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Exploring the Efficacy of Endoscopic Ventriculostomy for Hydrocephalus Treatment via a Multicompartmental Poroelastic Model of CSF Transport: A Computational Perspective

Vardakis, JC; Tully, BJ; Ventikos, Y; (2013) Exploring the Efficacy of Endoscopic Ventriculostomy for Hydrocephalus Treatment via a Multicompartmental Poroelastic Model of CSF Transport: A Computational Perspective. PLoS ONE , 8 (12) , Article e84577. 10.1371/journal.pone.0084577. Green open access

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Abstract

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.

Type: Article
Title: Exploring the Efficacy of Endoscopic Ventriculostomy for Hydrocephalus Treatment via a Multicompartmental Poroelastic Model of CSF Transport: A Computational Perspective
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pone.0084577
Publisher version: http://dx.doi.org/10.1371/journal.pone.0084577
Language: English
Additional information: © 2013 Vardakis et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering
URI: https://discovery.ucl.ac.uk/id/eprint/1436080
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