Computational Fluid Dynamics Simulation of Hemodynamic Alterations in Sigmoid Sinus Diverticulum and Ipsilateral Upstream Sinus Stenosis After Stent Implantation in Patients with Pulsatile Tinnitus

Autor: Aike Qiao, Jun Xia, Long Jin, Zeran Yang, Yanjing Han, Tianhao Su, Qingqing Yang, Jianan Yu
Rok vydání: 2017
Předmět:
medicine.medical_specialty
Computed Tomography Angiography
Transverse sinuses
Blood Pressure
Constriction
Pathologic
Cranial Sinuses
digestive system
030218 nuclear medicine & medical imaging
Tinnitus
03 medical and health sciences
0302 clinical medicine
otorhinolaryngologic diseases
medicine
Humans
Computer Simulation
Sinus (anatomy)
Computed tomography angiography
Sigmoid sinus
Transverse Sinuses
medicine.diagnostic_test
business.industry
Endovascular Procedures
Hemodynamics
Angiography
Digital Subtraction
Phlebography
Blood flow
Middle Aged
medicine.disease
digestive system diseases
Cerebral Angiography
Diverticulum
Stenosis
surgical procedures
operative
medicine.anatomical_structure
Flow velocity
Hydrodynamics
Stents
Surgery
Stress
Mechanical
Neurology (clinical)
Radiology
business
Blood Flow Velocity
030217 neurology & neurosurgery
Zdroj: World Neurosurgery. 106:308-314
ISSN: 1878-8750
DOI: 10.1016/j.wneu.2017.06.168
Popis: Objective To investigate the relationships between upstream venous sinus stenosis and pulsatile tinnitus (PT), and to assess the correlation with diverticulum growth and the effectiveness of stent implantation. Methods Patient-specific geometric models were constructed using computed tomography venography images from a patient with PT, with sigmoid sinus diverticulum, and with upstream transverse sinus stenosis, in whom stenting of the upstream sinus stenosis alone achieved complete remission of PT. Computational fluid dynamics simulation based on this patient-specific geometry was performed using commercially available finite element software (ANSYS-14) to qualitatively and quantitatively compare the flow velocity, flow rate, velocity vector, pressure, vorticity, and wall shear stress on the affected side transverse and sigmoid sinuses, before and after stent implantation. Results Stenting improved the flow direction and magnitude. After stenting, the flow pattern became smoother and more regular. High-speed blood flow at the level of the diverticulum neck was confined to a smaller area, and its direction changed from approximately perpendicular to the diverticular dome to the distal side of the diverticular neck. The diverticulum showed obvious flow reduction, with decreases of 80.7%, 68.7%, 96.1%, and 91.3% in peak velocity, inflow rate, pressure gradient, and peak vorticity, respectively. The abnormally low wall shear stress at the dome of diverticulum was eliminated. Conclusions Our findings strongly support a major role of diverticulum stenosis before in PT development and suggest that such stenosis is a causative factor of diverticulum growth. They also confirm the effectiveness of stent implantation for the treatment of PT.
Databáze: OpenAIRE
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