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Munster DW, Lewandowski BE, Nelson ES, Prabhu RK, Myers JG. Modeling the impact of thoracic pressure on intracranial pressure. NPJ Microgravity 2024; 10:46. [PMID: 38600142 PMCID: PMC11006658 DOI: 10.1038/s41526-024-00385-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
A potential contribution to the progression of Spaceflight Associated Neuro-ocular Syndrome is the thoracic-to-spinal dural sac transmural pressure relationship. In this study, we utilize a lumped-parameter computational model of human cerebrospinal fluid (CSF) systems to investigate mechanisms of CSF redistribution. We present two analyses to illustrate potential mechanisms for CSF pressure alterations similar to those observed in microgravity conditions. Our numerical evidence suggests that the compliant relationship between thoracic and CSF compartments is insufficient to solely explain the observed decrease in CSF pressure with respect to the supine position. Our analyses suggest that the interaction between thoracic pressure and the cardiovascular system, particularly the central veins, has greater influence on CSF pressure. These results indicate that future studies should focus on the holistic system, with the impact of cardiovascular changes to the CSF pressure emphasized over the sequestration of fluid in the spine.
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Affiliation(s)
- Drayton W Munster
- NASA Glenn Research Center, 21000 Brookpark Road, Cleveland, OH, 44135, USA.
| | - Beth E Lewandowski
- NASA Glenn Research Center, 21000 Brookpark Road, Cleveland, OH, 44135, USA
| | - Emily S Nelson
- NASA Glenn Research Center, 21000 Brookpark Road, Cleveland, OH, 44135, USA
| | - R K Prabhu
- Universities Space Research Association, 21000 Brookpark Road, Cleveland, OH, 44135, USA
| | - Jerry G Myers
- NASA Glenn Research Center, 21000 Brookpark Road, Cleveland, OH, 44135, USA
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2
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Zadka Y, Rosenthal G, Doron O, Barnea O. Limitation of cerebral blood flow by increased venous outflow resistance in elevated ICP. J Appl Physiol (1985) 2024; 136:224-232. [PMID: 38059286 DOI: 10.1152/japplphysiol.00477.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/13/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
Extensive investigation and modeling efforts have been dedicated to cerebral pressure autoregulation, which is primarily regulated by the ability of the cerebral arterioles to change their resistance and modulate cerebral blood flow (CBF). However, the mechanisms by which elevated intracranial pressure (ICP) leads to increased resistance to venous outflow have received less attention. We modified our previously described model of intracranial fluid interactions with a newly developed model of a partially collapsed blood vessel, which we termed the "flow control zone" (FCZ). We sought to determine the degree to which ICP elevation causing venous compression at the FCZ becomes the main parameter limiting CBF. The FCZ component was designed using nonlinear functions representing resistance as a function of cross-sectional area and the pressure-volume relations of the vessel wall. We used our previously described swine model of cerebral edema with graduated elevation of ICP to calculate venous outflow resistance and a newly defined parameter, the cerebral resistance index (CRI), which is the ratio between venous outflow resistance and cerebrovascular resistance. Model simulations of cerebral edema and increased ICP led to increased venous outflow resistance. There was a close similarity between model predictions of venous outflow resistance and experimental results in the swine model (cross-correlation coefficient of 0.97, a mean squared error of 0.087, and a mean absolute error of 0.15). CRI was strongly correlated to ICP in the swine model (r2 = 0.77, P = 0.00012, 95% confidence interval [0.15, 0.45]). A CRI value of 0.5 was associated with ICP values above clinically significant thresholds (24 mmHg) in the swine model and a diminished capacity of changes in arteriolar resistance to influence flow in the mathematical model. Our results demonstrate the importance of venous compression at the FCZ in determining CBF when ICP is elevated. The cerebral resistance index may provide an indication of when compression of venous outflow becomes the dominant factor in limiting CBF following brain injury.NEW & NOTEWORTHY The goal of this study was to investigate the effects of venous compression caused by elevated intracranial pressure (ICP) due to cerebral edema, validated through animal experiments. The flow control zone model highlights the impact of cerebral venous compression on cerebral blood flow (CBF) during elevated ICP. The cerebral venous outflow resistance-to-cerebrovascular resistance ratio may indicate when venous outflow compression becomes the dominant factor limiting CBF. CBF regulation descriptions should consider how arterial or venous factors may predominantly influence flow in different clinical scenarios.
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Affiliation(s)
- Yuliya Zadka
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Guy Rosenthal
- Department of Neurosurgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Omer Doron
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Ofer Barnea
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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Mantovani G, Zangrossi P, Flacco ME, Di Domenico G, Nastro Siniscalchi E, De Ponte FS, Maugeri R, De Bonis P, Cavallo MA, Zamboni P, Scerrati A. Styloid Jugular Nutcracker: The Possible Role of the Styloid Process Spatial Orientation-A Preliminary Morphometric Computed Study. Diagnostics (Basel) 2023; 13:diagnostics13020298. [PMID: 36673108 PMCID: PMC9857444 DOI: 10.3390/diagnostics13020298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Styloid Jugular Nutcracker (SJN, also known as Eagle Jugular Syndrome EJS) derives from a jugular stenosis caused by an abnormal styloid process, compressing the vessel in its superior portion (J3) against the C1 anterior arch. It could be considered a venous vascular variant of Eagle Syndrome (ES). Main clinical features of this ES variant are headache, pulsatile tinnitus and dizziness, possibly related to venous hypertension and impaired cerebral parenchyma drainage. In our opinion, conceptually, it is not the absolute length of the styloid bone that defines its abnormality, but its spatial direction. An elongated bone pointing outward far away from the midline could not compress the vein; vice versa, a short styloid process tightly adherent to the cervical spine could be pathological. To prove this hypothesis, we developed a semi-automatic software that processes CT-Angio images, giving quantitative information about distance and direction of the styloid process in three-dimensional space. We compared eight patients with SJN to a sample of healthy subjects homogeneous for sex and age. Our results suggest that SJN patients have a more vertically directed styloid, and this feature is more important than the absolute distance between the two bony structures. More studies are needed to expand our sample, including patients with the classic and carotid variants of Eagle Syndrome.
