Cerebrospinal Fluid Dynamics / Liquordynamik

In patients with acute spinal cord injury (SCI) and degenerative cervical myelopathy (DCM), spinal cord compression is a main contributor to spinal cord damage and associated with cerebrospinal fluid (CSF) space obstruction. Timely and sufficient surgical decompression is a critical objective with many pre-clinical and clinical studies focused on surgical timing. However, it remains difficult to quantify the degree of cord compression and provide intraoperative guidance in decompression surgery. New diagnostic approaches are needed to improve treatment decisions. Increased resistance to CSF flow through spinal stenosis results in differing infra- and supra- stenotic CSF pressure (CSFP) dynamics. CSFP dynamics can be measured at bedside and intraoperatively during surgery. Findings can be readily compared to structural and dynamic imaging and evoked potentials. We investigate the physiology and clinical utility of CSFP assessments in DCM and SCI, as well as in preclinical models. These studies can provide the basis for better informed and more precise, patient-specific treatment decisions.

Key publications:

Queckenstedt's test repurposed for the quantitative assessment of the cerebrospinal fluid pulsatility curve.

Kheram N, Boraschi A, Pfender N, Spiegelberg A, Kurtcuoglu V, Curt A, Schubert M, Zipser CM. Acta Neurochir (Wien). 2023 Jun;165(6):1533-1543. doi: 10.1007/s00701-023-05583-w.

Intraoperative Monitoring of CSF Pressure in Patients with Degenerative Cervical Myelopathy (COMP-CORD Study): A Prospective Cohort Study. Zipser CM, Pfender N, Kheram N, Boraschi A, Aguirre J, Ulrich NH, Spirig JM, Ansorge A, Betz M, Wanivenhaus F, Hupp M, Kurtcuoglu V, Farshad M, Curt A, Schubert M. J Neurotrauma. 2022 Feb;39(3-4):300-310. doi: 10.1089/neu.2021.0310.

Cerebrospinal fluid pressure dynamics across the intra- and postoperative setting: Retrospective study of a spine surgery cohort. Kheram N, Boraschi A, Aguirre J, Farshad M, Pfender N, Curt A, Schubert M, Kurtcuoglu V, Zipser CM. J Clin Neurosci. 2024 Aug 19;128:110803. doi: 10.1016/j.jocn.2024.110803.

Cerebrospinal Fluid Pressure Dynamics as a Bedside Test in Traumatic Spinal Cord Injury to Assess Surgical Spinal Cord Decompression: Safety, Feasibility, and Proof-of-Concept. Kheram N, Boraschi A, Pfender N, Friedl S, Rasenack M, Fritz B, Kurtcuoglu V, Schubert M, Curt A, Zipser CM. Neurorehabil Neural Repair. 2023 Apr;37(4):171-182. doi: 10.1177/15459683231159662.

Cerebrospinal fluid pressure dynamics reveal signs of effective spinal canal narrowing in ambiguous spine conditions. Kheram N, Pfender N, Boraschi A, Farshad M, Kurtcuoglu V, Curt A, Schubert M, Zipser CM. Front Neurol. 2022 Aug 9;13:951018. doi: 10.3389/fneur.2022.951018. eCollection 2022.

External project partners:

• Prof. Vartan Kurtcuoglu, PhD, Institute of Physiology, Head of the Interface Group, University of Zurich
• Ass. Prof. Claire Jones, School of Electrical and Mechanical Engineering, Faculty of Sciences, Engineering and Technology, University of Adelaide
• Dr. Benjamin M. Davies, Department of Academic Neurosurgery, University of Cambridge