Simulating cerebral edema and delayed fatality after traumatic brain injury using triphasic swelling biomechanics

Biomechanics of brain tissue damage caused by fiber endoscope penetration in third ventriculostomy surgery

Third ventriculostomy is the preferred treatment for obstructive hydrocephalus, but the biomechanics of brain tissue damage caused by fiber endoscopes remains unclear. In this study, brain tissue material parameters were tested based on the Ogden model to simulate needle puncture mechanics, and replicated the entire fiber endoscope advancement process during third ventriculostomy. It was found that a smaller diameter fiber endoscope, a perpendicular puncture angle, and a faster puncture speed would decrease the damage of brain tissue caused by the fiber endoscope. This study provides valuable insights for optimizing the instrumentation and surgical process of third ventriculostomy.

Simulating Cerebral Edema and Ischemia After Traumatic Acute Subdural Hematoma Using Triphasic Swelling Biomechanics

Poor outcome following traumatic acute subdural hematoma (ASDH) is associated with the severity of the primary injury and secondary injury including cerebral edema and ischemia. However, the underlying secondary injury mechanism contributing to elevated intracranial pressure (ICP) and high mortality rate remains unclear. Cerebral edema occurs in response to the exposure of the intracellular fixed charge density (FCD) after cell death, causing ICP to increase. The increased ICP from swollen tissue compresses blood vessels in adjacent tissue, restricting blood flow and leading to ischemic damage. We hypothesize that the mass occupying effect of ASDH exacerbates the ischemic injury, leading to ICP elevation, which is an indicator of high mortality rate in the clinic. Using FEBio (febio.org) and triphasic swelling biomechanics, this study modeled clinically relevant ASDHs and simulated post-traumatic brain swelling and ischemia to predict ICP. Results showed that common convexity ASDH significantly increased ICP by exacerbating ischemic injury, and surgical removal of the convexity ASDH may control ICP by preventing ischemia progression. However, in cases where the primary injury is very severe, surgical intervention alone may not effectively decrease ICP, as the contribution of the hematoma to the elevated ICP is insignificant. In addition, interhemispheric ASDH, located between the cerebral hemispheres, does not significantly exacerbate ischemia, supporting the conservative surgical management generally recommended for interhemispheric ASDH. The joint effect of the mass occupying effect of the blood clot and resulting ischemia contributes to elevated ICP which may increase mortality. Our novel approach may improve the fidelity of predicting patient outcome after motor vehicle crashes and traumatic brain injuries due to other causes.

Alterations in brain fluid physiology during the early stages of development of ischaemic oedema

Oedema occurs when higher than normal amounts of solutes and water accumulate in tissues. In brain parenchymal tissue, vasogenic oedema arises from changes in blood-brain barrier permeability, e.g. in peritumoral oedema. Cytotoxic oedema arises from excess accumulation of solutes within cells, e.g. ischaemic oedema following stroke. This type of oedema is initiated when blood flow in the affected core region falls sufficiently to deprive brain cells of the ATP needed to maintain ion gradients. As a consequence, there is: depolarization of neurons; neural uptake of Na+ and Cl- and loss of K+; neuronal swelling; astrocytic uptake of Na+, K+ and anions; swelling of astrocytes; and reduction in ISF volume by fluid uptake into neurons and astrocytes. There is increased parenchymal solute content due to metabolic osmolyte production and solute influx from CSF and blood. The greatly increased [K+]isf triggers spreading depolarizations into the surrounding penumbra increasing metabolic load leading to increased size of the ischaemic core. Water enters the parenchyma primarily from blood, some passing into astrocyte endfeet via AQP4. In the medium term, e.g. after three hours, NaCl permeability and swelling rate increase with partial opening of tight junctions between blood-brain barrier endothelial cells and opening of SUR1-TPRM4 channels. Swelling is then driven by a Donnan-like effect. Longer term, there is gross failure of the blood-brain barrier. Oedema resolution is slower than its formation. Fluids without colloid, e.g. infused mock CSF, can be reabsorbed across the blood-brain barrier by a Starling-like mechanism whereas infused serum with its colloids must be removed by even slower extravascular means. Large scale oedema can increase intracranial pressure (ICP) sufficiently to cause fatal brain herniation. The potentially lethal increase in ICP can be avoided by craniectomy or by aspiration of the osmotically active infarcted region. However, the only satisfactory treatment resulting in retention of function is restoration of blood flow, providing this can be achieved relatively quickly. One important objective of current research is to find treatments that increase the time during which reperfusion is successful. Questions still to be resolved are discussed.