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Affiliation(s)
- Giorgio Mantovani
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
- Correspondence:
| | - Pietro Zangrossi
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Maria Elena Flacco
- Department of Environmental and Preventive Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Giovanni Di Domenico
- Department of Physic and Earth Science, University of Ferrara, 44122 Ferrara, Italy
| | | | | | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP “Paolo Giaccone”, 90127 Palermo, Italy
| | - Pasquale De Bonis
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Michele Alessandro Cavallo
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Vascular Diseases Center, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Alba Scerrati
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, University Hospital of Ferrara, 44121 Ferrara, Italy
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Modelling of the dilated sagittal sinuses found in multiple sclerosis suggests increased wall stiffness may be a contributing factor. Sci Rep 2022; 12:17575. [PMID: 36266424 PMCID: PMC9585051 DOI: 10.1038/s41598-022-21810-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/04/2022] [Indexed: 01/13/2023] Open
Abstract
The cross-sectional area of the superior sagittal sinus (SSS) is larger in multiple sclerosis than normal and correlates with disease severity and progression. The sinus could be enlarged due to a decrease in the pressure difference between the lumen and the subarachnoid space, an increase in wall thickness or increased wall stiffness. The cross-sectional area of the SSS and straight sinus (ST) were measured in 103 patients with multiple sclerosis and compared to 50 controls. The cross-sectional area of the SSS and ST were increased by 20% and 13% compared to the controls (p = 0.005 and 0.02 respectively). The deflection of the wall of the sinus was estimated. The change in pressure gradient, wall thickness or elastic modulus between groups was calculated by modelling the walls as simply supported beams. To account for these findings, the modelling suggests either a 70% reduction in transmural venous pressure or a 2.4 fold increase in SSS wall stiffness plus an 11% increase in wall thickness or a combination of changes. An increase in sinus pressure, although the most straight forward possibility to account for the change in sinus size may exist in only a minority of patients. An increase in sinus wall stiffness and thickness may need further investigation.
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Baselli G, Laganà MM. The intracranial Windkessel implies arteriovenous pulsatile coupling increased by venous resistances. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Plethysmography System to Monitor the Jugular Venous Pulse: A Feasibility Study. Diagnostics (Basel) 2021; 11:diagnostics11122390. [PMID: 34943625 PMCID: PMC8699927 DOI: 10.3390/diagnostics11122390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 12/05/2022] Open
Abstract
Cerebral venous outflow is investigated in the diagnosis of heart failure through the monitoring of jugular venous pulse, an indicator to assess cardiovascular diseases. The jugular venous pulse is a weak signal stemming from the lying internal jugular vein and often invasive methodologies requiring surgery are mandatory to detect it. Jugular venous pulse can also be extrapolated via the ultrasound technique, but it requires a qualified healthcare operator to perform the examination. In this work, a wireless, user-friendly, wearable device for plethysmography is developed to investigate the possibility of monitoring the jugular venous pulse non-invasively. The proposed device can monitor the jugular venous pulse and the electrocardiogram synchronously. To study the feasibility of using the proposed device to detect physiological variables, several measurements were carried out on healthy subjects by considering three different postures: supine, sitting, and upright. Data acquired in the experiment were properly filtered to highlight the cardiac oscillation and remove the breathing contribution, which causes a considerable shift in the amplitude of signals. To evaluate the proper functioning of the wearable device for plethysmography, a comparison with the ultrasound technique was carried out. As a satisfactory result, the acquired signals resemble the typical jugular venous pulse waveforms found in literature.
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Scerrati A, De Bonis P, Zamboni P, Dones F, Fontanella M, Cenzato M, Visani J, Bianchi F, Zanin L, Cavallo MA, Sturiale CL. A New Insight in Nonaneurysmal Subarachnoid Hemorrhage: the Potential Role of the Internal Jugular Veins. J Neurol Surg A Cent Eur Neurosurg 2021; 83:344-350. [PMID: 34687035 DOI: 10.1055/s-0041-1733895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Causes of the nonaneurysmal subarachnoid hemorrhage (na-SAH) are still debated. Many studies confirmed the possible involvement of the intracranial venous system, in particular variants of the basal vein of Rosenthal. STUDY OBJECT The aim of this study is to investigate the role of extracranial venous system, in particular the jugular drainage, in the na-SAH pathophysiology. MATERIALS AND METHODS This is a multicenter retrospective study including patients suffering from na-SAH who were radiologically screened to exclude vascular malformations. The course of the internal jugular veins was evaluated to reveal any stenosis (caliber reduction >80%). Particular attention was paid at the passage between the styloid process and the arch of C1 to detect possible compression. As a control group, we enrolled patients who underwent CT angiograms and/or cerebral DSAs in the past 2 years. RESULTS We included 194 patients. The na-SAH group consisted of 94 patients, whereas the control group consisted of 100 patients. Fifty patients of the control group underwent a CT angiography for an ischemic cerebrovascular disease or trauma and 50 patients for an SAH due to a ruptured aneurysm. A significant jugular stenosis was found in 49 (52.1%) patients in the na-SAH group and in 18 (18%) patients in the control group. At univariate and multivariate analysis, the difference was statistically significant (p < 0.0001). CONCLUSIONS This is the first study investigating the correlation between jugular stenosis and the occurrence of na-SAH. The impaired venous outflow due to reduced venous caliber could result in an engorgement of the upstream intracranial veins with transient hypertensive phases facilitating ruptures. Further larger prospective studies are necessary to confirm these data.
