Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Hydrocephalus Revisited: New Insights Into Dynamics of Neurofluids on Macro- and Microscales

Version 1 : Received: 12 December 2020 / Approved: 14 December 2020 / Online: 14 December 2020 (10:21:21 CET)

A peer-reviewed article of this Preprint also exists.

Journal reference: Neuropediatrics 2021
DOI: 10.1055/s-0041-1731981


New experimental and clinical findings question the historic view of hydrocephalus and its 100-year-old classification. In particular, real-time MRI evaluation of CSF flow and detailed insights into brain water regulation on the molecular scale indicate the existence of at least three main mechanisms that determine the dynamics of neurofluids. (i) Inspiration is a major driving force (ii) Adequate filling of brain ventricles by balanced cerebrospinal fluid upsurge is sensed by cilia (iii) The perivascular glial network connects the ependymal surface to the pericapillary Virchow-Robin spaces. Hitherto, these aspects have not been considered a common physiologic framework improving knowledge and therapy for severe disorders of normal-pressure and post-haemorrhagic hydrocephalus, spontaneous intracranial hypotension and spaceflight disease.


Cerebrospinal fluid; real-time MRI; hydrocephalus; space flight disease; aquaporin; spontaneous intracranial hypotension; neural tube defect



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