Marcotti Stefania, Marchetti Lara, Cecconi Pietro, Votta Emiliano, Fiore Gianfranco Beniamino, Barberio Antonello, Viotti Stefano, Redaelli Alberto, Laganà Maria Marcella
Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo Da Vinci, 32, 20133, Milan, Italy.
Magnetic Resonance Laboratory, Fondazione Don Carlo Gnocchi ONLUS, IRCCS Santa Maria Nascente, Via Capecelatro 66, 20148, Milan, Italy.
BMC Neurol. 2015 Jun 23;15:95. doi: 10.1186/s12883-015-0352-y.
The relationship between extracranial venous system abnormalities and central nervous system disorders has been recently theorized. In this paper we delve into this hypothesis by modeling the venous drainage in brain and spinal column areas and simulating the intracranial flow changes due to extracranial morphological stenoses.
A lumped parameter model of the cerebro-spinal venous drainage was created based on anatomical knowledge and vessels diameters and lengths taken from literature. Each vein was modeled as a hydraulic resistance, calculated through Poiseuille's law. The inputs of the model were arterial flow rates of the intracranial, vertebral and lumbar districts. The effects of the obstruction of the main venous outflows were simulated. A database comprising 112 Multiple Sclerosis patients (Male/Female = 42/70; median age ± standard deviation = 43.7 ± 10.5 years) was retrospectively analyzed.
The flow rate of the main veins estimated with the model was similar to the measures of 21 healthy controls (Male/Female = 10/11; mean age ± standard deviation = 31 ± 11 years), obtained with a 1.5 T Magnetic Resonance scanner. The intracranial reflux topography predicted with the model in cases of internal jugular vein diameter reduction was similar to those observed in the patients with internal jugular vein obstacles.
The proposed model can predict physiological and pathological behaviors with good fidelity. Despite the simplifications introduced in cerebrospinal venous circulation modeling, the key anatomical feature of the lumped parameter model allowed for a detailed analysis of the consequences of extracranial venous impairments on intracranial pressure and hemodynamics.
颅外静脉系统异常与中枢神经系统疾病之间的关系最近已形成理论。在本文中，我们通过对脑和脊柱区域的静脉引流进行建模，并模拟颅外形态狭窄导致的颅内血流变化，深入探讨这一假设。
基于解剖学知识以及从文献中获取的血管直径和长度，创建了一个脑脊液静脉引流的集总参数模型。每条静脉都被建模为一个水力阻力，通过泊肃叶定律计算得出。该模型的输入为颅内、椎动脉和腰段区域的动脉血流速率。模拟了主要静脉流出道阻塞的影响。对一个包含112例多发性硬化症患者的数据库（男性/女性 = 42/70；年龄中位数±标准差 = 43.7±10.5岁）进行了回顾性分析。
用该模型估算的主要静脉血流速率与21名健康对照者（男性/女性 = 10/11；平均年龄±标准差 = 31±11岁）通过1.5T磁共振扫描仪测得的结果相似。在颈内静脉直径减小的情况下，用该模型预测的颅内反流形态与颈内静脉受阻患者中观察到的相似。
所提出的模型能够以较高的逼真度预测生理和病理行为。尽管在脑脊液静脉循环建模中引入了简化，但集总参数模型的关键解剖特征允许对颅外静脉损伤对颅内压和血流动力学的影响进行详细分析。