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Affiliation(s)
- Alba Scerrati
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Paolo Zamboni
- Department of Vascular Surgery, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Flavia Dones
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Marco Fontanella
- Neurosurgery Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, Brescia, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Ospedale Niguarda Ca Granda, Milano, Lombardia, Italy
| | - Jacopo Visani
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Federico Bianchi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Zanin
- Department of Neurosurgery, University of Brescia, Brescia, Lombardia, Italy
| | - Michele Alessandro Cavallo
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Haacke EM, Ge Y, Sethi SK, Buch S, Zamboni P. An Overview of Venous Abnormalities Related to the Development of Lesions in Multiple Sclerosis. Front Neurol 2021; 12:561458. [PMID: 33981281 PMCID: PMC8107266 DOI: 10.3389/fneur.2021.561458] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 03/26/2021] [Indexed: 12/21/2022] Open
Abstract
The etiology of multiple sclerosis (MS) is currently understood to be autoimmune. However, there is a long history and growing evidence for disrupted vasculature and flow within the disease pathology. A broad review of the literature related to vascular effects in MS revealed a suggestive role for abnormal flow in the medullary vein system. Evidence for venous involvement in multiple sclerosis dates back to the early pathological work by Charcot and Bourneville, in the mid-nineteenth century. Pioneering work by Adams in the 1980s demonstrated vasculitis within the walls of veins and venules proximal to active MS lesions. And more recently, magnetic resonance imaging (MRI) has been used to show manifestations of the central vein as a precursor to the development of new MS lesions, and high-resolution MRI using Ferumoxytol has been used to reveal the microvasculature that has previously only been demonstrated in cadaver brains. Both approaches may shed new light into the structural changes occurring in MS lesions. The material covered in this review shows that multiple pathophysiological events may occur sequentially, in parallel, or in a vicious circle which include: endothelial damage, venous collagenosis and fibrin deposition, loss of vessel compliance, venous hypertension, perfusion reduction followed by ischemia, medullary vein dilation and local vascular remodeling. We come to the conclusion that a potential source of MS lesions is due to locally disrupted flow which in turn leads to remodeling of the medullary veins followed by endothelial damage with the subsequent escape of glial cells, cytokines, etc. These ultimately lead to the cascade of inflammatory and demyelinating events which ensue in the course of the disease.
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Affiliation(s)
- E. Mark Haacke
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Yulin Ge
- Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, New York, NY, United States
| | - Sean K. Sethi
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Sagar Buch
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy
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9
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Scerrati A, Norri N, Mongardi L, Dones F, Ricciardi L, Trevisi G, Menegatti E, Zamboni P, Cavallo MA, De Bonis P. Styloidogenic-cervical spondylotic internal jugular venous compression, a vascular disease related to several clinical neurological manifestations: diagnosis and treatment-a comprehensive literature review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:718. [PMID: 33987416 PMCID: PMC8106058 DOI: 10.21037/atm-20-7698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Internal jugular vein (IJV) stenosis is associated with several central nervous system disorders such as Ménière or Alzheimer’s disease. The extrinsic compression between the styloid process and the C1 transverse process, is an emerging biomarker related to several clinical manifestations. However, nowadays a limited number of cases are reported, and few information are available about treatment, outcome and complications. Our aim is to collect and identify clinical-radiological characteristics, diagnosis and treatment of the styloidogenic internal jugular venous compression. We performed a comprehensive literature review. Studies reporting patients suffering from extracranial jugular stenosis were searched. For every patient we collected: demography, clinical and radiological characteristics and outcome, type of treatment, complications. Thirteen articles reporting 149 patients were included. Clinical presentation was non-specific. Most frequent symptoms were headache (46.3%), tinnitus (43.6%), insomnia (39.6%). The stenosis was monolateral in 51 patients (45.9%) and bilateral in 60 (54.1%). Anticoagulants were the most common prescribed drug (57.4%). Endovascular treatment was performed in 50 patients (33.6%), surgery in 55 (36.9%), combined in 28 (18.8%). Improvement of general conditions was reported in 58/80 patients (72.5%). Complications were reported in 23% of cases. Jugular stenosis is a complex and often underestimated disease. Conservative medical treatment usually fails while surgical, endovascular or a combined treatment improves general conditions in more than 70% of patients.
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Affiliation(s)
- Alba Scerrati
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Nicoló Norri
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Lorenzo Mongardi
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Flavia Dones
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Luca Ricciardi
- Neurosurgery, Azienda Ospedaliera Sant'Andrea, Sapienza, Rome, Italy
| | | | - Erica Menegatti
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.,HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.,HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Michele Alessandro Cavallo
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
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10
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Mohammadyari P, Gadda G, Taibi A. Modelling physiology of haemodynamic adaptation in short-term microgravity exposure and orthostatic stress on Earth. Sci Rep 2021; 11:4672. [PMID: 33633331 PMCID: PMC7907254 DOI: 10.1038/s41598-021-84197-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/08/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular haemodynamics alters during posture changes and exposure to microgravity. Vascular auto-remodelling observed in subjects living in space environment causes them orthostatic intolerance when they return on Earth. In this study we modelled the human haemodynamics with focus on head and neck exposed to different hydrostatic pressures in supine, upright (head-up tilt), head-down tilt position, and microgravity environment by using a well-developed 1D-0D haemodynamic model. The model consists of two parts that simulates the arterial (1D) and brain-venous (0D) vascular tree. The cardiovascular system is built as a network of hydraulic resistances and capacitances to properly model physiological parameters like total peripheral resistance, and to calculate vascular pressure and the related flow rate at any branch of the tree. The model calculated 30.0 mmHg (30%), 7.1 mmHg (78%), 1.7 mmHg (38%) reduction in mean blood pressure, intracranial pressure and central venous pressure after posture change from supine to upright, respectively. The modelled brain drainage outflow percentage from internal jugular veins is 67% and 26% for supine and upright posture, while for head-down tilt and microgravity is 65% and 72%, respectively. The model confirmed the role of peripheral veins in regional blood redistribution during posture change from supine to upright and microgravity environment as hypothesized in literature. The model is able to reproduce the known haemodynamic effects of hydraulic pressure change and weightlessness. It also provides a virtual laboratory to examine the consequence of a wide range of orthostatic stresses on human haemodynamics.
