Medical & Biological Engineering & Computing

, Volume 45, Issue 8, pp 719–735 | Cite as

Assessment of cerebrospinal fluid outflow resistance

  • Anders EklundEmail author
  • Peter Smielewski
  • Iain Chambers
  • Noam Alperin
  • Jan Malm
  • Marek Czosnyka
  • Anthony Marmarou
Review Article


The brain and the spinal cord are contained in a cavity and are surrounded by cerebrospinal fluid (CSF), which provides physical support for the brain and a cushion against external pressure. Hydrocephalus is a disease, associated with disturbances in the CSF dynamics, which can be surgically treated by inserting a shunt or third ventriculostomy. This review describes the physiological background, modeling and mathematics, and the investigational methods for determining the CSF dynamic properties, with specific focus on the CSF outflow resistance, R out. A model of the cerebrospinal fluid dynamic system, with a pressure-independent R out, a pressure-dependent compliance and a constant formation rate of CSF is widely accepted. Using mathematical expressions calculated from the model, along with active infusion of artificial CSF and observation of corresponding change in ICP allows measurements of CSF dynamics. Distinction between normal pressure hydrocephalus and differential diagnoses, prediction of clinical response to shunting and the possibility of assessment of shunt function in vivo are the three most important applications of infusion studies in clinical practice.


Constant Infusion Infusion Test Normal Pressure Hydrocephalus Normal Pressure Hydrocephalus Outflow Resistance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Nina Andersson for assisting with the mathematical derivations. Dr. Czosnyka is on unpaid leave from Warsaw University of Technology, Warsaw, Poland. Dr. Eklund was supported by grant 621-2005-3047 from Swedish Research Council.


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Copyright information

© International Federation for Medical and Biological Engineering 2007

Authors and Affiliations

  • Anders Eklund
    • 1
    Email author
  • Peter Smielewski
    • 2
  • Iain Chambers
    • 3
  • Noam Alperin
    • 4
  • Jan Malm
    • 5
  • Marek Czosnyka
    • 2
  • Anthony Marmarou
    • 6
  1. 1.Department of Biomedical Engineering and InformaticsUmeå University HospitalUmeåSweden
  2. 2.Academic Neurosurgical Unit, Department of NeuroscienceAddenbrooke’s HospitalCambridgeUK
  3. 3.Regional Medical Physics DepartmentThe James Cook University HospitalMiddlesbroughUK
  4. 4.Department of RadiologyUniversity of IllinoisChicagoUSA
  5. 5.Department of Clinical NeuroscienceUmeå UniversityUmeåSweden
  6. 6.Department of NeurosurgeryMedical College of Virginia Commonwealth UniversityRichmondUSA

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