CSF PathwayObstruction & Clinical correlates

Integrated Teaching session for 1st MBBSDepartment of Neurosurgery

MGMCRI

CSF pathway Lateral ventricles,Third Ventricle, Fourth Ventricle

CSF pathway – FormationCSF pathway Formation: Choroid plexus

• Lateral ventricles

• Third ventricle• Fourth

ventricle

CSF pathway Formation: Choroid plexus

CSF pathway Formation: Choroid plexus

CSF production is an active process – ATP is spent

CSF pathway Lateral ventricles-> Third Ventricle

CSF pathwayCSF pathway Fourth Ventricle -> Subarachnoid space

CSF pathwaySpinal Subarachnoid space

CSF pathwayCSF pathwayCSF resorption: Arachnoid granulations

CSF pathwayCSF resorption: Arachnoid granulations

CSF pathwayMonro-Kelly Doctrine

Normal ICP: 5-15 mm Hg

Raised ICP: > 20 mm Hg

CSF pathwayHydrocephalus

MRI of normal ventricles MRI of dilated ventricles

CSF pathwayHydrocephalus - Adult

HeadacheVomitingAltered sensoriumDiplopia

CSF pathwayHydrocephalus - Child

MacrocephalyPersistent AF – BulgingSun setting sign

HydrocephalusTreatment – Ventriculoperitoneal shunt

HydrocephalusTreatment – Endoscopic Third Ventriculostomy