Acta Neurochirurgica

, Volume 161, Issue 2, pp 247–256 | Cite as

Magnitude and direction of aqueductal cerebrospinal fluid flow: large variations in patients with intracranial aneurysms with or without a previous subarachnoid hemorrhage

  • Erika Kristina Lindstrøm
  • Geir Ringstad
  • Angelika Sorteberg
  • Wilhelm Sorteberg
  • Kent-Andre Mardal
  • Per Kristian EideEmail author
Original Article - Vascular Neurosurgery - Aneurysm
Part of the following topical collections:
  1. Vascular Neurosurgery – Aneurysm



Net cerebrospinal fluid (CSF) flow within the cerebral aqueduct is usually considered to be antegrade, i.e., from the third to the fourth ventricle with volumes ranging between 500 and 600 ml over 24 h. Knowledge of individual CSF flow dynamics, however, is hitherto scarcely investigated. In order to explore individual CSF flow rate and direction, we assessed net aqueductal CSF flow in individuals with intracranial aneurysms with or without a previous subarachnoid hemorrhage (SAH).


A prospective observational study was performed utilizing phase-contrast magnetic resonance imaging (PC-MRI) to determine the magnitude and direction of aqueductal CSF flow with an in-depth, pixel-by-pixel approach. Estimation of net flow was used to calculate CSF flow volumes over 24 h. PC-MRI provides positive values when flow is retrograde.


The study included eight patients with intracranial aneurysms. Four were examined within days after their SAH; three were studied in the chronic stage after SAH while one patient had an unruptured intracranial aneurysm. There was a vast variation in magnitude and direction of aqueductal CSF flow between individuals. Net aqueductal CSF flow was retrograde, i.e., directed towards the third ventricle in 5/8 individuals. For the entire patient cohort, the estimated net aqueductal CSF volumetric flow rate (independent of direction) was median 898 ml/24 h (ranges 69 ml/24 h to 12.9 l/24 h). One of the two individuals who had a very high estimated net aqueductal CSF volumetric flow rate, 8.7 l/24 h retrograde, later needed a permanent CSF shunt.


The magnitude and direction of net aqueductal CSF flow vary extensively in patients with intracranial aneurysms. Following SAH, PC-MRI may offer the possibility to perform individualized assessments of the CSF circulation.


Phase-contrast magnetic resonance imaging Subarachnoid hemorrhage Cerebral aqueduct Cerebrospinal fluid flow 



Anterior communicating artery


Cerebrospinal fluid


Endovascular treatment


Internal carotid artery


Idiopathic normal pressure hydrocephalus


Phase-contrast magnetic resonance imaging


Region of interest


Subarachnoid hemorrhage


Signal-to-noise ratio



Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants for whom identifying information is included in this article.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Mathematics, Faculty of Mathematics and Natural SciencesUniversity of OsloOsloNorway
  2. 2.Department of Radiology and Nuclear MedicineOslo University Hospital, RikshospitaletOsloNorway
  3. 3.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  4. 4.Department of NeurosurgeryOslo University Hospital, RikshospitaletOsloNorway
  5. 5.Department of Numerical Analysis and Scientific ComputingSimula Research LaboratoryFornebuNorway

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