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Affiliation(s)
- Parvin Mohammadyari
- Department of Physics and Earth Sciences, University of Ferrara, 44122, Ferrara, Italy
| | - Giacomo Gadda
- National Institute for Nuclear Physics (INFN), Section of Ferrara, 44122, Ferrara, Italy.
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, 44122, Ferrara, Italy
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11
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Simka M, Latacz P. Numerical modeling of blood flow in the internal jugular vein with the use of computational fluid mechanics software. Phlebology 2021; 36:541-548. [PMID: 33611976 DOI: 10.1177/0268355521996087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the site and nature of altered hemodynamics in pathological internal jugular veins. METHOD With the use of computational fluid mechanics software we simulated blood flow in 3 D models of the internal jugular veins that exhibited different morphologies, including nozzle-like strictures in their upper parts and valves in the lower parts. RESULTS In a majority of models with nozzle-like strictures, especially those positioned asymmetrically, abnormal flow pattern was revealed, with significant flow separation and regions with reversed flow. Abnormal valves had no significant impact on flow in a case of already altered flow evoked by stricture in upper part of the vein. CONCLUSIONS In our jugular model, cranially-located stenoses, which in clinical practice are primarily caused by external compression, cause more significant outflow impact respect to endoluminal defects and pathological valves located more caudally.
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Affiliation(s)
- Marian Simka
- Department of Anatomy, Institute of Medicine, University of Opole, Opole, Poland
| | - Paweł Latacz
- Department of Neurology, University Hospital, Jagiellonian University Medical College, Kraków, Poland
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12
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Christ A, Barowsky D, Gekle M, Thews O. A hydraulic model of cardiovascular physiology and pathophysiology embedded into a computer-based teaching system for student training in laboratory courses. ADVANCES IN PHYSIOLOGY EDUCATION 2020; 44:423-429. [PMID: 32697155 DOI: 10.1152/advan.00069.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Functional understanding of the different parts of the cardiovascular system is essential for an insight into pathomechanisms of numerous diseases. During training cardiovascular physiology, students and early-stage medical personnel should understand the role of different functional parameters for systolic and diastolic blood pressure, as well as for blood flow. The impact of isolated parameters can only be studied in models. Here physical hydraulic models are an advantage in which the students have a direct contact to the mechanical properties of the circulatory system. But these models are often difficult to handle. The aim of the present study was to develop a comprehensive model of the cardiovascular system, including a mechanical heart with valves, an elastic aorta, a more rigid peripheral artery system, a total peripheral resistance, and a venous reservoir representing the variable cardiac preload. This model allows one to vary systematically several functional parameters and to continuously record their impact on pressure and flow. This model is embedded into a computer-based teaching system (LabTutor) in which the students are guided through the handling of the model (as well as the systematic variation of parameters), and the measured data can be analyzed. This hybrid teaching system, which is routinely integrated in physiology laboratory courses of medical students, allows students to work with a complex hydraulic model of the cardiovascular system and to analyze systematically the impact of influencing variables (e.g., increased peripheral resistance or changed cardiac preload) as well as pathophysiological dysfunctions (e.g., reduced aortic compliance).
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Affiliation(s)
- Andreas Christ
- Julius Bernstein Institute of Physiology, University of Halle, Halle/Saale, Germany
| | - Dieter Barowsky
- Julius Bernstein Institute of Physiology, University of Halle, Halle/Saale, Germany
| | - Michael Gekle
- Julius Bernstein Institute of Physiology, University of Halle, Halle/Saale, Germany
| | - Oliver Thews
- Julius Bernstein Institute of Physiology, University of Halle, Halle/Saale, Germany
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13
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Mohammadyari P, Gadda G, Taibi A, Munuera Del Cerro J. Paediatric haemodynamic modelling: development and experimental validation using quantitative flow MRI. Eur Radiol Exp 2020; 4:16. [PMID: 32173785 PMCID: PMC7073351 DOI: 10.1186/s41747-020-0146-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Congenital vascular disease is one of the leading causes of death in paediatric age. Despite the importance of paediatric haemodynamics, large investigations have been devoted to the evaluation of circulation in adults. The novelty of this study consists in the development of a well calibrated mathematical model of cardiovascular circulation in paediatric subjects. To reach the purpose, a model for adult circulation was modified and recalibrated with experimental data and literature from children to be able to calculate the flow rates and pressures in the brain and neck. Methods The haemodynamic model simulates the 76 main arteries, together with the main veins in brain and neck. A proper magnetic resonance imaging (MRI) dataset of 29 volunteers aged 12 ± 5 years (mean ± standard deviation) was used to extract age-dependent physiological and clinical parameters such as heart rate, flow rate, vessel cross section area, and blood pressure. The computational model was calibrated using such experimental data. The paediatric and adult model results were compared. Results Increase of the vessels stiffness due to aging contributes to a flow rate decrease while blood pressure increases. In accordance, our simulation results show about 16% decrease in mean pressure of internal jugular vein in paediatric rather than adult subjects. The model outcomes indicated about 88% correlation with MRI data. Conclusions The mathematical model simulates the paediatric head and neck blood circulation. The model provides detailed information of human haemodynamics including arterial and venous network to study both paediatric and adult blood circulation.
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Affiliation(s)
- Parvin Mohammadyari
- Department of Physics and Earth Sciences, University of Ferrara, Via Giuseppe Saragat, 1, 44122, Ferrara, Italy
| | - Giacomo Gadda
- National Institute for Nuclear Physics (INFN) - Section of Ferrara, Via Giuseppe Saragat, 1, 44122, Ferrara, Italy.
