Hydrocephalus-Induced Changes in the Composition of Cerebrospinal Fluid

Abstract

Studies reporting the composition of cerebrospinal fluid (CSF) obtained from hydrocephalic humans have been critically reviewed. Alterations in the concentrations of products of glycolysis and nucleotide metabolism indicate that ischemia may play a role in the pathophysiology of hydrocephalus. In some patients the integrity of the blood brain barrier may be disrupted as indicated by the presence of serum proteins in the CSF. Changes in the concentrations of neurotransmitters and neuromodulators suggest that the functional status of some neurons is altered in the hydrocephalic brain. The presence of neural cell-derived proteins and enzymes in CSF indicate that periventricular tissue damage may occur. All of these changes are more pronounced when intracranial pressure is elevated. Although no assays of CSF composition have provided an entirely useful guide to aid decisions regarding shunting, they have provided in vivo information regarding the pathophysiology of hydrocephalus. Properly controlled studies are required to address the clinical usefullness of this type of testing. (Neurosurgery 25: 416–423,1989)