Cerebrospinal fluid and hydrocephalus
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The findings establish ventricular CSF-to-blood water transport as a quantifiable physiological metric in adult hydrocephalus and suggest that ventricular water exchange is regulated independently of global intracranial pressure and ventricular morphology, consistent with intrinsic barrier and microvascular exchange mechanisms.
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Water exchange between cerebrospinal fluid (CSF) and blood is fundamental to brain fluid homeostasis, yet ventricular CSF-to-blood water transport has never been quantified as a physiological parameter in adult humans. We investigated ventricular water absorption kinetics in 40 adults undergoing diagnostic evaluation for hydrocephalus. During ventricular infusion testing, 15O-labelled water was administered intraventricularly via an external ventricular drain, with continuous jugular bulb blood sampling and simultaneous intracranial pressure (ICP) monitoring. Ventricular water absorption was estimated using non-parametric population pharmacokinetic modelling of venous radioactivity-time curves.Model performance demonstrated robust individual parameter estimation. Ventricular water absorption showed substantial inter-individual variability (mean half-time 65.2 ± 34.3 s; range 31.5-196.8 s). Absorption kinetics were not associated with static or pulsatile ICP metrics (overnight or during infusion), ventricular volume or surface area, or CSF-blood osmotic gradients. No associations were observed with demographic variables. A modest positive association was detected with the CSF-blood protein concentration difference.These findings establish ventricular CSF-to-blood water transport as a quantifiable physiological metric in adult hydrocephalus and suggest that ventricular water exchange is regulated independently of global intracranial pressure and ventricular morphology, consistent with intrinsic barrier and microvascular exchange mechanisms.
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@article{Eide2026EXPRESS,
title = {EXPRESS: Ventricular CSF-to-blood water transport kinetics in adult hydrocephalus},
author = {Per Kristian Eide and Alexander Gul Sherwani and Luis Romundstad and Jan Gunnar Fjeld and Amanda Eriksson and Trine Hjørnevik and Markus Hovd},
journal = {Journal of Cerebral Blood Flow & Metabolism},
year = {2026},
doi = {10.1177/0271678x261466792},
url = {https://doi.org/10.1177/0271678x261466792}
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