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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
.
Diseases
Validation
Diseases presenting
"severe cases"
symptom
coats disease
congenital diaphragmatic hernia
dentin dysplasia
dentinogenesis imperfecta
erythropoietic protoporphyria
hereditary cerebral hemorrhage with amyloidosis
hydrocephalus with stenosis of the aqueduct of sylvius
locked-in syndrome
megacystis-microcolon-intestinal hypoperistalsis syndrome
neuralgic amyotrophy
proteus syndrome
scrub typhus
trochlear dysplasia
typhoid
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