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Neuropediatrics 2021; 52(04): 233-241
DOI: 10.1055/s-0041-1731981
Review Article

Hydrocephalus Revisited: New Insights into Dynamics of Neurofluids on Macro- and Microscales

Hans C. Ludwig 
1   Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
,
Hans C. Bock 
1   Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
,
Jutta Gärtner 
2   Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
,
Stina Schiller
2   Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
,
Jens Frahm 
3   Biomedical NMR, Max Planck Institute for Biophysical Chemistry, Göttingen, Germany
,
Steffi Dreha-Kulaczewski 
2   Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
› Author Affiliations Funding S. D.-K., H. C. L., H. C. B., and J. G. gratefully acknowledge financial support from Mrs. L. Grun funds.
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Abstract

New experimental and clinical findings question the historic view of hydrocephalus and its 100-year-old classification. In particular, real-time magnetic resonance imaging (MRI) evaluation of cerebrospinal fluid (CSF) flow and detailed insights into brain water regulation on the molecular scale indicate the existence of at least three main mechanisms that determine the dynamics of neurofluids: (1) inspiration is a major driving force; (2) adequate filling of brain ventricles by balanced CSF upsurge is sensed by cilia; and (3) the perivascular glial network connects the ependymal surface to the pericapillary Virchow–Robin spaces. Hitherto, these aspects have not been considered a common physiologic framework, improving knowledge and therapy for severe disorders of normal-pressure and posthemorrhagic hydrocephalus, spontaneous intracranial hypotension, and spaceflight disease.

Keywords

cerebrospinal fluid - real-time MRI - hydrocephalus - space flight disease - aquaporin - spontaneous intracranial hypotension - neural tube defect

Author Contributions

H. C. L., S. D.-K., and J. F. edited the manuscript; H. C. L., S. D.-K., H. C. B., and J. G. defined the scope, objective, and clinical details. H. C. L., S. D.-K., H. C. B., J. F., J.-G., and S. S. reviewed the manuscript.


Competing Interests

The authors declare no competing financial interests.




Publication History

Received: 02 September 2020

Accepted: 07 March 2021

Article published online:
30 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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