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, Via Giuseppe Saragat, 1, 44122, Ferrara, Italy
| | - Josep Munuera Del Cerro
- Department of Diagnostic Imaging, Fundació Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
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Chatterjee K, Carman-Esparza CM, Munson JM. Methods to measure, model and manipulate fluid flow in brain. J Neurosci Methods 2020; 333:108541. [PMID: 31838183 PMCID: PMC7607555 DOI: 10.1016/j.jneumeth.2019.108541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 01/15/2023]
Abstract
The brain consists of a complex network of cells and matrix that is cushioned and nourished by multiple types of fluids: cerebrospinal fluid, blood, and interstitial fluid. The movement of these fluids through the tissues has recently gained more attention due to implications in Alzheimer's Disease and glioblastoma. Therefore, methods to study these fluid flows are necessary and timely for the current study of neuroscience. Imaging modalities such as magnetic resonance imaging have been used clinically and pre-clinically to image flows in healthy and diseased brains. These measurements have been used to both parameterize and validate models of fluid flow both computational and in vitro. Both of these models can elucidate the changes to fluid flow that occur during disease and can assist in linking the compartments of fluid flow with one another, a difficult challenge experimentally. In vitro models, though in limited use with fluid flow, allow the examination of cellular responses to physiological flow. To determine causation, in vivo methods have been developed to manipulate flow, including both physical and pharmacological manipulations, at each point of fluid movement of origination resulting in exciting findings in the preclinical setting. With new targets, such as the brain-draining lymphatics and glymphatic system, fluid flow and tissue drainage within the brain is an exciting and growing research area. In this review, we discuss the methods that currently exist to examine and test hypotheses related to fluid flow in the brain as we attempt to determine its impact on neural function.
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Affiliation(s)
- Krishnashis Chatterjee
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Cora M Carman-Esparza
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Jennifer M Munson
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States.
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Shim EB, Heldt T. Fluid-structure Interaction in the Cerebral Venous Transverse Sinus. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4544-4547. [PMID: 30441362 DOI: 10.1109/embc.2018.8513150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The biomechanics of the cerebral venous system plays an important role in determining blood flow to the brain. Computational approaches to help elucidate the role of the cerebral venous system in health and disease have largely focused on lumped-parameter models and one-dimensional computational fluid dynamics simulations. To expand upon the prior work, and to investigate the possible role of cerebral venous collapse in normal physiology and pathological conditions, we developed a fluid-structure interaction (FSI) model of the cerebral venous transverse sinus (TS), coupled to a lumpedparameter representation of the upstream cerebral circulation to provide boundary conditions for the FSI simulation. We simulated the effects of local venous hemodynamics on the TS distention and investigated TS vascular collapse under increased intracranial pressure, as has been hypothesized in the pathogenesis of idiopathic intracranial hypertension. Our baseline simulations reproduced pressures and flows in the cerebral venous system that compared favorably with what has been reported in the literature. The FSI simulations under increased intracranial pressure showed a decreased venous flow through and progressive collapse of the TS veins. Our simulations captured the dynamic behavior of the vascular collapse and may help shed light on the interactions between the cerebrovascular and cerebrospinal fluid spaces in health and disease.
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Gadda G, Majka M, Zieliński P, Gambaccini M, Taibi A. A multiscale model for the simulation of cerebral and extracerebral blood flows and pressures in humans. Eur J Appl Physiol 2018; 118:2443-2454. [DOI: 10.1007/s00421-018-3971-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/21/2018] [Indexed: 01/26/2023]
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Zamboni P, Menegatti E, Cittanti C, Sisini F, Gianesini S, Salvi F, Mascoli F. Fixing the jugular flow reduces ventricle volume and improves brain perfusion. J Vasc Surg Venous Lymphat Disord 2018; 4:434-45. [PMID: 27638998 DOI: 10.1016/j.jvsv.2016.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 06/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Increased ventricle volume and brain hypoperfusion are linked to neurodegeneration. We hypothesized that in patients with restricted jugular flow, surgical restoration may reduce brain ventricle volume, because it should improve the pressure gradient, hence promoting cerebrospinal fluid reabsorption into the venous system. METHODS The effects of restoring the jugular flow were assessed by means of a validated echocardiography with color Doppler (ECD) protocol of flow quantification, magnetic resonance venography, and single-photon emission computed tomography combined with computed tomography (SPECT-CT). The main outcome measurement was the cerebral ventricle volume blindly assessed at SPECT-CT. Secondary outcomes were brain perfusion in the whole brain and in another 12 cerebral regions. The mean follow-up of the SPECT-CT and ECD parameters was 30 days. Patency rate was subsequently monitored by means of the same ECD protocol every 3 months. RESULTS Among 56 patients (28 male and 28 female; mean age, 44 ± 10 years) with ECD screening positive for chronic cerebrospinal venous insufficiency due to nonmobile jugular leaflets, 15 patients were excluded from the initial cohort because they did not meet the inclusion and exclusion criteria. Of the remaining 41 patients, 27 patients (14 male, 13 female; mean age, 48 ± 7 years) underwent endophlebectomy and autologous vein patch angioplasty. Omohyoid muscle section was performed when appropriate. The control group comprised 14 patients matched by age and gender (8 male, 6 female; mean age, 44 ± 11 years) who were not treated. Comorbidity was multiple sclerosis without significant differences in relapsing remitting (RR) and secondary progressive (SP) clinical course among groups. In the control group, neither ECD nor SPECT-CT showed any significant changes at follow-up. On the contrary, in the group operated on, the collateral flow index went from 70% to 30% (P < .0003) thanks to improved flow through the internal jugular vein. Correspondingly, ventricle volume dramatically decreased in the treated group (from 34 ± 14 cm(3) to 31 ± 13 cm(3); P < .01). The effect was much more evident in the RR subgroup (P = .009), whereas in the SP subgroup, it was not significant. Perfusion was found to be improved in the surgical group with respect to controls, particularly in the occipital and parietal regions of the RR subgroup (P < .0001 and P = .017, respectively), but not in the SP subgroup. The probability of reducing ventricle size is increased by 13-fold (P < .03) when restoration of the jugular flow achieves a postoperative collateral flow index ≤20%. Finally, the 18-month patency rate was 74%. CONCLUSIONS Fixing the flow in the jugulars in patients with chronic cerebrospinal venous insufficiency might significantly reduce brain ventricle volume and improve cerebral perfusion. These changes are more evident in patients in the earlier stages of neurodegenerative disease.
