THE CEREBROSPINAL FLUID Production, Circulation and Absorption Ciba Foundation Symposia General Volumes : Mammalian Germ Cells- - - - - Preservation and Transplantation of Normal Tissues - - - - - LeukaemiaResearch - - - - Chemistry and Biology of Pteridines - Porphyrin Biosynthesis and Metabolism Histamine - - - - - - Extrasensory Perception - - - Bone Structure and Metabolism - - Paper Electrophoresis - - - - Ionizing Radiations and Cell Metabolism TheNatureofViruses - - - - Chemistry and Biology of Purines - - Drug Resistance in Micro-organisms - Chemistry and Biology of Mucopolysac- charides - - - - - - - Neurological Basis of Behaviour - - - A leaflet giving fuller details of these volumes, also of the Ciba Foundation Colloquia on Endocrinology and Colloquia on Ageing, is available from the Publishers. CIBA FOUNDATION SYMPOSIUM ON THE CEREBROSPINAL FLUID Production, Circulation and Absorption Editors for the Ciba Foundation G. E. W. WOLSTENHOLME, O.B.E., M.A., M.B., B.Ch. and CECILIA M. O’CONNOR, B.Sc. With 141 Illustrations LITTLE, BROWN AND COMPANY BOSTON Library of Congress Catalog No. 58-8769 THE CIBA FOUNDATION for the Promotion of International Co-operationi n Medical and Chemical Research 41 PORTLAPNLDA CEL,O NDONW, .l. Trustees : THE RIGHTH ON.L ORDA DRIANO, .M., F.R.S. THE RIGHTH ON.L ORDB EVERIDGEK,. C.B., F.B.A. SIR RUSSELLB RAIN,B T. THE HON.S IR GEORGEL LOYD-JACOB SIR RAYMONNDE EDHAMQ, .C. Executive Council : SIR RAYMONNDE EDHAMC, hairman PROFESSODRR. R. MEIER LORDB EVERIDGE MR. PHILIPM AIR PROFESSAO. RH ADDOW PROFESSFO. RG . YOUNGF, .R.S. Director, and Secretary to the Executive Council: DR. G. E. W. WOLSTENHOLMOE.B, .E. Deputy Director : DR. H. N. H. GENESE Assistant Secretury : Editorial Assistants : MISS N. BLAND MISS CECILIA M. O'CONNORB, .Sc. MISS MAEVE O'CONNOR, B.A. Librarian : MISS JOANET HERINGTON ALL RIGHTSR ESERVED This book may not be reproduced by any means, in whole or in part, with- out the permission of the Publishers Published in London by J. & A. Churchill Ltd. 104 Gloucester Place, W.1 First published 1958 Prinied in Great Britain PREFACE THE symposium on Production, Circulation and Absorp- " tion of the Cerebrospinal Fluid ", held in May 1957, had a sad background. It had originally been suggested by Professor G. B. Wislocki, who died during its preparation, but who courageously maintained to the last his intention to be present. Then Professor Settlage, who was expected to make a notable contribution to the programme, was accidentally drowned a month beforehand. The members paid respect in customary silence to the memory of Professor Wislocki and Professor Settlage, but equally the vigorous discussion of the subject, which both did so much to advance, was a tribute to these two workers. The symposium was organized for the Foundation by Dr. H. N. H. Genese, who received most generous help and advice from its eventual Chairman, Professor G. A. G. Mitchell, and also from Professor J. D. Boyd. The group present was as usual a small one, for the purpose of thorough discussion. It is hoped that the papers and the arguments they aroused, which are here recorded, will prove a helpful reminder to those who were present, useful and enjoy- able to those in the field who could not be asked to participate on this occasion, and of interest