Der prognostische Wert des Radiozisternogramms für die Shuntoperation beim Hydrozephalus communicans internus

New aspects of cerebrospinal fluid dynamics in humans investigated by sequential gammacamera cisternography, with data evaluation by the digital multichannel analyzer. Part 3: Physiopathology of the ventricular reflux

Although well described and intensively used for diagnostic purposes, the ventricular reflux as a gammacisternographic phenomen has not yet been satisfactorily explained, and its physiopathology is a subject of controversy. Based on our method of quantitative gammacisternography and gammaventriculography we study the evolution of the tracer concentrations in two main chambers:--the basal cisterns together with the upper cervical canal, considered as a functional unity (the distribution area) and--the ventricular system. We propose the mathematical analysis of a theoretical model which represents the normal and pathological situations of these two chambers, as a method for measuring ventricular volume and ventricular tracer clearance. From the correlation in results with patients and models, we suggest turbulence as the main factor in generating backmixing or total mixing, the appearance of which is called ventricular reflux. We deny the existence of a real inversion of CSF flow. The spinal canal velocity of isotope flow is proposed as additional evidence of turbulence. The normal general dynamics of CSF are delineated, and we propose the following factors that lead to ventricular reflux:--partial obstruction to epicortical CSF flow;--total obstruction to epicortical CSF flow. Their principal characteristics are given, and the importance of using their quantitative parameters in descriptions of patients is stressed. Different aspects in the evolution of hydrocephalus, transependymal resorption, and factors involved in hydrodynamic changes etc. are discussed.