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Affiliation(s)
- Paolo Zamboni
- Unit of Translational Surgery, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy.
| | - Erica Menegatti
- Unit of Translational Surgery, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Corrado Cittanti
- Unit of Nuclear Medicine, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy
| | | | - Sergio Gianesini
- Unit of Translational Surgery, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy
| | | | - Francesco Mascoli
- Unit of Vascular Surgery, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy
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Beggs CB, Giaquinta A, Veroux M, De Marco E, Mociskyte D, Veroux P. Mid-term sustained relief from headaches after balloon angioplasty of the internal jugular veins in patients with multiple sclerosis. PLoS One 2018; 13:e0191534. [PMID: 29360844 PMCID: PMC5779669 DOI: 10.1371/journal.pone.0191534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/05/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Multiple sclerosis (MS) patients frequently suffer from headaches and fatigue, and many reports have linked headaches with intracranial and/or extracranial venous obstruction. We therefore designed a study involving MS patients diagnosed with obstructive disease of internal jugular veins (IJVs), with the aim of evaluating the impact of percutaneous transluminal angioplasty (PTA) on headache and fatigue indicators. METHODS 286 MS patients (175 relapsing remitting (RR), 75 secondary progressive (SP), and 36 primary progressive (PP)), diagnosed with obstructive disease of IJVs, underwent PTA of IJVs during the period 2011-2015. This included 113 headache positive patients (82 RR, 22 SP, and 9 PP) and 277 fatigue positive patients (167 RR, 74 SP, and 36 PP). Migraine Disability Assessment (MIDAS), and the Fatigue Severity Scale (FSS) were evaluated: before PTA; 3-months after PTA; and at final follow-up in 2017. Patients were evaluated with Doppler sonography of the IJVs at 1, 6 and 12 months after PTA and yearly thereafter. Non-parametric statistical analysis was performed using a combination of the Friedman test and Spearman correlation analysis. RESULTS With the exception of the PP patients there were significant reductions (all p < 0.001) in the MIDAS and FSS scores in the 3-month following PTA. The improvement in MIDAS score following PTA was maintained throughout the follow-up period in both the RR (p < 0.001; mean of 3.55 years) and SP (p = 0.002; mean of 3.52 years) MS cohorts. With FSS, significant improvement was only observed at 2017 follow-up in the RR patients (p < 0.001; mean of 3.37 years). In the headache-positive patients, post-PTA MIDAS score was significantly negatively correlated with the change in the blood flow score in the left (r = -0.238, p = 0.031) and right (r = -0.250, p = 0.023) IJVs in the RR patients and left IJV (r = -0.727, p = 0.026) in the PP patients. In the fatigue-positive cohort, post-PTA FSS score was also significantly negatively correlated with the change in blood flow in the right IJV in the PP patients (r = -0.423, p = 0.010). In addition, the pre and post-PTA FSS scores were significantly positively correlated in the fatigue-positive RR (r = 0.249, p = 0.001) and SP patients (r = 0.272, p = 0.019). CONCLUSIONS The intervention of PTA was associated with a large and sustained (>3 years) reduction in MIDAS score in both RR and SP MS patients. While a similar initial post-PTA reduction in FSS score was also observed, this was not maintained in the SP and PP patients, although it remained significant at follow-up (>3 years) in the RR MS patients. This suggests that venoplasty might be a useful intervention for treating patients with persistent headaches and selected concomitant obstructive disease of the IJVs.
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Affiliation(s)
- Clive B. Beggs
- Institute for Sport, Physical Activity and Leisure, School of Sport, Leeds Beckett University, Leeds, United Kingdom
| | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
| | - Ester De Marco
- Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
| | - Dovile Mociskyte
- Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
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Taibi A, Gadda G, Gambaccini M, Menegatti E, Sisini F, Zamboni P. Investigation of cerebral venous outflow in microgravity. Physiol Meas 2017; 38:1939-1952. [PMID: 28857747 DOI: 10.1088/1361-6579/aa8980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The gravitational gradient is the major component to face when considering the physiology of venous return, and there is a growing interest in understanding the mechanisms ensuring the heart filling, in the absence of gravity, for astronauts who perform long-term space missions. APPROACH The purpose of the Drain Brain project was to monitor the cerebral venous outflow of a crew member during an experiment on the International Space Station (ISS), so as to study the compensatory mechanisms that facilitate this essential physiological action in subjects living in a microgravity environment. Such venous function has been characterized by means of a novel application of strain-gauge plethysmography which uses a capacitive sensor. MAIN RESULTS In this contribution, preliminary results of our investigation have been presented. In particular, comparison of plethysmography data confirmed that long duration spaceflights lead to a redistribution of venous blood volume, and showed interesting differences in the amplitude of cardiac oscillations measured at the level of the neck veins. SIGNIFICANCE The success of the experiment has also demonstrated that thanks to its easy portability, non-invasiveness, and non-operator dependence, the proposed device can be considered as a novel tool for use aboard the ISS. Further trials are now under way to complete the investigation on the drainage function of the neck veins in microgravity.