to a wider circle of anatomists, physiologists and others not so directly concerned. This volume is unusual among those published for the Foundation, of which it is the thirty-ninth to appear, in that the large number of plates has made it desirable to print the whole book on coated paper. The Editors are always grateful to their Publishers, but would like to take advantage of this departure from habit to express publicly their indebtedness to Mr. J. Rivers and Mr. J. A. Rivers of J. & A. Churchill Limited. V vi PREFACE To some readers this book may form an introduction to the work of the Ciba Foundation, and it may be helpful to add a few words about its interests. Under its eminent Trustees, the Foundation is engaged in a number of activities with the purpose of improving co- operation in medical and chemical research between workers in different countries and different disciplines. At its house in London the Foundation provides accommodation for scientists, organizes conferences, conducts a medical post- graduate exchange scheme between Great Britain and France, arranges a variety of informal discussions, awards two annual lectureships, and is building up a library service in special fields. The Foundation assists international congresses and scientific institutions, and it is hoped that in its hospitality, its meetings, and in such a volume as this, it is also proving of value to the individual scientist. CONTENTS PAGE Chairman’s opening remarks . G. A. G. MITCHELL 1 Structural and functional changes in the telencephalic choroid plexus during human ontogenesis . by J. ARIENSK APPERS 3 Discussion : BOWSIIERB,O YDD, AVSONK, APPERSL,A URENCE, . MILLENM, ITCHELL,S ELVERSTONE 26 The structure and relationships of the arachnoid granu- lations . by LESLIET URNER 32 Discussion : BOWSHERB, OYD,C OOPER, DAVSONJ,O HNSON, LAURENCE,S CHALTENBRANSDE,L VERSTONET,U RNER, . WOOLLAMZG, LCH 50 The fine structure of the mammalian choroid plexus . by The late GEORGEB . WISLOCKaIn d A. J. LADMAN 55 Discussion :B OYDC, AUSEY,D AVSONE,D STROMGI,L LINCHAM, HERLINK, APPERSL, ADMANLU, MSDENM,I LLEN, SCHALTEN- BRAND 75 Nerves of the meninges an.d choroid plexus by E. R. A. COOPER 80 Discussion : BRIERLEY, CARMICHAELC,O OPER, CUMINGS, DAVSON,G ILLINGHAM, JOHNSOKNA,P PERS,M ITC. HELL, SCHALTENBRASNEDL,V ERSTONWEO, OLLAMZ~, ~LCH 92 Observations on the choroid plexus maintained as an organ in tissue culture . by C. E. LUMSDEN 97 Discussion : BOWSHERB, OYD,D AVSONK, APPERSL, ADMAN, . LAURENCLEU, MSDENM, ITCHELL,S CHALTENBRAND 120 Observations on the production and circulation of the cerebrospinal fluid . by D. H. M. WOOLLAaMnd J. W. MILLEN 124 Discussion : BOWSHERB, RIERLEYD, AVSONH, ERLIN,K AP- PERS,L ADM.A NL,U MSDENS,C HALTENBRASNEDL,V ERSTONE, WOOLLAM 142 Vii ... Vlll CONTENTS PAGE Studies of the formation and absorption of the cerebro- spinal fluid using radioactive isotopes . by B. SELVERSTONE 147 Discussion :B OWSHERB,O YDB, RIERLEYD,A VSO.NL ,A URENCE, LUMSDENSC, HALTENBRASNEDL,V ERSTONE 164 . Vitamins and the cerebrospinal fluid . by J. W. MILLEN and D. H. M. Woo~usr 168 Discussion :B OWSHERJO, HNSONK,A PPERSL,A URENCLEU, MS- DEN, MILLEN, MIT.C HELL, SCHALTENBRASNEDL,V ERSTONE, SMITHT, URNER 185 Some aspects of the relationship between the cerebro- spinal fluid and the central nervous