Modeling of CSF dynamics: Legacy of professor Anthony Marmarou

Abstract

The mathematical model of cerebrospinal fluid (CSF) pressure volume compensation, introduced by Anthony Marmarou in 1973 and modified in later studies, provides a theoretical basis for differential diagnosis in hydrocephalus. The Servo-Controlled Constant Pressure Test (Umea, Sweden) and Computerised Infusion Test (Cambridge, UK) are based on this model and are designed to compensate for inadequate accuracy of estimation of both the resistance to CSF outflow and elasticity of CSF pressure volume compensation. Dr. Marmarou's further works introduced the pressure volume index (PVI), a parameter used to describe CSF compensation in hydrocephalic children and adults. A similar technique has been also utilized in traumatic brain injury (TBI). The presence of a vascular component of intracranial pressure (ICP) was a concept proposed in the 1980s. Marmarou demonstrated that only around 30% of cases of elevated ICP in patients with TBI could be explained by changes in CSF circulation. The remaining 70% of cases should be attributable to vascular components, which have been proposed as equivalent to raised brain venous pressure. Professor Marmarou's work has had a direct impact in the field of contemporary clinical neurosciences, and many of his ideas are still being investigated actively today.