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Affiliation(s)
- A Taibi
- Dipartimento di Fisica e Scienze della Terra, Università degli Studi di Ferrara and INFN, Sezione di Ferrara, via Saragat 1, 44122 Ferrara, Italy
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Sato K, Oba N, Washio T, Sasaki H, Oue A, Otsuki A, Sadamoto T, Ogoh S. Relationship between cerebral arterial inflow and venous outflow during dynamic supine exercise. Physiol Rep 2017; 5:5/12/e13292. [PMID: 28663325 PMCID: PMC5492200 DOI: 10.14814/phy2.13292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/01/2017] [Indexed: 11/24/2022] Open
Abstract
The regulation of cerebral venous outflow during exercise has not been studied systematically. To identify relations between cerebral arterial inflow and venous outflow, we assessed the blood flow (BF) of the cerebral arteries (internal carotid artery: ICA and vertebral artery: VA) and veins (internal jugular vein: IJV and vertebral vein: VV) during dynamic exercise using ultrasonography. Nine subjects performed a cycling exercise in supine position at a light and moderate workload. Similar to the ICA BF, the IJV BF increased from baseline during light exercise (P < 0.05). However, the IJV BF decreased below baseline levels during moderate exercise, whereas the ICA BF returned near resting levels. In contrast, BF of the VA and VV increased with the workload (P < 0.05). The change in the ICA or VA BF from baseline to exercise was significantly correlated with the change in the IJV (r = 0.73, P = 0.001) or VV BF (r = 0.52, P = 0.028), respectively. These findings suggest that dynamic supine exercise modifies the cerebral venous outflow, and there is coupling between regulations of arterial inflow and venous outflow in both anterior and posterior cerebral circulation. However, it remains unclear whether changes in cerebral venous outflow influence on the regulation of cerebral arterial inflow during exercise.
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Affiliation(s)
- Kohei Sato
- Research Institute of Physical Fitness, Japan Women's College of Physical Education, Tokyo, Japan
| | - Naoko Oba
- Research Institute of Physical Fitness, Japan Women's College of Physical Education, Tokyo, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Saitama, Japan
| | - Hiroyuki Sasaki
- Department of Biomedical Engineering, Toyo University, Saitama, Japan
| | - Anna Oue
- Department of Food and Nutrition Science, Toyo University, Gunma, Japan
| | - Aki Otsuki
- Research Institute of Physical Fitness, Japan Women's College of Physical Education, Tokyo, Japan
| | - Tomoko Sadamoto
- Research Institute of Physical Fitness, Japan Women's College of Physical Education, Tokyo, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Saitama, Japan
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Miraucourt O, Salmon S, Szopos M, Thiriet M. Blood flow in the cerebral venous system: modeling and simulation. Comput Methods Biomech Biomed Engin 2016; 20:471-482. [PMID: 27802781 DOI: 10.1080/10255842.2016.1247833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The development of a software platform incorporating all aspects, from medical imaging data, through three-dimensional reconstruction and suitable meshing, up to simulation of blood flow in patient-specific geometries, is a crucial challenge in biomedical engineering. In the present study, a fully three-dimensional blood flow simulation is carried out through a complete rigid macrovascular circuit, namely the intracranial venous network, instead of a reduced order simulation and partial vascular network. The biomechanical modeling step is carefully analyzed and leads to the description of the flow governed by the dimensionless Navier-Stokes equations for an incompressible viscous fluid. The equations are then numerically solved with a free finite element software using five meshes of a realistic geometry obtained from medical images to prove the feasibility of the pipeline. Some features of the intracranial venous circuit in the supine position such as asymmetric behavior in merging regions are discussed.
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Affiliation(s)
- Olivia Miraucourt
- a Laboratoire de Mathématiques, EA 4535 FR CNRS ARC 3399 , Université de Reims Champagne-Ardenne, UFR Sciences Exactes et Naturelles , Reims Cedex 2 , France
| | - Stéphanie Salmon
- a Laboratoire de Mathématiques, EA 4535 FR CNRS ARC 3399 , Université de Reims Champagne-Ardenne, UFR Sciences Exactes et Naturelles , Reims Cedex 2 , France
| | - Marcela Szopos
- b Université de Strasbourg , CNRS, IRMA UMR 7501 , F-67000 Strasbourg , France
| | - Marc Thiriet
- c Laboratoire J.-L. Lions , UMR 7598 CNRS/Université Pierre et Marie Curie-Paris 6 , Paris , France .,d INRIA, Equipe-projet REO , Le Chesnay , France
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Gadda G, Taibi A, Sisini F, Gambaccini M, Sethi SK, Utriainen DT, Haacke EM, Zamboni P, Ursino M. Validation of a Hemodynamic Model for the Study of the Cerebral Venous Outflow System Using MR Imaging and Echo-Color Doppler Data. AJNR Am J Neuroradiol 2016; 37:2100-2109. [PMID: 27444939 DOI: 10.3174/ajnr.a4860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/09/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A comprehensive parameter model was developed to investigate correlations between cerebral hemodynamics and alterations in the extracranial venous circulation due to posture changes and/or extracranial venous obstruction (stenosis). The purpose of this work was to validate the simulation results by using MR imaging and echo-color Doppler experimental blood flow data in humans. MATERIALS AND METHODS To validate the model outcomes, we used supine average arterial and venous extracerebral blood flow, obtained by using phase-contrast MR imaging from 49 individuals with stenosis in the acquisition plane at the level of the disc between the second and third vertebrae of the left internal jugular vein, 20 with stenosis in the acquisition plane at the level of the disc between the fifth and sixth vertebrae of the right internal jugular vein, and 38 healthy controls without stenosis. Average data from a second group of 10 healthy volunteers screened with an echo-color Doppler technique were used to evaluate flow variations due to posture change. RESULTS There was excellent agreement between experimental and simulated supine flows. Every simulated CBF fell inside the standard error from the corresponding average experimental value, as well as most of the simulated extracerebral arterial flow (extracranial blood flow from the head and face, measured at the level of the disc between second and third vertebrae) and venous flows. Simulations of average jugular and vertebral blood flow variations due to a change of posture from supine to upright also matched the experimental data. CONCLUSIONS The good agreement between simulated and experimental results means that the model can correctly reproduce the main factors affecting the extracranial circulation and could be used to study other types of stenotic conditions not represented by the experimental data.
