I think facial palsy is due to impaired CSF drainage along the nerve into the lymphatic system.

See Hippocrates (eg Places in Man). He describes the circulation system of CSF and lymph via nerves, blood vessels and bones, and various disorders resulting from its impairment.

See also Janetta's work on decompression of cranial nerves.

Dear Dr Gordon,

From several responses of you, I found you an interested researcher.

Let us take from Janneta work her electrical monitoring of facial muscles and face.

Decompression in hydrocephalus is done by shunting. The sensitive target is to find an objective indicator to adjust the valve and CSF pressure optimally postoperative.

My idea depends on different anatomy of cranial nerves.

Trigeminal nerve is creeping over base of skull. Trigeminal ganglion is placed in a cave filled with CSF. Motor part of it is the most down supplying temporalis and masseter. This anatomy makes it more affected by increased CSF pressure rather than low pressure causing more tension in these muscles.

Come now to the anatomy of facial nerve which is looking like a rope in air like circus rope but not as long. So I think it will sag down when CSF pressure is low. Increased CSF pressure will cause less effect. Facial nerve supplies different group of muscles which can be monitored also.

The idea needs neurophysiologists to work on with neurodoctors.Hopefully it can help in pos-shunt adjustments.

Other areas of effect of CSF pressure changes is the limbic system. This place can also be relevant in facial muscle expressions.

Also we have to think of 4th ventricle where CSF waves are in touch with nuclei of trigeminal and facial. I think these are the 3 possibilities. Intracranial cranial nerves course looks relevant to me.

https://images.app.goo.gl/FeQLvmQXKiRXi14J8

https://images.app.goo.gl/FeQLvmQXKiRXi14J8

https://images.app.goo.gl/hGRjuVA77b5gg6GH9

"Come now to the anatomy of facial nerve which is looking like a rope in air like circus rope but not as long. So I think it will sag down when CSF pressure is low. "

I think facial palsy is caused by increased pressure inside the nerve. Thus it can be helped by surgical nerve decompression, and it is so common because it runs through long narrow bony channels.

Swedenborg had an extensive discussion of CSF circulation.

Dear Dr Gordon,

I was talking about facial nerve course before meatal opening. Kindly see the diagram of link mentioned. Before the meatal opening surely the nerve is exposed to CSF.

My anatomical doubt is about its course inside the meatal canal inside the narrow bony tunnel. Is it exposed here to CSF or not? Is there a cuff of subarachnoid with CSF under it inside this bony canal? I need to review anatomical details. But facial palsy is surely caused by inflammation of nerve, and I think it is an established pathology and I agree with you 100%.

Thanks also for giving attention about Swedenborg and history of CSF.

Dear Omer Elsabbagh

As I am a trained craniosacral therapist in two schools, your question interests me as does your own experience as a hydrocephalus patient. In craniosacral therapy we work by listening in the the movement on the waves the cranio sacral movement creates. I always tell my clients that the system resembles that of a tadpole - with the wings being where the temporal bones are. This whole system rises up and then moves down in rhythmical movements, the most gross being between 10 and 12 cycles per minute - but there are slower movements. As each nerve passes through this membranous system, any impediment to the craniosacral movement will be reflected in all the system. So it is impossible to touch one part in isolation, a change in one part will affect the whole..This includes facial nerves. Obviously the increase and decrease of CSF also has an effect on the whole system as does slight bone miss alignment or even a tension in a certain part of the meninges. How we came into the world, can have long term effects unless these old tensions are released. I am not sure if this helps you in any way.

Kind regards Tina

Dear Tina Linard,

Thank you for your response. I have no idea about craniosacral therapy. Do you monitor the tension of facial muscles? In that case it can be very helpful. I am not sure about the waves you talked about. Do you record CSF waves?

I am offering my idea to neurophysiologists to prove or disprove. I am claiming that increase in CSF pressure will increase tension in masseter and temporalis supplied trigeminal more than frontal facial muscles supplied by facial nerve. I claim the opposite happens in case of low CSF pressure.

If this proved correct, I think it can greatly help neurodoctors in adjusting shunt valve to normalize CSF pressure. It is a sensitive process and needs sensitive indicators.

Dear Omer Elsabbagh

Cranial Sacral therapy or osteopathy was developed by William Sutherland in the lat Century. It grew out of the work of DR. ANDREW TAYLOR STILL You can read about its history https://iacst.ie/history-craniosacral-therapy

Basically the therapist listens to these very slow inner movements through their hands - science has not yet fully recognised these movements - but some work was done in Michigan University. It seems the hands has the capacity to amplify micro movements as for people trained in this way, the movements are unmistakable and one can tap into different levels at will. So we would need to develop very sensitive instruments to pick up these very slow "waves". In the biodynamic school very deep listening and imitating what the the system does, allows changes to take place naturally. Other approaches involve slight adjustments of the bones. One approach does not exclude the other. All the nervous system is worked during the therapy and if the blockage is picked up to be in the cranium, the therapist will work there. Sometimes cranial blockages have more to do with the etiology of a blockage in the sacrum (or elsewhere) than in the cranial area. It is one continuous whole and releasing any blockage anywhere in the system on any level will affect the whole.

