Cerebrospinal fluid dynamics between the basal cisterns and the subarachnoid space of the optic nerve in patients with papilloedema

Open Access
Publisher Website
Google Scholar
Abstract
Aims To determine cerebrospinal fluid (CSF) dynamics between intracranial CSF spaces and CSF in the subarachnoid space (SAS) of optic nerves (ONs) in 10 patients with papilloedema. Methods Prospective assessment of 10 patients with papilloedema and two control subjects using CT cisternography and analysis of CSF for the presence of lipocalin-like prostaglandin D synthase (betatrace protein). Results CT cisternography showed a progressively reduced influx of contrast-loaded CSF from intracranial CSF spaces into the SAS. The lowest concentration of contrast-loaded CSF was found in the region of the ON immediately behind the globe, where the ON sheath was widened (possibly by unfolding) in all patients compared with normal subjects. The concentration of lipocalin-like prostaglandin D synthase differed between the spinal CSF and the CSF in the SAS, with a markedly higher concentration in the SAS. Conclusion The results of this study suggest that CSF turnover in the SAS of the ON is reduced in patients with papilloedema from various causes and that the composition of CSF differs between spinal CSF and that surrounding the ON. Patients with increased intracranial pressure (ICP) often develop papilloedema. This potentially vision-threatening ophthalmological condition results from transmission of the increased ICP to the subarachnoid space (SAS) of the optic nerve (ON). The associated increase in cerebrospinal fluid (CSF) volume in the perioptic space results in unfolding of the ON sheath, and it is believed that this, in turn, compresses the nerve, causing stasis of axonal transport, thus producing swelling of the ON axons.1–5 Pressure measurements in the SAS surrounding the ON have not been performed in this setting, but it has been assumed that the pressure in the SAS is the same as that measured during lumbar …