Hydrocephalus pp 195-206 | Cite as

CSF Flow Dynamics in External Ventricular Drains

  • James M. Drake
  • Christian Sainte-Rose
  • Marcia DaSilva
  • Jean-François Hirsch


Fifty-five children had 64 external ventricular drains (EVD) placed predominantly (95%) for cerebrospinal fluid (CSF) shunt infection. In 9 children, a computer monitoring system measured the CSF output each second continuously for up to 24 hours. The monitoring was repeated daily for up to 9 days. The state of arousal of the patients was recorded simultaneously. In all children, daily EVD outputs were related to age, sex, weight, method of establishing the EVD, height of the drip chamber, time since insertion, and type of infecting organism. Computer monitoring revealed wide fluctuations in flow rate, with peak rates frequently greater than 20cc/h, and periods of flow arrest. These changes were usually associated with increased arousal, but also occurred with sleep. The mean EVD flow rate of all children was 6.3cc/h. EVD output increased with age and weight and decreased with gram negative or multiple organism infections, and with elevation of the drip chamber. Resolution of the infection, sex of the patient, and method of establishing the EVD had no effect on output. These results predict that — CSF production increases with brain growth in humans; CSF production is depressed by gram negative and multiple organism infections; implanted CSF shunts with standard valves flow at equivalent rates to an EVD in the supine position; and the CSF drainage requirements in this group are approximately equal to their EVD output.


Hydrocephalus Cerebrospinal fluid shunts Cerebrospinal fluid production External ventricular drainage 


