Nonlinear poroplastic model of ventricular dilation in hydrocephalus.

OBJECT The mechanism of ventricular dilation in normal-pressure hydrocephalus remains unclear. Numerical finite-element (FE) models of hydrocephalus have been developed to investigate the biomechanics of ventricular enlargement. However, previous linear poroelastic models have failed to reproduce the relatively larger dilation of the horns of the lateral ventricles. In this paper the authors instead elaborated on a nonlinear poroplastic FE model of the brain parenchyma and studied the influence of the introduction of these potentially more realistic mechanical behaviors on the prediction of the ventricular shape. METHODS In the proposed model the elasticity modulus varies as a function of the distension of the porous matrix, and the internal mechanical stresses are relaxed after each iteration, thereby simulating the probable plastic behavior of the brain tissue. The initial geometry used to build the model was extracted from CT scans of patients developing hydrocephalus, and the results of the simulations using this model were compared with the real evolution of the ventricular size and shape in the patients. RESULTS The authors' model predicted correctly the magnitude and shape of the ventricular dilation in real cases of acute and chronic hydrocephalus. In particular, the dilation of the frontal and occipital horns was much more realistic. CONCLUSIONS This finding suggests that the nonlinear and plastic mechanical behaviors implemented in the present numerical model probably occur in reality. Moreover, the availability of such a valid FE model, whose mechanical parameters approach real mechanical properties of the brain tissue, might be useful in the further modeling of ventricular dilation at a normal pressure.