Abstract
BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionsThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0352-y) contains supplementary material, which is available to authorized users.
Highlights
The relationship between extracranial venous system abnormalities and central nervous system disorders has been recently theorized
We considered subjects in the supine position, where the principal extracranial outflow routes are the internal jugular veins (IJV), and the flow rate in the vertebral veins (VV) is lower compared to the upright position [19, 28,29,30,31,32]
Cerebrospinal venous lumped parameter model Hydraulic lumped-parameter models allow for quantifying pressures and flow rates at different locations within a vessel network in which different tracts can be described as combinations of i) hydraulic resistances relating the flow rate in a conduit and the corresponding pressure drop, ii) compliance elements quantifying the tendency of the conduit to dilate due to inner pressure, and iii) inertance elements accounting for the inertia of the fluid in the conduit
Summary
The relationship between extracranial venous system abnormalities and central nervous system disorders has been recently theorized. The relationship between extracranial venous system abnormalities and central nervous system (CNS) disorders has been subjected to scrutiny in the latest years [1, 2]. Researchers investigated the association of venous abnormalities with aging [3], leukoaraiosis [4]. A pathological vascular condition termed chronic cerebrospinal venous insufficiency (CCSVI) was introduced [12]. The hypothesis assumed that CCSVI could have a causal relationship with MS [12], which has sparked significant debate in the literature [1, 16], as well as the criteria defining CCSVI itself and its diagnosis [15, 17]
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