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Cerebrospinal fluid dynamics between the basal cisterns and the subarachnoid space of the optic nerve in patients with papilloedema
  1. Hanspeter Esriel Killer1,2,
  2. Gregor Peter Jaggi1,
  3. Neil R Miller3,
  4. Andreas R Huber4,
  5. Hans Landolt5,
  6. Angel Mironov6,
  7. Peter Meyer2,7,
  8. Luca Remonda8
  1. 1Department of Ophthalmology, Kantonsspital Aarau, Switzerland
  2. 2Eye Institute, University of Basel, Switzerland
  3. 3Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
  4. 4Department of Laboratory Medicine, Kantonsspital Aarau, Switzerland
  5. 5Department of Neurosurgery, Kantonsspital Aarau, Switzerland
  6. 6Department of Neuroradiology, Creighton University, Omaha, Nebraska, USA
  7. 7Department of Pathology, University of Basel, Switzerland
  8. 8Institute of Neuroradiology, Kantonsspital Aarau, Switzerland
  1. Correspondence to Professor Hanspeter Esriel Killer, University of Basel, Eye Institute and Kantonsspital Aarau, Department of Ophthalmology, Tellstrasse, Aarau 5001, Switzerland; killer{at}


Aims To determine cerebrospinal fluid (CSF) dynamics between intracranial CSF spaces and CSF in the subarachnoid space (SAS) of optic nerves (ONs) in 10 patients with papilloedema.

Methods Prospective assessment of 10 patients with papilloedema and two control subjects using CT cisternography and analysis of CSF for the presence of lipocalin-like prostaglandin D synthase (betatrace protein).

Results CT cisternography showed a progressively reduced influx of contrast-loaded CSF from intracranial CSF spaces into the SAS. The lowest concentration of contrast-loaded CSF was found in the region of the ON immediately behind the globe, where the ON sheath was widened (possibly by unfolding) in all patients compared with normal subjects. The concentration of lipocalin-like prostaglandin D synthase differed between the spinal CSF and the CSF in the SAS, with a markedly higher concentration in the SAS.

Conclusion The results of this study suggest that CSF turnover in the SAS of the ON is reduced in patients with papilloedema from various causes and that the composition of CSF differs between spinal CSF and that surrounding the ON.

  • Cerebrospinal fluid
  • cisternography
  • intracranial pressure
  • papilloedema
  • pseudotumor cerebri
  • optic nerve
  • imaging

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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