If you want to know more I can direct you to further readings on the subject -

Warm regards Tina

Dear Tina,

It is interesting to know more about craniosacral therapy and I will be happy to get your links. But in my opinion craniosacral therapy would have a place in the rehabilitation phase of IH treatment. We cannot leave the basic pathology untreated. We have to normalise first CSF pressure through a programmable shunt. Otherwise it would be a professional sin. Do you agree?

Best regards,

Dear Omer Elsabbagh

Every case is different - and from the cranial sacral point of view each system needs to be listened to before making a generalisation -.

Kind regards Tina

Dear Tina Lindhard,

Yes I agree. But do you have clinical evidence that craniosacral therapy can decrease CSF pressure?

Anyway I am a patient and only giving my impression.

I have met few neurosurgeons on web and in life who prefer avoiding shunt, but personally I disagree.

For a favourable result shunt have to pass several challenges successfully. I am here trying to raise some points, I faced during my self experience. But of course it is out of my professional domain, and neurodoctors are the decision makers in this regard.

Giving us attention to craniosacral therapy and its relation to CSF is very interesting. Human mind is mysterious. I hope you get successes with your patients, and if I was nearby surely I would try your therapy. Trial satisfies curiosty much more than arguments. I am waiting for your links.

Many thanks and my best regards,

Dear Tina Lindhard,

Where are your links? You should not got angry because of different opinions. I did not say craniosacral therapy should not be used. I was setting priorities as I understand. If you think craniosacral therapy alone without a shunt can treat IH explain it. Disagreements enrich discussions and uncover unclear points. Your discussion was positive, why do you want to discontinue?

My best regards,

Dear Omer Elsabbagh

I am certainly not angry - but you never highlight my name so I do not get notifications or your responses to me - 90 percent of all mails the RG send to me land up in my trash box as I have not time to look at them as I have a very heavy work schedule. If you direct your answers to me personally, when I have time I will answer them. If you look in google about cranial sacral therapy - biodynamic school - you will find 444,000 results so this should keep you busy for a while

(smile)

https://www.google.com/search?q=cranals+sacral+tehrapy+biodynamic+school&oq=cranals+sacral+tehrapy+biodynamic+school&aqs=chrome..69i57j33.17850j0j4&sourceid=chrome&ie=UTF-8

Although I am a trained craniosacral therapist my main scientific interest is consciousness and meditation so I do not follow research into work concerning craniosacral therapy. Most scientists even doubt that this very subtle movement in the body exists - but I believe that some work was done in Michigan University in the seventies. We are talking of a very subtle system but I have never found a person who cannot feel it through their hands when trained in deep listening. There are many things science does not yer acknowledge fully - like the meridian system in Acupuncture and even the deeper levels of consciousness which I investigate.

Hope this keeps you busy for a while -

Warm regards Tina .

Dear Tina Lindhard,

I do appreciate your answer. I will take a look at the links and if your schedule allows, I hope we can discuss some points.

My best regards,

Dear Omer

In the second post you wrote "Let us take from Janneta work her electrical monitoring of facial muscles and face".

Can you share this file or article?

Regards

Dear Omer

You mentioned about relationships between increase of CSF pressure and optic nerve and consequently, eye symptoms of these patients. Evaluation relationship of increase of CSF pressure and facial nerve is valuable for researchers. However, what is the clinical application of this relationship for doctors? Because all nerves stimulate together (optic nerve, facial nerve....) and assessment of eye symptoms is very easy and accessible.

Regards

Dear Tina Lindhard,

I have found the following presentation a proof to me that you are talking relevant:

https://youtu.be/hh_mvbAUuCw

To be honest, on first discussion I thought not.

Touches to body giving long lasting effects seems unbelievable to me. Also medical committees proved no benefit.

Regards,

Dear Seifoallah,

Jannetta was mentioned by Dr Gordon above. I searched on google to find out and Wikipedia mentioned that during the proceudre he made facial monitoring:

https://en.m.wikipedia.org/wiki/Microvascular_decompression

I do not have his original paper.

Dear Seifollah,

To answer your second question:

1 During my adjustments I have found that when I was in overdrainage (documented by MRI) I was feeling more tension in frontal facial muscles(facial nerve). When my pressure was high I felt more tension in temporalis and masseter ( trigeminal). So if proved it can be used as an objective guide to avoid overdrainage on opening the valve more and more. This can help to come to balance range or point (optimal adjustment) and avoiding coming too low (overdrainage) which is serious.

