reported to be age dependent. The aim of this study was to investigate whether CSF compensatory parameters are dependent on age in patients who have symptoms of hydrocephalus and apparently normal intracranial pressure (ICP).

Methods. Forty-six patients who presented with ventriculomegaly, the clinical symptoms of hydrocephalus, and normal ICPs underwent a computerized CSF infusion test. Parameters used to describe CSF compensation were calculated and correlated with the age of each patient.

The mean ICPs were found to be independent of the age of the patient. Resistance to CSF outflow (Rcsf), however, demonstrated a nonlinear increase with advancing age (r = −0.57; p < 0.0001) and was associated with a decrease in the CSF production rate, which also occurred with increasing age (r = 0.49; p < 0.002). Both the pulse amplitude of the ICP waveform and the slope of the amplitude—ICP regression line increased significantly with advancing age (r = 0.39; p < 0.01 and r = 0.43, p < 0.004, respectively). The nonlinear increase in the elastance coefficient indicated increasing brain stiffness, which acompanies older ages (r = −0.31; p < 0.04).

Conclusions. In a study of patients with symptoms of hydrocephalus, but normal ICPs, the increase in Rcsf and decrease in CSF production were most pronounced in patients who were older than 56 years of age. This relationship was more significant than previously suggested.

Article Information

Address reprint requests to: Marek Czosnyka, Ph.D., D.Sc., Academic Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge CB2 2QQ, United Kingdom. email: MC141@MEDSCHL.CAM.AC.UK.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph demonstrating the relationship between Rcsf and age in patients presenting with symptoms of hydrocephalus. The best-fit model is inverse: y = 1/(a − bx).

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    Graphs depicting the relationship between ICP and patient age. In patients presenting with symptoms of hydrocephalus, baseline ICP does not depend on age (upper). In the same group of patients the pulse amplitude of ICP (AMP; center) and the slope of the amplitude—pressure (AMP-ICP) regression line (lower) are significantly related to age.

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    Graph showing the relationship between CSF production and patient age. In hydrocephalic patients, the estimated CSF production rate is inversely proportional to age.

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    Graph demonstrating the realtionship between the elastance coefficient of the brain and patient age. The elastance coefficient (E1) increases with age in a nonlinear fashion in hydrocephalic patients. The best-fit model is inversely proportional: y = 1/(a − bx).

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