Brain 101: The Ventricles and CSF Flow

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by Karima Roumila

This blog submission brings us to the close of Brain Awareness Week. As a follow up to the previous article on the anatomy and physiology of the brain, we would like to continue our learning and explore the terms we so often hear when dealing with hydrocephalus. These definitions are taken from our various educational publications, which are all found primarily under the Education and Support  section of our website.

Ventricles

The Ventricles are four cavities in the brain. To the rights is a drawing of the ventricles. As you look at the drawing, imagine the ventricles as chambers filled with fluid. There are four in all: the two lateral ventricles, the third ventricle and the fourth ventricle. As you can see, the ventricles are interconnected by narrow passageways. Your neurosurgeon can learn valuable information about the patient’s condition by closely monitoring the size and shape of these ventricles.
Illustration of Ventricles

Illustration by Lynne Larson

Endoscopic Third Ventriculostomy (ETV) is a surgical treatment option for hydrocephalus and an alternative to a shunt device. A neurosurgeon makes a small hole in the floor of the third ventricle, allowing CSF to flow from the blocked lateral ventricles.



Cerebrospinal Fluid Circulation and Absorption

CSF is formed within the ventricles by small, delicate tufts of spe­cialized tissue called the choroid plexus. The solid arrows in the draw­ing below, Cerebrospinal fluid (CSF) Circulatory Pathway, show the major pathway of CSF flow. Beginning in the lateral ventricles, CSF flows through two passageways into the third ventricle. From the third ventricle it flows down a long, narrow passageway (the aqueduct of Sylvius) into the fourth ventricle. From the fourth ventricle it passes through three small openings (foramina) into the subarachnoid space surrounding the brain and spinal cord. CSF is absorbed through blood vessels over the surface of the brain back into the bloodstream. Some absorption also occurs through the lymphatic system. Once in the bloodstream, it is carried away and filtered by our kidneys and liver in the same way as are our other body fluids.

Illustration of circulation of CSF

Illustration by Lynne Larson

The ventricular system is the major pathway for the flow of CSF. CSF also flows directly from the ventricles into the brain tissue sur­rounding them. This is shown by the broken arrows. Here the CSF passes through the spaces between the cells to where it eventually enters the subarachnoid space. It is believed that the brain tissue does not absorb any CSF, but simply provides another pathway for the fluid moving to the subarachnoid space. Some small amounts of CSF are also absorbed into lymphatic channels along the membranes covering the nerves (nerve sheaths) as they leave the brain stem and spinal cord .

Our bodies produce approximately a pint (500 ml) of CSF daily, continuously replacing CSF as it is absorbed. Under normal conditions there is a delicate balance between the amount of CSF that is pro­duced and the rate at which it is absorbed. Hydrocephalus occurs when this balance is disrupted. Although there are many factors that can disrupt this balance, the most common is a blockage, or obstruc­tion, somewhere along the circulatory pathway of CSF. The obstruction may develop from a variety of causes, such as brain tumors, cysts, scarring and infection.

Normal pressure hydrocephalus (NPH) is an abnormal accumulation of cerebrospinal fluid (CSF) that causes the ventricles in the brain to become enlarged, sometimes with little or no increase in intracranial pressure (ICP). With continuous pressure-recording techniques now available, we know that the phrase “normal pressure” is misleading, because many patients have fluctuations in CSF pressure ranging from high to normal to low. However, normal pressure hydrocephalus, or NPH, continues to be the common name for the condition, as originally coined by Dr. Salomon Hakim in 1964.

 

To learn more about hydrocephalus, visit these areas of our website:

22 Comments for : Brain 101: The Ventricles and CSF Flow
  1. Reply

    I am a mother and this helped me!

  2. Reply

    If the CSF does not flow through the brain properly, can this cause dizziness, headaches, pain, etc.?

    • evan brown
    • May 13, 2019
    Reply

    Why would surgeons elect to route the VP shunt into someones lateral ventricles, given they have to pierce the brain in the process?

    Why not utilize the passageway through the hemispheres and connect the shunt to to the Interventricular foramen of Monro?