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Affiliation(s)
- G Gadda
- From the Department of Physics and Earth Sciences (G.G., A.T., F.S., M.G.)
| | - A Taibi
- From the Department of Physics and Earth Sciences (G.G., A.T., F.S., M.G.)
| | - F Sisini
- From the Department of Physics and Earth Sciences (G.G., A.T., F.S., M.G.)
| | - M Gambaccini
- From the Department of Physics and Earth Sciences (G.G., A.T., F.S., M.G.)
| | - S K Sethi
- MRI Institute for Biomedical Research (S.K.S., D.T.U., E.M.H.), Detroit, Michigan
| | - D T Utriainen
- MRI Institute for Biomedical Research (S.K.S., D.T.U., E.M.H.), Detroit, Michigan
| | - E M Haacke
- MRI Institute for Biomedical Research (S.K.S., D.T.U., E.M.H.), Detroit, Michigan
| | - P Zamboni
- Vascular Diseases Center (P.Z.), University of Ferrara, Ferrara, Italy
| | - M Ursino
- Department of Electrical, Electronic and Information Engineering (M.U.), University of Bologna, Bologna, Italy
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Gadda G, Taibi A, Sisini F, Gambaccini M, Sethi SK, Utriainen D, Haacke EM, Zamboni P, Ursino M. A simulation model to study the role of the extracranial venous drainage pathways in intracranial hemodynamics. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:7800-3. [PMID: 26738101 DOI: 10.1109/embc.2015.7320201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Alterations in the extracranial venous circulation due to posture changes, and/or extracranial venous obstructions in patients with vascular diseases, can have important implications on cerebral hemodynamics. A hemodynamic model for the study of cerebral venous outflow was developed to investigate the correlations between extracranial blood redistributions and changes in the intracranial environment. Flow data obtained with both magnetic resonance (MR) and Echo-Color Doppler (ECD) technique are used to validate the model. The very good agreement between simulated supine and upright flows and experimental results means that the model can correctly reproduce the main factors affecting the extracranial venous circulation.
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Fang Q, Chen F, Jiang A, Huang Y, Deng X. Computed tomographic angiography of the superficial cerebral venous anastomosis based on volume rendering, multi-planar reconstruction, and integral imaging display. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2015; 38:777-83. [PMID: 26577709 DOI: 10.1007/s13246-015-0403-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/05/2015] [Indexed: 12/01/2022]
Abstract
As damage to the superficial cerebral venous anastomosis may create catastrophic complications even after successful surgery, it is important to visualize and determine the normal features of the venous anastomosis with computed tomographic angiography. A total of 90 patients underwent a 64-detector row helical CT scan of head. The superficial cerebral venous anastomosis was reconstructed by volume rendering, multi-planar reconstruction, and integral display algorithm. In particular, we examined the vein of Trolard, the vein of Labbe, and the vein of Sylvian, in order to analyze the venous anastomosis. The superficial cerebral venous anastomosis varied across different individuals, and in this study, six types of anastomosis were found. In 28 % of patients, no venous anastomosis was found in the unilateral cerebral hemisphere. The display rate of the vein of Trolard, the vein of Labbe, and the vein of Sylvian in contributing to venous anastomosis was 70, 80, and 91 %, respectively. The number of vein of Trolard and vein of Labbe on the left side was greater than that of those on the right side. We implemented the 64-detector row helical CT as a rapid and noninvasive method to investigate the superficial cerebral venous anastomosis in our group of patients. We performed substantial image processing for the visualization of the superficial cerebral venous anastomosis; this would not only enable the early diagnosis of cerebral venous disease, but also protect the cerebral vein during neurosurgical intervention.
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Affiliation(s)
- Qiong Fang
- Department of Anatomy, Anhui Medical College, Hefei, Anhui, China
| | - Feng Chen
- Department of Anatomy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Anhong Jiang
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanping Huang
- Department of Anatomy, Anhui Medical College, Hefei, Anhui, China
| | - Xuefei Deng
- Department of Anatomy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
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Marcotti S, Marchetti L, Cecconi P, Votta E, Fiore GB, Barberio A, Viotti S, Redaelli A, Laganà MM. An anatomy-based lumped parameter model of cerebrospinal venous circulation: can an extracranial anatomical change impact intracranial hemodynamics? BMC Neurol 2015; 15:95. [PMID: 26099795 PMCID: PMC4476203 DOI: 10.1186/s12883-015-0352-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/10/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Stefania Marcotti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo Da Vinci, 32, 20133, Milan, Italy.
| | - Lara Marchetti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo Da Vinci, 32, 20133, Milan, Italy.
| | - Pietro Cecconi
- Magnetic Resonance Laboratory, Fondazione Don Carlo Gnocchi ONLUS, IRCCS Santa Maria Nascente, Via Capecelatro 66, 20148, Milan, Italy.
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo Da Vinci, 32, 20133, Milan, Italy.
| | - Gianfranco Beniamino Fiore
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo Da Vinci, 32, 20133, Milan, Italy.
| | - Antonello Barberio
- Magnetic Resonance Laboratory, Fondazione Don Carlo Gnocchi ONLUS, IRCCS Santa Maria Nascente, Via Capecelatro 66, 20148, Milan, Italy.
| | - Stefano Viotti
- Magnetic Resonance Laboratory, Fondazione Don Carlo Gnocchi ONLUS, IRCCS Santa Maria Nascente, Via Capecelatro 66, 20148, Milan, Italy.
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo Da Vinci, 32, 20133, Milan, Italy.
| | - Maria Marcella Laganà
- Magnetic Resonance Laboratory, Fondazione Don Carlo Gnocchi ONLUS, IRCCS Santa Maria Nascente, Via Capecelatro 66, 20148, Milan, Italy.
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