Role of cranial bone mobility in cranial compliance.

Abstract

Increases in intracranial pressure are normally buffered by the displacement of blood and cerebrospinal fluid from the cranium when there is an increase in intracranial volume (ICV). How much pressure increases with an increase in ICV is expressed in the calculation of cranial compliance (delta ICV/delta P, where delta P is change in pressure) and elastance (delta P/delta ICV). Data reported here indicate that the movement of the cranial bones at their sutures is an additional factor defining total cranial compliance. Using controlled bolus injections of artificial cerebrospinal fluid into a lateral cerebral ventricle in anesthetized cats and a newly developed instrument to quantify cranial bone movement at the midline sagittal suture where the bilateral parietal bones meet, we show that these cranial bones move in association with increases in ICV along with corresponding peak intracranial pressures and changes in intracranial pressure. External restraints to the head restrict these movements and reduce the compliance characteristics of the cranium. We propose that total cranial compliance depends on the mobility of intracranial fluid volumes of blood and cerebrospinal fluid when there is an increase in ICV, but it also varies as a function of cranial compliance attributable to the movement of the cranial bones at their sutures. Our data indicate that although the cranial bones move apart even with small (nominally 0.2 ml) increases in ICV, total cranial compliance depends more on fluid migration from the cranium when ICV increases are less than approximately 3% of total cranial volume. Cranial bone mobility plays a progressively larger role in total cranial compliance with larger ICV increases.