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Exploring the efficacy of endoscopic ventriculostomy for hydrocephalus treatment via a multicompartmental poroelastic model of CSF transport: a computational perspective.
[hydrocephalus with stenosis of the aqueduct of sylvius]
This
study
proposes
the
implementation
of
a
Multiple
-
Network
Poroelastic
Theory
(
MPET
)
model
coupled
with
finite-volume
computational
fluid
dynamics
for
the
purpose
of
studying
,
in
detail
,
the
effects
of
obstructing
CSF
transport
within
an
anatomically
accurate
cerebral
environment
.
The
MPET
representation
allows
the
investigation
of
fluid
transport
between
CSF
,
brain
parenchyma
and
cerebral
blood
,
in
an
integral
and
comprehensive
manner
.
A
key
novelty
in
the
model
is
the
amalgamation
of
anatomically
accurate
choroid
plexuses
with
their
feeding
arteries
and
a
simple
relationship
relaxing
the
constraint
of
a
unique
permeability
for
the
CSF
compartment
.
This
was
done
in
order
to
account
for
the
Aquaporin-
4
-
mediated
swelling
characteristics
.
The
aim
of
this
varying
permeability
compartment
was
to
bring
to
light
a
feedback
mechanism
that
could
counteract
the
effects
of
ventricular
dilation
and
subsequent
elevations
of
CSF
pressure
through
the
efflux
of
excess
CSF
into
the
blood
system
.
This
model
is
used
to
demonstrate
the
impact
of
aqueductal
stenosis
and
fourth
ventricle
outlet
obstruction
(
FVOO
)
.
The
implications
of
treating
such
a
clinical
condition
with
the
aid
of
endoscopic
third
(
ETV
)
and
endoscopic
fourth
(
EFV
)
ventriculostomy
are
considered
.
We
observed
peak
CSF
velocities
in
the
aqueduct
of
the
order
of
15
.
6
cm
/
s
in
the
healthy
case
,
45
.
4
cm
/
s
and
72
.
8
cm
/
s
for
the
mild
and
severe
cases
respectively
.
The
application
of
ETV
reduced
the
aqueductal
velocity
to
levels
around
16
-
17
cm
/
s
.
Ventricular
displacement
,
CSF
pressure
,
wall
shear
stress
(
WSS
)
and
pressure
difference
between
lateral
and
fourth
ventricles
(
ΔP
)
increased
with
applied
stenosis
,
and
subsequently
dropped
to
nominal
levels
with
the
application
of
ETV
.
The
greatest
reversal
of
the
effects
of
atresia
come
by
opting
for
ETV
rather
than
the
more
complicated
procedure
of
EFV
.