Cerebrospinal Fluid Flow in the Normal and Hydrocephalic Human Brain

Linninger, Andreas A.; Xenos, Michalis; Zhu, David C.; Somayaji, Mahadevabharath R.; Kondapalli, Srinivasa; Penn, Richard D.

doi:10.1109/tbme.2006.886853

Cited by 150 publications

(145 citation statements)

References 30 publications

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“…Our current model provides a physics-based explanation for hydrocephalus which has been validated by MRI studies and which also resolves the problems with Hakim’s pressure gradient hypothesis. For the interested reader, the detailed assumptions and the mathematical approaches are described in several of our recent articles in engineering journals [2,3,4]. …”

Section: Hakim’s Premise Of the Brain As A ‘Sponge’mentioning

confidence: 99%

“…Using appropriate equations governing fluid movement and the sizes of the fluid spaces, these motions can be precisely computed [2, 3]. The scheme for representing this is shown in figure 3 and the relevant equations and constants from the literature are listed in table 1.…”

Section: Movement Of Csfmentioning

confidence: 99%

“…In doing so, we take advantage of new computer-based mathematical techniques, MRI studies, and pressure monitoring which were not available 30 years ago. Much of our experimental work has been presented in engineering and imaging literature [2,3,4]. Since the goal is to advance understanding and improve neurosurgical treatments for brain diseases and in particular hydrocephalus, this review article is designed to present in a clear, relatively nontechnical manner our main findings leading to a comprehensive quantitative picture of intracranial dynamics and their implications for clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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The Physics of Hydrocephalus

Penn

Linninger

2009

Pediatr Neurosurg

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This article reviews our previous work on the dynamics of the intracranial cavity and presents new clinically relevant results about hydrocephalus that can be gained from this approach. Simulations based on fluid dynamics and poroelasticity theory are used to predict CSF flow, pressures and brain tissue movement in normal subjects. Communicating hydrocephalus is created in the model by decreasing CSF absorption. The predictions are shown to reflect dynamics demonstrated by structural MRI and cine-MRI studies of normal subjects and hydrocephalus patients. The simulations are then used to explain unilateral hydrocephalus and how hydrocephalus could occur without CSF pulsations. The simulations also predict the known pressure/volume relationships seen on bolus infusions of CSF, and the small transmural pressure gradients observed in animal experiments and in patients with hydrocephalus. The complications and poor performance of shunts based on pressure-sensitive valves are explained and a system of feedback control is suggested as a solution.

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Section: Hakim’s Premise Of the Brain As A ‘Sponge’mentioning

confidence: 99%

Section: Movement Of Csfmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Physics of Hydrocephalus

Penn

Linninger

2009

Pediatr Neurosurg

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“…Quantitatively, the results obtained were compatible with the physiological data present in the literature. In future studies, the presented technique will be used for validation of existing computational fluid dynamics studies, performed in healthy volunteers and patients suffering from hydrocephalus (31,32) and Chiari malformation, and to provide in vivo data for a better definition of these pathologies.…”

Section: Discussionmentioning

confidence: 99%

Time‐resolved three‐dimensional (3D) phase‐contrast (PC) balanced steady‐state free precession (bSSFP)

Santini

Wetzel

Bock

et al. 2009

Magnetic Resonance in Med

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In this study the feasibility of a time-resolved, three-dimensional (3D), three-directional flow-sensitive balanced steadystate free precession (bSSFP) sequence is demonstrated. Due to its high signal-to-noise ratio (SNR) in blood and cerebrospinal fluid (CSF) this type of sequence is particularly effective for acquisition of blood and CSF flow velocities. Flow sensitivity was achieved with the phase-contrast (PC) technique, implementing a custom algorithm for calculation of optimal gradient parameters. Techniques to avoid the most important sources of bSSFP-related artifacts (including distortion due to eddy currents and signal voids due to flow-related steady-state disruption) are also presented. Magnetic resonance imaging (MRI) is a widely used technique for noninvasive flow quantification, useful in the evaluation of both anatomy and function within the human circulatory system; e.g., the cardiovascular system and the cerebrospinal fluid (CSF) circulation system. A traditional method of flow quantification is the phasecontrast (PC) technique, which was first introduced in 1960 by Hahn (1). PC-MRI is based on the encoding of the mean velocity of an isochromat into the corresponding voxel location of the reconstructed phase image. An additional reference image is acquired to remove background effects via phase subtraction and the underlying fluid velocity or tissue motion is represented by the pixel intensity in the resulting phase difference image.The traditional approach consists of the acquisition of two-dimensional (2D) slices with a modified radio frequency (RF)-spoiled sequence that is sensitive to flow in the throughplane direction (2). More recently, time-resolved three-dimensional (3D) sequences, encoding flow in three directions, were proposed and used in research studies of thoracic and brain vessels (3-8). Such data acquisition strategies allow for improved quantification of velocities, compared to singledirection flow encoding, which is biased if the flow is not completely parallel to the encoding direction. Furthermore, the acquisition of 3D volumes in combination with threedirectional velocity encoding permits the visualization of complex flow patterns, and the estimation of other parameters such as wall shear stress or vorticity (9) Although 3D methods suffer from longer scan times, 3D acquisitions also provide improved and potentially isotropic resolution related to the higher signal-to-noise ratio (SNR) of a thick 3D slab compared to the signal obtained from a thin 2D slice.One major disadvantage of typical flow quantification methods based on RF-spoiled gradient-echo (GRE) sequences is tissue saturation that occurs when the repetition time TR is significantly shorter than T 1 , as in the case of blood and CSF. This disadvantage is particularly noticeable for 3D acquisitions of large slabs or in cases of slow flow because of reduced in-flow enhancement. For this reason, and particularly for CSF flow, which is more prone to tissue saturation, through-slice flow-sensitive balanced steady-state ...

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“…Other studies used porous media to model the entire cerebral compartments: cerebral ventricles, cerebral SAS and the brain, like in Linninger et al study [14] where numerical velocity, obtained using the time-dependent Navier-Stokes equations and a Darcy's law, was compared to MRI measurements to look for a clinical indication.…”

Section: Mechanical Modelingmentioning

confidence: 99%

Numerical Modeling of the Intracranial Pressure using Windkessel Models

Garnotel¹,

Salmon²,

Balédent³

2017

MathS In A.

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The intracranial pressure (ICP) is an important factor in the proper functioning of the brain. This pressure is needed to be constantly regulated, since an abnormal elevation can be quite dangerous. In this article, we develop some numerical tools to better understand the regulation of this pressure. In particular, as it is impossible to measure the ICP in a non-invasive way, these numerical tools can allow to estimate values of the ICP. In addition, we propose to compute the dynamics of the cerebrospinal fluid (CSF), taking into account the connected environment of the skull and the arterio-venous flows. A computational fluid dynamics model in two dimensions is developed for the cerebrospinal fluid system, with Windkessel type boundary conditions. This model shows that the dynamics can impact the distribution of the CSF in the different compartments of the cerebrospinal system.

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Cerebrospinal Fluid Flow in the Normal and Hydrocephalic Human Brain

Cited by 150 publications

References 30 publications

The Physics of Hydrocephalus

The Physics of Hydrocephalus

Time‐resolved three‐dimensional (3D) phase‐contrast (PC) balanced steady‐state free precession (bSSFP)

Numerical Modeling of the Intracranial Pressure using Windkessel Models

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