2021 Nov 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
ABSTRACT
The cerebrospinal fluid (CSF) acts as a nourishing and protective layer surrounding the central nervous system. This protective cushion circulates within the ventricular system and the subarachnoid space around the brain and the spinal cord, which helps to provide the buoyancy to counteract various shear and stress encountered during the movement of the skull and vertebral column.
In various disorders that present with CSF leak, the loss of this protective nutrient-rich layer can injure the function of the brain and the spinal cord. Such conditions might be associated with fractures in the skull base, congenital bony defects, or might be associated with raised intracranial pressure (ICP). It also predisposes the brain and spinal cord to the external environment increasing the risk of meningitis, ventriculitis, and arachnoiditis.
The traditional concept of CSF formation, distribution, and absorption was previously based on the bulk flow model. However, this model seems inadequate to explain the pathophysiological mechanisms of various CSF flow-related disorders based on recent literature. The currently accepted CSF flow system comprises pulsatile CSF flow, lymphatic system, capillary exchange, and the traditional ventricular-cisternal system. According to the current understanding, the production of CSF is from multiple sources, primarily from the choroid plexus of the lateral and fourth ventricles. Apart from this, interstitial space, ependyma, and dural sleeves of the spinal nerve roots also contribute to the total CSF turnover.
Similarly, CSF is absorbed in multiple sites, with dural venous sinuses being the major drainage site via arachnoid granulations followed by choroid plexus and glymphatic system.
PMID:35015396 | Bookshelf:NBK576371
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