Intracranial pressure and cerebrospinal fluid

The cranium becomes an almost rigid container following closure of the fontanelles and sutures, with three minimally compressible components contained within:

The brain parenchyma: 80%-85%

The circulating CSF: 10%

The cerebral vascular bed: 5%-10%

The cranium is in direct communication with the vertebral canal, which forms part of the cranio-spinal axis. According to the Monro-Kellie doctrine (Alexander Monro, 1783 and George Kellie, 1824) of constant intracranial contents, any increase in either brain, blood or CSF occurs at the expense of the other components.

The slope of the intracranial pressure-volume curve dP/dV defines the ela-stance of the system and reflects the resistance to deformation exerted by the intracranial contents in the face of rising intracranial volume.

The brain is contained within the meninges, which comprise, from outside inwards:

The vascular pia mater;

The subarachnoid space;

The arachnoid membrane;

The subdural space;

The dura mater, which contains the dural venous sinuses.

The cranial dura forms two sheets, the falx cerebri and the tentorium cerebelli, which divide the cranial cavity into compartments. Rises in intracranial pressure result in pressure gradients between these compartments and a shift of brain structures.

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