Author(s): Adelisa Avezzu; Eleuterio F. Toro; Christian Contarino; Kenneth C. Liu; Thomas J. Buell

Linked Author(s):

Keywords: Idiopathic intracranial hypertension; Transverse sinus stenosis; Mathematical modeling; Cerebrospinal fluid pressure; Venous sinus pressure

Abstract: Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure without an intracranial mass and of unknown etiology, responsible for several disorders. Venous sinus stenosis is a very sensitive and specific predictor of IIH but its effect on the course and outcome of IIH is unknown. Most subjects present stenosis of the transverse sinus (TS). Clinicians do not usually take into account the degree, the length or the position along the TS when considering management strategies, neither the bilateral stenosis nor a severe stenosis in the non-dominant TS as different contributors. Due to the great invasiveness of venous and cerebrospinal fluid (CSF) pressure measurements, mathematical modeling has become more and more attractive as an alternative approach for better understanding the mechanisms involved in the origin and progression of IIH, the causes of which are not clear yet. Here we propose a systematic study of the TS stenosis behavior, simulating numerically different positions, lengths and obstruction degrees of the stenosis, as well as comparing unilateral stenosis in dominant and non-dominant TS with the bilateral one. A global multi-scale and closed-loop mathematical model for the human circulation is used. A validation of the mathematical model for the pressure in the venous dural sinuses is provided by comparing the results obtained from numerical simulations with in-vivo pressure measurements. The study shows how stenosis in the transverse sinus influences the venous and CSF pressure, with effect on the average pressure and the pressure waveform. Specifically, the pressure is higher when the stenosis is located in the tract between the vein of Labbe and the sigmoid sinus. A severe stenosis in the non-dominant sinus also contributes to the increase of pressure, especially when bilateral stenosis occurs. Finally, when the pressure increases, the pressure waveform also changes, showing a rise of the second peak above the first one, which is broadly in agreement with experimental measurements in the event of IIH.

DOI: https://doi.org/10.3850/978-981-11-2731-1_375-cd

Year: 2018