The Somatic Connection  |   January 2018
CSF Flow Has a Significant Respiratory Component
Author Notes
  • University of California, San Diego School of Medicine 
Article Information
The Somatic Connection   |   January 2018
CSF Flow Has a Significant Respiratory Component
The Journal of the American Osteopathic Association, January 2018, Vol. 118, 52-53. doi:
The Journal of the American Osteopathic Association, January 2018, Vol. 118, 52-53. doi:
Takizawa K, Matsumae M, Sunohara S, Yatsushiro S, Kuroda K. Characterization of cardiac- and respiratory-driven cerebrospinal fluid motion based on asynchronous phase-contrast magnetic resonance imaging in volunteers. Fluids Barriers CNS. 2017;14(1):25. doi:10.1186/s12987-017-0074-1 
Neuroscientists at Tokai University Schools of Medicine in Kanagawa, Japan, used innovative imaging technology and Fourier analysis to analyze cerebrospinal fluid (CSF) velocities at the foramen magnum and Sylvian aqueduct. The purpose of this study was to characterize the cardiac- vs respiratory-driven motion of CSF. The prevailing consensus has been that the cardiac cycle is the dominant force in CSF flow, but this research from Takizawa et al suggests a significant contribution from the respiratory cycle. 
Seven healthy volunteers (6 male, 1 female, aged 21-31 years) participated in a 55-second asynchronous 2-dimensional phase-contrast steady-state-free precession performed on a 3T magnetic resonance scanner. The frame rate was 4.6 images per second. Volunteers were asked to control their respiration according to audio guidance for inhalation and exhalation timing at cycles of 6, 10, and 16 seconds to cover the range of normal respiration. Respiration was monitored by a bellows-type pressure sensor placed around the abdomen. Electrocardiography was used to identify the frequency distribution of individual cardiac motion. 
The motion of CSF was separated into cardiac and respiratory components. The amount of CSF displacement was found to be significantly larger in the respiratory component but at a slower rate than in the cardiac component. Likewise, the cardiac displacement was more rapid but with a smaller displacement than in the respiratory component in the Sylvian aqueduct area and to a lesser degree at the foramen magnum. Although cardiac-related CSF motion is predominant to maintain CSF pressure in the CSF cavity, the contribution of the respiratory component advances the process of understanding the pathogenesis of CSF circulatory disturbances as in hydrocephalus and Alzheimer dementia. 
The application of osteopathic cranial manipulative medicine (OCMM) may affect CSF flow dynamics according to the postulated mechanisms of action, particularly compression of the fourth ventricle technique.1 Technology used and data generated in this study have the potential to empirically demonstrate the effects of OCMM in clinical practice. 
King HH. Osteopathy in the cranial field. In: Chila AG, executive ed. Foundations of Osteopathic Medicine. 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2011:728-748.