system . by H. DAVSON 189 Discussion : BOWSHERB, OYD,B RIERLEYC, AUSEYD, AVSON, KAPPERSL, ADMANL,U MSDENS, CHALTENBRASNEDL, VER- STONE 203 The existence of a barrier between the cerebrospinal fluid and the boundary of the brain, including experimental investigations on rabbits, using bilirubinaemia . by L. HERLIN 209 Discussion : BOYD,D . AVSONH, ERLIN,K APPERSL, UMSDEN, SELVERSTONE 226 Neuropathological observations on the cerebrospinal fluid pathway by K. J. ZU" LCH 230 Discussion ; BOWSHERB,R IERLEYD, AVSONK, APPERSL, AUR- ENCE, LUMSDENS, CHALTENBRASNEDL, VERSTONSEM, ITH, ZtiLCH 242 Mechanical aspects of the cerebrospinal fluid circulation- physiological, pathological, surgical . by NORMAMN. DOTTa nd F. JOHGNIL LINGHAM 246 Discussion : CARMICHAEL,C AUSEY, CUMINGS, GILLINGHAM, HERLIN,J OHNSOLNAU, RENCEL,U MSDENS, ELVERSTONE, Z~~LCH 261 Clinicopathological aspects of the cerebrospinal fluid circulation by R. T. JOHNSO.N 265 Discussion :B OYDG, ILLINGHAMH, ERLINJ,O HNSONK,A PPERS, LAURENCEL, UMSDEN,S CHALTENBRANSDE,L VERSTONE, ZfhCH 278 CONTENTS ix PAGE A possible mechanism of hydrocephalus : the osmotic regulation of cerebrospinal fluid volume . by D. BOWSHER 282 Discussion : BOWSHERD, AVSON,H ERLIN,S CHALTENBRAND, . . SELVERSTONE 297 Some problems of experimental spinal anaesthesia by A. D. MACDONALD. . 302 Discussion : COOPER, JOHNSON,L UMSDEN, M. ACDONA.L D, MITCHELLS, CHALTENBRASNEDL, VERSTONE 307 General Discussion BOWSHERB, OYD, CARMICHAEL, DAVSON,G ILLINGHAM, HERLIN, JOHNSON,K APPERS, LADMAN, LAURENCE, LUMSDENM, ACDONALDM, ILLEN, MITCHELL,S CHALTE. N- BRANDS, ELVERSTONTEU, RNERW, OOLLAMZU, LCH 310 List of those participating in or attending the Symposium on Production, Circulation and Absorption of the " Cerebrospinal Fluid " 27th-29th May, 1957 D.BOWSHER . . Dept. of Anatomy, University of Liverpool J.D.BoYD . . Dept. of Anatomy, University of Cambridge J. B. BRIERLEY. . Inst. of Psychiatry, Maudsley Hospital, London E. A. CAKMICHAEL . Neurological Research Unit, National Hospi- tal, London G. CAUSEY . . Royal College of Surgeons, London E. R. A. COOPER. . Dept. of Anatomy, University of Manchester J. N. CUMINGS . . Clinical Pathological Laboratory, National Hospital, London H.DAVSON . . Medical Research Council, Dept. of Physio- logy, University College, London R.EDSTROM . . Neurologiska Kliniken, Sahlgrenska Sjuk- huset, Gothenburg F. J. GILLINCHAM . Dept. of Surgical Neurology, Royal Infirmary, Edinburgh L. HERLIN . Neurosurgical Clinic, Serafimerlasarettet, Stockholm R. T. JOHNS.O N . Dept. of Neurosurgery, Royal Infirmary, University of Manchester J. ARIENSK APPERS . Dept. of Anatomy and Embryology, State University, Groningen A. J.LADMAN . . Dept. of Anatomy, Harvard Medical School, Boston, Mass. K. M. LAURENCE . Dept. of Morbid Anatomy, The Hospital for Sick Children, Gt. Ormond St., London C. E. LUMSDXN. . Dept. of Pathology, University of Leeds A. D. MACDONALI) . Dept. of Pharmacology, University of Man- Chester . . J. W. MILLEN Dept. of Anatomy, University of Cambridge G. A. G. MITCHELL . Dept. of Anatomy, University of Manchester . G. SCHALTENBRAND Neruologische Universitats-Klinik, Luitpold- krankenhaus, Wiirzburg B. SELVERSTONE . Dept. of Neurosurgery, Tufts University School of Medicine and the New England Medical Center, Boston, Mass. xi