Paradigm shift in hydrocephalus research in legacy of Dandy’s pioneering work: rationale for third ventriculostomy in communicating hydrocephalus

OBJECTIVE: This study aims to question the generally accepted cerebrospinal fluid (CSF) bulk flow theory suggesting that the CSF is exclusively absorbed by the arachnoid villi and that the cause of hydrocephalus is a CSF absorption deficit. In addition, this study aims to briefly describe the new hydrodynamic concept of hydrocephalus and the rationale for endoscopic third ventriculostomy (ETV) in communicating hydrocephalus. CRITIQUE: The bulk flow theory has proven incapable of explaining the pivotal mechanisms behind communicating hydrocephalus. Thus, the theory is unable to explain why the ventricles enlarge, why the CSF pressure remains normal and why some patients improve after ETV. HYDRODYNAMIC CONCEPT OF HYDROCEPHALUS: Communicating hydrocephalus is caused by decreased intracranial compliance increasing the systolic pressure transmission into the brain parenchyma. The increased systolic pressure in the brain distends the brain towards the skull and simultaneously compresses the periventricular region of the brain against the ventricles. The final result is the predominant enlargement of the ventricles and narrowing of the subarachnoid space. The ETV reduces the increased systolic pressure in the brain simply by venting ventricular CSF through the stoma. The patent aqueduct in communicating hydrocephalus is too narrow to vent the CSF sufficiently

Tensor hierarchies, Borcherds algebras and E11

Gauge deformations of maximal supergravity in D=11-n dimensions generically give rise to a tensor hierarchy of p-form fields that transform in specific representations of the global symmetry group E(n). We derive the formulas defining the hierarchy from a Borcherds superalgebra corresponding to E(n). This explains why the E(n) representations in the tensor hierarchies also appear in the level decomposition of the Borcherds superalgebra. We show that the indefinite Kac-Moody algebra E(11) can be used equivalently to determine these representations, up to p=D, and for arbitrarily large p if E(11) is replaced by E(r) with sufficiently large rank r.Comment: 22 pages. v2: Published version (except for a few minor typos detected after the proofreading, which are now corrected

The general gaugings of maximal d=9 supergravity

We use the embedding tensor method to construct the most general maximal gauged/massive supergravity in d=9 dimensions and to determine its extended field content. Only the 8 independent deformation parameters (embedding tensor components, mass parameters etc.) identified by Bergshoeff \textit{et al.} (an SL(2,R) triplet, two doublets and a singlet can be consistently introduced in the theory, but their simultaneous use is subject to a number of quadratic constraints. These constraints have to be kept and enforced because they cannot be used to solve some deformation parameters in terms of the rest. The deformation parameters are associated to the possible 8-forms of the theory, and the constraints are associated to the 9-forms, all of them transforming in the conjugate representations. We also give the field strengths and the gauge and supersymmetry transformations for the electric fields in the most general case. We compare these results with the predictions of the E11 approach, finding that the latter predicts one additional doublet of 9-forms, analogously to what happens in N=2, d=4,5,6 theories.Comment: Latex file, 43 pages, reference adde

Superconformal symmetry and maximal supergravity in various dimensions

In this paper we explore the relation between conformal superalgebras with 64 supercharges and maximal supergravity theories in three, four and six dimensions using twistorial oscillator techniques. The massless fields of N=8 supergravity in four dimensions were shown to fit into a CPT-self-conjugate doubleton supermultiplet of the conformal superalgebra SU(2,2|8) a long time ago. We show that the fields of maximal supergravity in three dimensions can similarly be fitted into the super singleton multiplet of the conformal superalgebra OSp(16|4,R), which is related to the doubleton supermultiplet of SU(2,2|8) by dimensional reduction. Moreover, we construct the ultra-short supermultiplet of the six-dimensional conformal superalgebra OSp(8*|8) and show that its component fields can be organized in an on-shell superfield. The ultra-short OSp(8*|8) multiplet reduces to the doubleton supermultiplet of SU(2,2|8) upon dimensional reduction. We discuss the possibility of a chiral maximal (4,0) six-dimensional supergravity theory with USp(8) R-symmetry that reduces to maximal supergravity in four dimensions and is different from six-dimensional (2,2) maximal supergravity, whose fields cannot be fitted into a unitary supermultiplet of a simple conformal superalgebra. Such an interacting theory would be the gravitational analog of the (2,0) theory.Comment: 54 pages, PDFLaTeX, Section 5 and several references added. Version accepted for publication in JHE

ICP curve morphology and intracranial flow-volume changes: a simultaneous ICP and cine phase contrast MRI study in humans

Background: The intracranial pressure (ICP) curve with its different peaks has been extensively studied, but the exact physiological mechanisms behind its morphology are still not fully understood. Both intracranial volume change (ΔICV) and transmission of the arterial blood pressure have been proposed to shape the ICP curve. This study tested the hypothesis that the ICP curve correlates to intracranial volume changes. Methods: Cine phase contrast magnetic resonance imaging (MRI) examinations were performed in neuro-intensive care patients with simultaneous ICP monitoring. The MRI was set to examine cerebral arterial inflow and venous cerebral outflow as well as flow of cerebrospinal fluid over the foramen magnum. The difference in total flow into and out from the cranial cavity (Flowtot) over time provides the ΔICV. The ICP curve was compared to the Flowtot and the ΔICV. Correlations were calculated through linear and logarithmic regression. Student’s t test was used to test the null hypothesis between paired samples. Results: Excluding the initial ICP wave, P1, the mean R2 for the correlation between the ΔICV and the ICP was 0.75 for the exponential expression, which had a higher correlation than the linear (p = 0.005). The first ICP peaks correlated to the initial peaks of Flowtot with a mean R2 = 0.88. Conclusion: The first part, or the P1, of the ICP curve seems to be created by the first rapid net inflow seen in Flowtot while the rest of the ICP curve seem to correlate to the ΔICV