The relationship between cerebral blood flow and venous sinus pressure: can hyperemia induce idiopathic intracranial hypertension?
The relationship between cerebral blood flow and venous sinus pressure: can hyperemia induce idiopathic intracranial hypertension?
复制标题
脑血流量与静脉窦压力的关系：充血会导致特发性颅内高压吗？
DOI：
10.1186/s12987-021-00239-2
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发表时间：
2021-02-04
影响因子：
7.3
通讯作者：
Barber T
中科院分区：
文献类型：
--
作者：
Bateman AR;Bateman GA;Barber T
研究表明，儿童特发性颅内高压（IIH）与脑充血有关，脑充血导致脑静脉压升高。目前的文献表明静脉压与血流呈线性关系，然而，线性关系不会使压力升高到足以诱发IIH。然而，有一些证据表明，这种关系在性质上可能是二次的。本文的目的是描述脑血流量和脑静脉系统压降之间的关系。本研究收集了10个CT静脉造影数据集，并创建了5个可用的几何形状。使用这些几何形状生成计算流体动力学（CFD）模型，每个患者进行10次模拟。测试的流速范围为200 mL/min至2000 mL/min。创建并分析每个CFD模型的3D压力和速度流线分布，并确定脑静脉系统的压降。测量上级矢状窦、横窦、乙状窦近端和远端的有效直径和水力直径。血流量与窦压呈二次曲线关系，所有5例患者的相关系数均为0.99或以上。涡流血流的存在被发现解释这种趋势，流体卷曲和压降的相关性高于0.97。这表明在IIH的诊断检查中应考虑高血流量的存在。脑静脉窦血流量和压力响应关系在本质上是二次的，其主要原因是在流动中引起的旋转程度。IIH患儿血流量升高可以解释继发于静脉压升高的ICP升高。
It has been shown that idiopathic intracranial hypertension (IIH) in children is associated with cerebral hyperemia, which induces an increase in cerebral venous pressure. The current literature suggests venous pressure scales with blood flow in a linear fashion, however, a linear relationship would not raise the pressure high enough to induce IIH. There is, however, some evidence to suggest that this relationship could be quadratic in nature. The purpose of this paper is to characterize the relationship between cerebral blood flow and the pressure drop across the cerebral venous system. 10 CT venogram data sets were collected for this study, with 5 useable geometries created. Computational fluid dynamics (CFD) models were generated using these geometries, with 10 simulations conducted per patient. The flow rates tested ranged from 200 mL/min to 2000 mL/min. 3D pressure and velocity streamline distributions were created and analyzed for each CFD model, with pressure drops across the cerebral venous system determined. The effective and hydraulic diameters were determined at the superior sagittal sinus, transverse sinus and both proximal and distal sigmoid sinuses. A quadratic relationship between blood flow and sinus pressure was found, with correlations of 0.99 or above in all five patients. The presence of vortical blood flow was found to explain this trend, with fluid curl and pressure drop correlations being above 0.97. This suggests that the presence of high blood flow should be considered in the diagnostic workup of IIH. The cerebral venous sinus blood flow and pressure response relationship are quadratic in nature, with the major cause of this being the degree of rotation induced in the flow. The elevated blood flow found in children with IIH can explain the increased ICP that is found, secondary to the increase in venous pressure that develops.