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CSF hypersecretion versus impaired CSF absorption in posthemorrhagic hydrocephalus: a systematic review

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Abstract

Background

The molecular mechanisms underlying development of posthemorrhagic hydrocephalus (PHH) remain elusive. The aim of this systematic review was to evaluate existing literature on increased CSF secretion and impaired CSF absorption as pathogenic contributors to CSF accumulation in neonatal and adult PHH.

Methods

The systematic review was conducted in accordance with the PRISMA guidelines. Relevant studies published before March 11th, 2023, were identified from PubMed and reference lists. Studies were screened for eligibility using predefined inclusion and exclusion criteria. Data from eligible studies were extracted and potential sources of bias were evaluated.

Results

Nineteen studies quantified CSF production rates and/or CSF absorption capacity in human patients with PHH or animals with experimentally induced PHH. Increased CSF production was reported as early as 24 h and as late as 28 days post ictus in six out of eight studies quantifying CSF production rates in animals with experimentally induced PHH. Impaired CSF absorption was reported in all four studies quantifying CSF absorption capacity in human patients with PHH and in seven out of nine studies quantifying CSF absorption capacity in animals with experimentally induced PHH. Impaired CSF absorption was reported as early as 30 min and as late as 10 months post ictus.

Conclusions

The pathological CSF accumulation in PHH likely arises from a combination of increased CSF secretion and impaired CSF absorption, which may manifest at different time scales following a hemorrhagic event. Emergent evidence on increased CSF secretion by the choroid plexus may herald a paradigm shift in our understanding of PHH.

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Data availability

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Abbreviations

aCSF:

Artificial cerebrospinal fluid

Akt:

Protein kinase B

CLIC6:

Chloride intracellular channel protein 6

CNS:

Central nervous system

C out :

Conductance to CSF-outflow

CSF:

Cerebrospinal fluid

FGF-2:

Fibroblast growth factor-2

ICH:

Intracerebral hemorrhage

ICP:

Intracranial pressure

IVH:

Intraventricular hemorrhage

KCNJ13:

Potassium inwardly rectifying channel subfamily J member 13

LPA:

Lysophosphatidic acid

mTOR:

Mechanistic target of rapamycin

NF-kB:

Nuclear factor kappa B

NKCC1:

Na+/K+/2Cl– cotransporter 1

NLRP3:

NOD-, LRR-, and pyrin domain-containing protein 3

PHH:

Posthemorrhagic hydrocephalus

PI3K:

Phosphatidylinositol 3-kinase

R out :

Resistance to CSF-outflow

SAH:

Subarachnoid hemorrhage

SPAK:

STE20/SPS1-related proline-alanine-rich kinase

TGF-β1:

Transforming growth factor beta-1

TLR4:

Toll-like receptor 4

TRPV4:

Transient receptor potential vanilloid 4

WNK:

With-no-lysine kinase

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This project was funded by the IMK Almene Fond (to NM) and the Novo Nordisk Foundation (Tandem Grant NNF17OC0024718 to NM).

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  1. Department of Neuroscience, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark

    Shai David Ben-Shoshan, Sara Diana Lolansen & Nanna MacAulay

  2. Department of Neurosurgery, University Hospital of Copenhagen – Rigshospitalet, Copenhagen, Denmark

    Sara Diana Lolansen & Tiit Illimar Mathiesen

  3. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Tiit Illimar Mathiesen

  4. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

    Tiit Illimar Mathiesen

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  1. Shai David Ben-Shoshan
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  2. Sara Diana Lolansen
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  4. Nanna MacAulay
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Idea conception: NM; design of study protocol/search strategy: SBS, NM; literature search: SBS; data analysis: SBS, SDL; writing—original draft preparation: SBS; writing—review and editing: SDL; critical revision: TIM, NM.

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Correspondence to Nanna MacAulay.

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Ben-Shoshan, S.D., Lolansen, S.D., Mathiesen, T.I. et al. CSF hypersecretion versus impaired CSF absorption in posthemorrhagic hydrocephalus: a systematic review. Acta Neurochir 165, 3271–3287 (2023). https://doi.org/10.1007/s00701-023-05746-9

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