A patient-specific, finite element model for noncommunicating hydrocephalus capable of large deformation

Cerebrospinal fluid flow dynamics in the aqueduct of Sylvius for rigid and deformable brain models

The cerebrospinal fluid (CSF) in the subarachnoid space and brain ventricles is crucial for maintaining brain health and influencing conditions such as hydrocephalus. This study explores CSF flow dynamics in the aqueduct of Sylvius (AoS) using rigid and deformable brain models based on MRI-derived 3D geometries. The rigid model captures the main characteristics of the CSF velocity waveform in the AoS, particularly in terms of waveform and timing of peaks and troughs. This model also predicts velocity increases in hydrocephalic conditions and velocity ranges in subarachnoid space. However, the rigid model falls short of representing the full range of velocity variations in the AoS. Using fluid-structure interaction simulation, the deformable model addresses the impact of brain tissue deformation on CSF flow. The deformable brain model have an excellent prediction and agrees with MRI measurements, effectively anticipating CSF flow dynamics and flow reversals, underscoring the importance of incorporating brain tissue deformation for accurate modeling. We also found out that the effect of the inlet waveform is critical on the model prediction for the velocity within AoS during a cardiac cycle.

Cortex tissue relaxation and slow to medium load rates dependency can be captured by a two-phase flow poroelastic model

This paper investigates the complex time-dependent behavior of cortex tissue, under adiabatic condition, using a two-phase flow poroelastic model. Motivated by experiments and Biot's consolidation theory, we tackle time-dependent uniaxial loading, confined and unconfined, with various geometries and loading rates from 1μm/s to 100μm/s. The cortex tissue is modeled as the porous solid saturated by two immiscible fluids, with dynamic viscosities separated by four orders, resulting in two different characteristic times. These are respectively associated to interstitial fluid and glial cells. The partial differential equations system is discretized in space by the finite element method and in time by Euler-implicit scheme. The solution is computed using a monolithic scheme within the open-source computational framework FEniCS. The parameters calibration is based on Sobol sensitivity analysis, which divides them into two groups: the tissue specific group, whose parameters represent general properties, and sample specific group, whose parameters have greater variations. Our results show that the experimental curves can be reproduced without the need to resort to viscous solid effects, by adding an additional fluid phase. Through this process, we aim to present multiphase poromechanics as a promising way to a unified brain tissue modeling framework in a variety of settings.

Boundary conditions investigation to improve computer simulation of cerebrospinal fluid dynamics in hydrocephalus patients

Three-D head geometrical models of eight healthy subjects and 11 hydrocephalus patients were built using their CINE phase-contrast MRI data and used for computer simulations under three different inlet/outlet boundary conditions (BCs). The maximum cerebrospinal fluid (CSF) pressure and the ventricular system volume were more effective and accurate than the other parameters in evaluating the patients' conditions. In constant CSF pressure, the computational patient models were 18.5% more sensitive to CSF volume changes in the ventricular system under BC "C". Pulsatile CSF flow rate diagrams were used for inlet and outlet BCs of BC "C". BC "C" was suggested to evaluate the intracranial compliance of the hydrocephalus patients. The results suggested using the computational fluid dynamic (CFD) method and the fully coupled fluid-structure interaction (FSI) method for the CSF dynamic analysis in patients with external and internal hydrocephalus, respectively.

Three-dimensional nonlinear finite element model to estimate backflow during flow-controlled infusions into the brain

Convection-enhanced delivery is a technique to bypass the blood–brain barrier and deliver therapeutic drugs into the brain tissue. However, animal investigations and preliminary clinical trials have reported reduced efficacy to transport the infused drug in specific zones, attributed mainly to backflow, in which an annular gap is formed outside the catheter and the fluid preferentially flows toward the surface of the brain rather than through the tissue in front of the cannula tip. In this study, a three-dimensional human brain finite element model of backflow was developed to study the influence of anatomical structures during flow-controlled infusions. Predictions of backflow length were compared under the influence of ventricular pressure and the distance between the cannula and the ventricles. Simulations with zero relative ventricle pressure displayed similar backflow length predictions for larger cannula-ventricle distances. In addition, infusions near the ventricles revealed smaller backflow length and the liquid was observed to escape to the longitudinal fissure and ventricular cavities. Simulations with larger cannula-ventricle distances and nonzero relative ventricular pressure showed an increase of fluid flow through the tissue and away from the ventricles. These results reveal the importance of considering both the subject-specific anatomical details and the nonlinear effects in models focused on analyzing current and potential treatment options associated with convection-enhanced delivery optimization for future clinical trials.