2 On reviewing intracranial anatomy I noticed motor trigeminal is resting on base of skull and so is stimulated more by high pressure than low pressure. Facial nerve is floating for about 1.5 cm before enters the ear. So with low pressure as having no support will sag down and stimulated more than trigeminal. When pressure is high possibly it is stimulated less as it is not resting on bone like trigeminal.

So facial nerve and trigeminal nerve are equally stimulated and this unequal stimulation can be used to differentiate between high pressure and low pressure and to grade it,I hope.

correction:

line 5 from down:

not equally stimulated

https://images.app.goo.gl/FeQLvmQXKiRXi14J8

https://images.app.goo.gl/aBowQbHZiRbzL4jG8

https://images.app.goo.gl/hGRjuVA77b5gg6GH9

Dear Omer

The root of facial nerve is near ear. Do not have any filling around ear?

The first half part of bellow paper is suitable for anatomical understanding of these nerves:

https://www.researchgate.net/publication/320863158_Nose-to-brain_peptide_delivery_-_The_potential_of_nanotechnology

Dear Omer Elsabbagh

I am pleased you are beginning to see the relevance of CSF to all the system. One day I hope you get to experience a therapy through the hands of a person who is well trained. I am always amazed at the results, but I never know before I start working how the session will go. The intelligence in the system guides one and often sessions do not go in a straight line, and sometimes it takes several sessions before the original complaint the client cam with, gets addressed. But all sessions do remove some blocks on different levels so in the end there is a better expression of the fluid in the system. But some meditation methods achieve the same results ... I personally like combining the two, and the knowledge of the cranio sacral system has helped me understand certain phases I have gone through in meditation in a new light. .

Warm regards Tina

Dear Seifollah,

The photos of the anatomy paper you have mentioned shows a terminal branch of trigeminal nerve. This is not the part I meant which is from its exit from pons and before it divides over bones of middle cranial fossa. For facial nerve I am also talking about the part from its exit from pons till its enterance in internal auditory meatus. Kindly look to the links of photos above and it would be clear. For anatomical details you can listen to Dr Najeeb:

https://youtu.be/r1ycM1b7Gnw

https://youtu.be/OdxI3kXOukw

I hope it is clear now.

My best regards,

Seifollah,

Second photo of trigeminal in your paper shows its whole course, but missing its relation to bones of middle cranial fossa before it divides.

Dear Tina Lindhard,

The question is;

In intracranial hypertension would you advice avoiding shunt for the sake of cranial therapy?

If your answer is yes you craniotherapists are intiating third world war with most neurosurgeons and conventional medicine.

To be truthful I would stand with the side of neurosurgeons if I did not personally get the chance of complete longlasting cure otherwise. Up to moment no scientific evidence of your method.

Regards,

Dear Omer Elsabbagh

Personally I would always try the less aggressive method first - no matter what ailment I was suffering from! Most people choose the other way around - they go the medical route and when it goes wrong, they choose complementary.

Mother Nature lets each of us choose for ourselves and I dear Omer, do the same!

Warm regards Tina

Dear Tina Lindhard,

Intracranial hypertension might cause blindess in few weeks.

https://youtu.be/Ml-TZIiBkwk

A better plan I think, is to try to come to agreements with neurosurgical societies. We should not risk our patients. If it is a functional disorder without prove of significant pathology we can direct patients to cranial therapy. Also in post shunt like me no problem of trying cranial therapy. "First do no harm". The harm here would come from the waiting time which may be many months to years as patients belief in you and postpone neurosurgical consultation. Also surgery is fearful to most patients.

My question also is how cranial therapy will correct the defective CSF absorption like in case of cerebral venous stenosis or narrowing of cerebral aqueduct as examples?

"Neurosurgical methods how" are well very well explained and known.

Regards,

Dear Omer Elsabbagh

I gave my personal opinion what I would choose - of course patients are welcome to choose what they like. Each case is different and as the you tube points out, not every operation is a success. Also what is success? Only a disappearance of symptoms? Or balancing the whole system. Also there are confounding problems like over weight - this can affect body alignment. Also the You tube you enclosed says this condition does not occur before 10years. In the baby there are several fontanelles in the skull - as we grow these slowly close. By 7 -8 years the skull is more set although movement continues in the expression of the bones. This makes me think there must be some restriction in the movement of the bones. So either you reduce the amount of fluid, or you increase the expression of the cranial bones. As we begin to release old patterns, the expression of the movement of the bones increase again. Some bones can be compromised from the birthing process, an accident or even a fall. Whatever happens to the sacrum will also affect the expression on the movement in the cranium. There can also be restrictions at the level of the membranes.The body is an interrelated whole, and whatever we do affects the whole. Again what I say see is my personal opinion -my speciality is working with emotional history and energetic cysts. Many cranio-sacral therapist specialise in different areas.