  3. Reply

    I am 71. I had bacterial meningitis 35 years ago. Since then I have suffered periodic bouts of pain – definitely not muscular – emanating from my spine into arms, legs, lower back, neck and, really painfully, my head. This often occurs when I am exhausted eg from looking after grandsons for lengthy periods, or as a result of a cold etc. There is never any obvious reasons for this ie injury etc. The pain reminds me of the prelude to meningitis, which in my case came on slowly, with pain all over my body, until the brain-bursting headache started.

    Could these pains be caused by infection triggering something in my cerebrospinal fluid?

      • Lakisha Harris
      • March 5, 2019
      Reply

      Hello Cathy Smith,

      I would like to suggest scheduling an evaluation with your neurologist to discuss your symptoms and concerns.

      All the best,
      Support and Education Team

    • Tony Notaro
    • January 28, 2019
    Reply

    My Daughter was diagnosed with fungal meningitis Dec. 0f 2016. The neurosurgeon said that her 4th ventricle has developed scar tissue and that 2 of the 3 aqueducts are clogged. they said that scraping the 4th ventricle is the only thing they can do to open the flow but it can cause more scar tissue later on. they also said that the brain may look for another way to drain on its own. is there other options to fix this problem

      • Pete
      • January 31, 2019
      Reply

      Did your surgeon talk about a shunt? A VPS would divert extra CSF away from the ventricles.

    • Matyas Tamasi
    • December 21, 2018
    Reply

    Hi People!

    My name is Matyas and my brother is at the intesive care with spinal fluid pressure related problem. Spina bifida plus blockage of ventricle potentially.

    Doctors do not have full visibility here in Hungary especially around holiday season.

    You guys know anybody expert who I could call for advice?

    Matyas
    +44(0)7397512324

    • Geraldine Anderson
    • October 21, 2018
    Reply

    I have 2 tumors in foramen of monro. they have been growing for many yrs and are up to 17mm ea. I can’t find any info on how big the the channel is between two sides of the brain. Dont return for next dr. apt for 6 mo. would like to find out now if I can. If anyone knows how much space that is in mm or cm. please email me. would take a huge weight off my mind.

    • Stacey
    • July 22, 2018
    Reply

    I’m looking for information about hydrocephalus due to spinal cord compression, severe disc herniation, central cord effect.

    • Reply

      Are you by any chance having odd symptoms like speach, heavy emotions, blood pressure spikes, butterflies in the stomach or anxiety during a flareup?

    • Janine Hobbes
    • May 24, 2018
    Reply

    My husband has a VP shunt which the pressure was recently adjusted from 12 to 20. On the recent CT scan, the ventricles did not change size like they expected. Any reasons as to why?

    • Rusudan
    • May 6, 2018
    Reply

    What is the direction of CSF flow in the central canal of spinal cord? How the CSF from subarachnoid of spinal cord reach the brain subarachnois space again to be absorbed into venous drainage?

      • A A
      • May 18, 2018
      Reply

      Brain and spinal cord’s sub arachnoid space are continuous

    • Rebecca Turner
    • April 23, 2018
    Reply

    Can ventricles appear to change from ellipses shaped to teardrop shaped when passing increased amounts of CSF when choroid plexus cysts are dissolving and more fluid is moved through?

      • Murtada Ahmed
      • December 10, 2018
      Reply

      Yeah maybe

    • Sara Venhuizen
    • February 13, 2018
    Reply

    My son has some fluid on the brain, trusting in Jesus everything will be okay! 🙂

      • Jacob
      • February 24, 2018
      Reply

      What were his results?

      • T
      • January 17, 2019
      Reply

      there are a group of practitioners who study upper cervical techniques such as NUCCA.org, AO, Orthospinology, Blair….there is research from a Cardiologist out of Chicago associating blood pressure studies and other research showing MRI studies by Dr. Rosa with AO, research with Dr. Harshfield, and several other related studies

  4. Reply

    Can you recommend a detailed book about hydrocephalus I can purchase thankyou.

    • Judy
    • November 21, 2017
    Reply

    I have a csf study that states: “On can Flow imaging, flow occurs mostly exclusively Ventral to the upper cervical spinal cord & brain stem. Is this serious? I’ve been referred to a specialist but its been a month & I’m still in pain just waiting to find out what it means for me. I was Dx with Chiari & Syringomyelia & had 2 decompression& 2 laminectomies . what does this new finding mean?

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