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  1. Barritault L, Rimbert JN, Hirsch JF, Pierre-Kahn A, Lacombe J, Zouaoui A, Mises J, Gabersek V (1980) Vasomotor origin of intracranial pressure waves in hydrocephalic infants. Eur J Nucl Med 5: 511–514PubMedCrossRefGoogle Scholar
  2. Bayston R, Hart CA, Barnicoat M (1987) Intraventricular vancomycin in the treatment of ventriculitis associated with cerebrospinal fluid shunting and drainage. J Neurol Neurosurg Psychiatry 50: 1419–1423PubMedCrossRefGoogle Scholar
  3. Breeze RE, McComb JG, Hyman S, Gilles FH (1989) CSF production in acute ventriculitis. J Neurosurg 70: 619–622PubMedCrossRefGoogle Scholar
  4. Brendel AJ, Wynchank S, Caster JP, Barat JL, Leccia F, Ducassou D (1983) Cerebrospinal fluid shunt flow in adults: radionuclide quantitation with emphasis on patient position. Radiology 149: 815–818PubMedGoogle Scholar
  5. Casey KF, Vries JK (1989) Cerebral fluid over-production in the absence of tumor or hypertrophy of the choroid plexus. Nerv Syst Child 5: 332–334CrossRefGoogle Scholar
  6. Chervu S, Chervu LR, Vallabhajosyula B, Milstein DM, Shapiro KM, Shulman K, Blaufox MD (1984) Quantitative evaluation of cerebrospinal fluid shunt flow. J Nucl Med 25: 91–95PubMedGoogle Scholar
  7. Cooper AJ, Beaty HN, Oppenheimer SI, Goodner CJ, Petersdorf RG (1968) Studies on the pathogenesis of meningitis, VII. Glucose transport and spinal fluid production in experimental pneumococcal meningitis. J Lab Clin Med 71: 473–483PubMedGoogle Scholar
  8. Cutler RWP, Page L, Galicich J, Watters GV (1968) Formation and absorption of cerebrospinal fluid in man. Brain 91: 707–720PubMedCrossRefGoogle Scholar
  9. Davson H (1984) Formation and drainage of the cerebrospinal fluid. In: Shapiro K, Marmarou A, Portnoy H (eds) Hydrocephalus. Raven, New York, pp 3–41Google Scholar
  10. Gardner P, Leipzig T, Phillips P (1985) Infections of central nervous system shunts. Med Clin North Am 69: 297–314PubMedGoogle Scholar
  11. Hara M, Kadowaki C, Konishi Y, Ogashiwa M, Numoto M, Takeuchi K (1983) A new method for measuring cerebrospinal fluid flow in shunts. J Neurosurg 58: 557–561PubMedCrossRefGoogle Scholar
  12. Harbert J, Haddad D, McCullough D (1974) Quantitation of cerebrospinal fluid shunt flow. Radiology 112: 379–387PubMedGoogle Scholar
  13. Marmarou A, Ward JD, Wilson JT, Maset AL, Becker DP (1983) Biomechanics of hydrocephalus: Application of pressure volume dynamics to test CSF absorption in hydrocephalic infants. In: Ishii (ed) Hydrocephalus: Proceedings of the International Symposium on Hydrocephalus, Tokyo, Japan. Excerpta Medica, Tokyo, pp 31–38Google Scholar
  14. Martin AJ, Drake JM, Lemaire C, Henkelman RM (1989) MR measurement of CSF shunt flow. Radiology 173: 243–247PubMedGoogle Scholar
  15. Matsumae M, Sato O, Itoh K, Fukuda T, Suzuki Y (1989) Quantification of cerebrospinal fluid shunt flow rates. Nerv Syst Child 5: 356–360CrossRefGoogle Scholar
  16. McCullough DC, Fox JC (1974) Negative intracranial pressure hydrocephalus with shunts and its relationship to the production of subdural hematoma. J Neurosurg 40: 372–375PubMedCrossRefGoogle Scholar
  17. McLaurin RL, Frame PT (1987) Treatment of infections of cerebrospinal fluid shunts. Rev Infect Dis 9: 595–603PubMedCrossRefGoogle Scholar
  18. Numoto M, Hara M, Tatsuo S, Kadowaki C, Takeuchi K (1984) A noninvasive CSF flowmeter. J Med Eng Technol 8: 218–220PubMedCrossRefGoogle Scholar
  19. Page LK, Bresnam MJ, Lorenzo AV (1973) Cerebrospinal fluid perfusion studies in childhood hydrocephalus. Surg Neurol 1: 317–320PubMedGoogle Scholar
  20. Rubin RC, Henderson ES, Ommaya AK, Walker M, Rall DP (1976) The production of cerebrospinal fluid in man and its modification by acetazolamide. J Neurosurg 44: 735–739CrossRefGoogle Scholar
  21. Shapiro K, Marmarou A (1983) Mechanism and treatment of intracranial hypertension in the head injured child. In: Shapiro K (ed) Pediatric head trauma. Future, New York, pp 45–69Google Scholar
  22. Shapiro K, Shulman K (1982) Shunt infections: A protocol for effective treatment Monogr Neural Sci 8: 69–71Google Scholar
  23. Scheid WM, Dacey RG, Winn HR, Welsh JE, Jane JA, Merle AS (1980) Cerebrospinal fluid outflow resistance in rabbits with experimental meningitis. J Clin Invest 66: 243–253CrossRefGoogle Scholar
  24. Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP (1984) Cerebrospinal fluid shunt infection influences on initial management and subsequent outcome. J Neurosurg 60: 1014–1021PubMedCrossRefGoogle Scholar
  25. Yamada H, Tajima M, Nagaya M (1975) Effect of respiratory movement on cerebrospinal fluid dynamics in hydrocephalic infants with shunts. J Neurosurg42: 194–200PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1991

Authors and Affiliations

  • James M. Drake
    • 1
  • Christian Sainte-Rose
    • 1
  • Marcia DaSilva
    • 1
  • Jean-François Hirsch
    • 2
  1. 1.Division of NeurosurgeryHospital For Sick Children, University of TorontoTorontoCanada
  2. 2.Department of NeurosurgeryHôpital Enfants MaladeParisFrance

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