Warm regards Tina

Dear Tina Lindhard,

Thank you for your answer.

How many sessions are needed in IH. How much time it takes each and about how much a course of treatment costs?

I appreciate your cooperation and many thanks,

Dear Omer Elsabbagh

Every case is different so the number of sessions are different - also it depends on the therapist - mostly these days (when my academic work permits) I teach people in different countries how it do a heart based meditation so that they can get into the deeper layers themselves so they are not dependent on me - and then I only have to give them a therapy if they get stuck. But this is not the norm. Also re costs - everyone is different - in the beginning for 8 years I worked for what people wanted to pay - again not normal but I learnt a lot. So find your therapist first - I would recommend somebody from the biodynamic school as it is a very light touch ...

Sorry I cannot be more specific but as you do not name a country where you will undertake the treatment I cannot say what is available and to be honest I am not so up to date with what is happening in the cranio sacral world.

Warm regards Tina

Dear Tina Lindhard,

Can you recommend a therapist in Cairo?

Best regards,

Dear Seifollah,

Is the anatomical part of trigeminal nerve and facial nerve are clear now?

I want also to give your attention that centres controlling facial muscles are many. Our concern here would be about the places where there are close contact with CSF. I can imagine now 3 places:

1 Lateral ventricles where CSF is in touch with caudate nucleus and limbic system.

2 Floor of 4th ventricle where nuclei of facial and trigeminal nerves are nearby.

3 The anatomical parts of trigeminal and facial nerves from their exit from pons and their short course in middle cranial fossa.

The effects of CSF changes on these parts are our more concern at the moment as I explained to you how stimulation effects can be different because of anatomy observations mentioned above.

This point lighted on from my self observation during my adjustments that behavior of lateral muscles is different from behavior of frontal muscles. I am trying to use it as a guide to fine tune my own adjustment.

The question is:

Is this is applicable to other patients?

What complicates the point is that IH shows different symptoms in different patients. I knew this from a colleague on researchgate who told me that this is explainable in fMRI in different patients.

I wanted to make it very clear to you in case you accepted to face this challenge. Proving or disproving the relation between facial muscle behavior is equally a research gain.

If the result would prove positive the clinical application is great and very valuable. You are then creating CSF pressure measure for follow up after shunt implantation to be able to adjust the valve. It would be like a BP appartus or blood sugar measure. Without these measures we cannot control hypertension or diabetes. Neurosurgeons then wll have better sight, and the efforts done for shunt implantation will be gained back. Also optimal adjustment not only will improve symptoms but also it will prolong shunt life significantly as no significant CSF stagnation and no particles precipitations in the valve. Most important you will avoid your patient the serious overdrainage. Follow up a shunt patient by clinical testing and imaging are insensitive and by them alone we cannot achieve our goal.

My best regards,

Dear Omer Elsabbagh

It seems there is a centre in Cairo - I just googled cranio sacral therapy Cairo and this is what came up - but I know nothing about it, who is involved or their training. You will have to find out for yourself.

Best of luck - Tina

http://nuncenter.com/treatments/

Dear Omer

A neurosurgerer of our team does not believe to the relationship, however, This subject is interesting for me and I am evaluating all aspects of this for start the project.

Furthermore, fMRI? I do not think so.

Regards

Dear Omer

What is the importance of controling hypertension or diabetes during the project?

I think our main concern is finding relationship between "CSF pressure amount" and "facial or ... nerve which was monitored using EMG".

I think "diabetes".... "fMRI"....or etc are not valuable parameters. fMRI can not give us a separated reliable behaviour of facial nerve easily. We can monitor behaviour of this nerve easily using EMG

Dear Seifollah,

I meant that EMG would be our measure of CSF pressure.

This is similar to our ways to measure hypertension or diabetes. Without a sensitive measure we can not control any disease like hypertension or diabetes even if we have effective therapeutics. I did not say that blood sugar or BP are directly related to sudying CSF pressure.

The above was my answer of your question about clinical application of EMG.

fMRI was not meant to be done. I am sorry if my words were not clear. I hope it is clear now.

Best regards

We can measure CSF pressure using computer simulation (FSI or CFD method) as similar as my previous papers. Also we can monitor the activation or stimulation of facial nerve using EMG.

Seifollah,

Fluid dynamics are difficult for me to understand. I donot

think they are invasive tests. May be they are used, I amnot sure. One problem is that CSF optimal pressure is different in different patients. I did not study your papers in measuring CSF pressure. Also I know little about the available sensor resrvoir:

https://www.miethke.com/en/products/sensor-reservoir/

The same for computerized valves.

The problem in fluid dynamics measures is that it doesnot measure the individual need in every patient which varies.

Suggested target in EMG is not only 7th nerve but also 8th nerve. But you have to convince neurosurgeons and neurophysiologists as they are the patients recruiters.