Effect of stenoses and occlusions in the cerebral venous vasculature on intracranial venous hemodynamics - a patient-specific computational model

BACKGROUND: Intracranial sinus stenoses (ISS) or sinus occlusions (ISO) can lead to elevated intracranial venous blood pressure. Treatment strategies are advancing, but clinical decision making and the prediction of treatment success is hampered by the variable venous anatomy. We aimed to create a patient-specific computational model that allows for simulating pathologies and their influence on venous flow dynamics and pressure. METHODS: The model was created based on a stroke patient's CT-angiography using semi-automatic threshold-based segmentation with subsequent flow modeling through computational fluid dynamics. Venous flow velocities were compared to a healthy cohort's flow encoded magnetic resonance imaging (4D Flow MRI). Nine scenarios, including ISS and ISO at different locations, were simulated and their influence on venous pressure and blood flow was quantified. RESULTS: In comparison to a healthy cohort's 4D Flow MRI, the model showed comparable venous velocities at all reference points. Unilateral transverse sinus occlusion or stenosis led to compensatory contralateral flow and elevated pressures up to 12 mmHg. Extensive ISO or bilateral transverse ISS led to markedly increased pressures > 100 mmHg. CONCLUSION: Our model depicts realistic venous blood pressures and gradients and could support in identifying patients with intracranial sinus stenosis or sinus occlusions profiting from endovascular treatment strategies.