Fracture Resistance Biomechanisms of Walnut Shell with High-Strength and Toughening

Walnut shell is lightweight material with high-strength and toughening characteristics, but it is different from other nut shells' microstructure with two or three short sclerotic cell layers and long bundle fibers. It is essential to explore the fracture resistance biomechanism of lightweight walnut shell and how to prevent damage of bionic structure. In this study, it is found that the asymmetric mass center and geometric center dissipated impact energy to the whole shell without loading concentration in the loading area. Diaphragma juglandis is a special structure improved walnut shell's toughening. The S-shape gradient porosity/elastic modulus distribution combined with pits on single auxetic sclerotic cells requires higher energy to crack expansion, then decreases its fracture behavior. These fantastic findings inspire to design fracture resistance devices including helmets, armor, automobile anti-collision beams, and re-entry capsule in spacecraft.

Is the fluid volume fraction equal to the water content in tendons? Insights on biphasic modeling

The mass density of highly hydrated soft tissues is generally assumed to be very close to that of the water, resulting that the fluid mass fraction (water content) being equal to the fluid volume fraction. Within this context, the present study aims to investigate whether such an assumption actually holds for tendon tissues and to what extent it may affect the constitutive characterizations based on biphasic (poroelastic) models. Once the water content was assessed by a classical drying assay, the fluid volume fraction was obtained based on an image segmentation approach. The main achieved results point out that the fluid volume fraction is ∼20% higher than the water content in the studied tendons (flexor digitorum profundus bovine tendons). Based on this, it is shown that the use of the water content instead of the fluid volume fraction may considerably bias the results drawn by biphasic modeling of tendons. Accordingly, a proper measurement of the fluid volume fraction is then required.

Distinguishing poroelasticity and viscoelasticity of brain tissue with time scale

Brain tissue is considered to be biphasic, with approximately 80% liquid and 20% solid matrix, thus exhibiting viscoelasticity due to rearrangement of the solid matrix and poroelasticity due to fluid migration within the solid matrix. However, how to distinguish poroelastic and viscoelastic effects in brain tissue remains challenging. In this study, we proposed a method of unconfined compression-isometric hold to measure the force versus time relaxation curves of porcine brain tissue samples with systematically varied sample lengths. Upon scaling the measured relaxation force and relaxation time with different length-dependent physical quantities, we successfully distinguished the poroelasticity and viscoelasticity of the brain tissue. We demonstrated that during isometric hold, viscoelastic relaxation dominated the mechanical behavior of brain tissue in the short-time regime, while poroelastic relaxation dominated in the long-time regime. Furthermore, compared with poroelastic relaxation, viscoelastic relaxation was found to play a more dominant role in the mechanical response of porcine brain tissue. We then evaluated the differences between poroelastic and viscoelastic effects for both porcine and human brain tissue. Because of the draining of pore fluid, the Young's moduli in poroelastic relaxation were lower than those in viscoelastic relaxation; brain tissue changed from incompressible during viscoelastic relaxation to compressible during poroelastic relaxation, resulting in reduced Poisson ratios. This study provides new insights into the physical mechanisms underlying the roles of viscoelasticity and poroelasticity in brain tissue. STATEMENT OF SIGNIFICANCE: Although the poroviscoelastic model had been proposed to characterize brain tissue mechanical behavior, it is difficult to distinguish the poroelastic and viscoelastic behaviors of brain tissue. The study distinguished viscoelasticity and poroelasticity of brain tissue with time scales and then evaluated the differences between poroelastic and viscoelastic effects for both porcine and human brain tissue, which helps to accurate selection of constitutive models suitable for application in certain situations (e.g., pore-dominant and viscoelastic-dominant deformation).

Cortex tissue relaxation and slow to medium load rates dependency can be captured by a two-phase flow poroelastic model

This paper investigates the complex time-dependent behavior of cortex tissue, under adiabatic condition, using a two-phase flow poroelastic model. Motivated by experiments and Biot's consolidation theory, we tackle time-dependent uniaxial loading, confined and unconfined, with various geometries and loading rates from 1μm/s to 100μm/s. The cortex tissue is modeled as the porous solid saturated by two immiscible fluids, with dynamic viscosities separated by four orders, resulting in two different characteristic times. These are respectively associated to interstitial fluid and glial cells. The partial differential equations system is discretized in space by the finite element method and in time by Euler-implicit scheme. The solution is computed using a monolithic scheme within the open-source computational framework FEniCS. The parameters calibration is based on Sobol sensitivity analysis, which divides them into two groups: the tissue specific group, whose parameters represent general properties, and sample specific group, whose parameters have greater variations. Our results show that the experimental curves can be reproduced without the need to resort to viscous solid effects, by adding an additional fluid phase. Through this process, we aim to present multiphase poromechanics as a promising way to a unified brain tissue modeling framework in a variety of settings.