Finite Element Model for Hydrocephalus and Idiopathic Intracranial Hypertension

Hydrocephalus and idiopathic intracranial hypertension (IIH) are neuropathies associated with disturbed cerebrospinal fluid dynamics. Several finite element (FE) brain models were suggested to simulate the pathological changes in hydrocephalus, but with overly simplified assumptions regarding the properties of the brain parenchyma. This study proposes a two-dimensional FE brain model, capable of simulating both hydrocephalus and IIH by incorporating poro-hyperelasticity of the brain and detailed structural information (i.e., sulci).

An Attempt to Predict the Preferential Cellular Orientation in Any Complex Mechanical Environment

Cells respond to their mechanical environment in different ways: while their response in terms of differentiation and proliferation has been widely studied, the question of the direction in which cells align when subject to a complex mechanical loading in a 3D environment is still widely open. In the present paper, we formulate the hypothesis that the cells orientate in the direction of unitary stretch computed from the right Cauchy-Green tensor in a given mechanical environment. The implications of this hypothesis are studied in different simple cases corresponding to either the available in vitro experimental data or physiological conditions, starting from finite element analysis results to computed preferential cellular orientation. The present contribution is a first step to the formulation of a deeper understanding of the orientation of cells within or at the surface of any 3D scaffold subject to any complex load. It is believed that these initial preferential directions have strong implications as far as the anisotropy of biological structures is concerned.

Finite element analysis of periventricular lucency in hydrocephalus: extravasation or transependymal CSF absorption?

OBJECTIVE

Periventricular lucency (PVL) is often observed in the hydrocephalic brain on CT or MRI. Earlier studies have proposed the extravasation of ventricular CSF into the periventricular white matter or transependymal CSF absorption as possible causes of PVL in hydrocephalus. However, there is insufficient evidence for either theory to be conclusive.

METHODS

A finite element (FE) model of the hydrocephalic brain with detailed anatomical geometry was constructed to investigate the possible mechanism of PVL in hydrocephalus. The initiation of hydrocephalus was modeled by applying a transmantle pressure gradient (TPG). The model was exposed to varying TPGs to investigate the effects of different geometrical characteristics on the distribution of PVL. The edema map was derived based on the interstitial pore pressure.

RESULTS

The model simulated the main radiological features of hydrocephalus, i.e., ventriculomegaly and PVL. The degree of PVL, assessed by the pore pressure, was prominent in mild to moderate ventriculomegaly. As the degree of ventriculomegaly exceeded certain values, the pore pressure across the cerebrum became positive, thus inducing the disappearance of PVL.

CONCLUSIONS

The results are in accordance with common clinical findings of PVL. The degree of ventriculomegaly significantly influences the development of PVL, but two factors were not linearly correlated. The results are indicative of the transependymal CSF absorption as a possible cause of PVL, but the extravasation theory cannot be formally rejected.

Porohyperelastic anatomical models for hydrocephalus and idiopathic intracranial hypertension

OBJECT

Brain deformation can be seen in hydrocephalus and idiopathic intracranial hypertension (IIH) via medical images. The phenomenology of local effects, brain shift, and raised intracranial pressure and herniation are textbook concepts. However, there are still uncertainties regarding the specific processes that occur when brain tissue is subject to the mechanical stress of different temporal and spatial profiles of the 2 neurological disorders. Moreover, recent studies suggest that IIH and hydrocephalus may be diseases with opposite pathogenesis. Nevertheless, the similarities and differences between the 2 subjects have not been thoroughly investigated.

METHODS

An anatomical porohyperelastic finite element model was used to assess the brain tissue responses associated with hydrocephalus and IIH. The same set of boundary conditions, with the exception of brain loading for development of the transmantle pressure gradient, was applied for the 2 models. The distribution of stress and strain during tissue distortion is described by the mechanical parameters.

RESULTS

The results of both the hydrocephalus and IIH models correlated with pathological characteristics. For the hydrocephalus model, periventricular edema was associated with the presence of positive volumetric strain and void ratio in the lateral ventricle horns. By contrast, the IIH model revealed edema across the cerebral mantle, including the centrum semiovale, with a positive void ratio and volumetric strain.

CONCLUSIONS

The model simulates all the clinical features in correlation with the MR images obtained in patients with hydrocephalus and IIH, thus providing support for the role of the transmantle pressure gradient and capillary CSF absorption in CSF-related brain deformation. The finite element methods can be used for a better understanding of the pathophysiological mechanisms of neurological disorders associated with parenchymal volumetric fluctuation.