Department of Biomedical Engineering, Islamic Azad University-Tehran North Branch, Tehran, Iran.
PLoS One. 2018 Apr 30;13(4):e0196216. doi: 10.1371/journal.pone.0196216. eCollection 2018.
3D fluid-structure interaction modelling was utilized for simulation of 13 normal subjects, 11 non-communicating hydrocephalus (NCH) patients at pre-treatment phase, and 3 patients at five post-treatment phases. Evaluation of ventricles volume and maximum CSF pressure (before shunting) following results validation indicated that these parameters were the most proper hydrodynamic indices and the NCH type doesn't have any significant effect on changes in two indices. The results confirmed an appropriate correlation between these indices although the correlation decreased slightly after the occurrence of disease. NCH raises the intensity of vortex and pulsatility (2.4 times) of CSF flow while the flow remains laminar. On day 18 after shunting, the CSF pressure decreased 81.0% and all clinical symptoms of patients vanished except for headache. Continuing this investigation during the treatment process showed that maximum CSF pressure is the most sensitive parameter to patients' clinical symptoms. Maximum CSF pressure has decreased proportional to the level of decrease in clinical symptoms and has returned close to the pressure range in normal subjects faster than other parameters and simultaneous with disappearance of patients' clinical symptoms (from day 81 after shunting). However, phase lag between flow rate and pressure gradient functions and the degree of CSF pulsatility haven't returned to normal subjects' conditions even 981 days after shunting and NCH has also caused a permanent volume change (of 20.1%) in ventricles. Therefore, patients have experienced a new healthy state in new hydrodynamic conditions after shunting and healing. Increase in patients' intracranial compliance was predicted with a more accurate non-invasive method than previous experimental methods up to more than 981 days after shunting. The changes in hydrodynamic parameters along with clinical reports of patients can help to gain more insight into the pathophysiology of NCH patients.
利用三维流固耦合模型对 13 名正常受试者、11 名非交通性脑积水（NCH）患者的治疗前阶段和 3 名患者的 5 个治疗后阶段进行了模拟。对结果验证后的脑室容积和最大脑脊髓液压力（分流前）进行评估表明，这些参数是最合适的流体动力指标，而且 NCH 类型对这两个指标的变化没有任何显著影响。结果证实了这些指标之间存在适当的相关性，尽管在疾病发生后相关性略有下降。NCH 增加了脑脊髓液流动的涡流和脉动强度（2.4 倍），同时保持了层流状态。分流后第 18 天，脑脊髓液压力下降了 81.0%，除头痛外，所有患者的临床症状均消失。在治疗过程中继续进行这项研究表明，最大脑脊髓液压力是对患者临床症状最敏感的参数。最大脑脊髓液压力与临床症状的下降程度成比例下降，并且比其他参数更快地接近正常受试者的压力范围，同时患者的临床症状也消失（从分流后第 81 天开始）。然而，即使在分流后 981 天，流量率和压力梯度函数之间的相位滞后以及脑脊髓液脉动程度仍未恢复到正常受试者的状态，而且 NCH 还导致了脑室容积的永久性变化（20.1%）。因此，患者在分流和治愈后，在新的流体动力学条件下经历了一种新的健康状态。与以前的实验方法相比，通过更准确的非侵入性方法预测了患者颅内顺应性的增加，甚至在分流后超过 981 天。随着患者临床报告的变化，这些流体动力学参数的变化可以帮助深入了解 NCH 患者的病理生理学。
