Computational Investigation of Cerebrospinal Fluid Dynamics in the Posterior Cranial Fossa and Cervical Subarachnoid Space in Patients with Chiari I Malformation

PLoS One. 2016 Oct 11;11(10):e0162938. doi: 10.1371/journal.pone.0162938. eCollection 2016.


Purpose: Previous computational fluid dynamics (CFD) studies have demonstrated that the Chiari malformation is associated with abnormal cerebrospinal fluid (CSF) flow in the cervical part of the subarachnoid space (SAS), but the flow in the SAS of the posterior cranial fossa has received little attention. This study extends previous modelling efforts by including the cerebellomedullary cistern, pontine cistern, and 4th ventricle in addition to the cervical subarachnoid space.

Methods: The study included one healthy control, Con1, and two patients with Chiari I malformation, P1 and P2. Meshes were constructed by segmenting images obtained from T2-weighted turbo spin-echo sequences. CFD simulations were performed with a previously verified and validated code. Patient-specific flow conditions in the aqueduct and the cervical SAS were used. Two patients with the Chiari malformation and one control were modelled.

Results: The results demonstrated increased maximal flow velocities in the Chiari patients, ranging from factor 5 in P1 to 14.8 in P2, when compared to Con1 at the level of Foramen Magnum (FM). Maximal velocities in the cervical SAS varied by a factor 2.3, while the maximal flow in the aqueduct varied by a factor 3.5. The pressure drop from the pontine cistern to the cervical SAS was similar in Con1 and P1, but a factor two higher in P2. The pressure drop between the aqueduct and the cervical SAS varied by a factor 9.4 where P1 was the one with the lowest pressure jump and P2 and Con1 differed only by a factor 1.6.

Conclusion: This pilot study demonstrates that including the posterior cranial fossa is feasible and suggests that previously found flow differences between Chiari I patients and healthy individuals in the cervical SAS may be present also in the SAS of the posterior cranial fossa.

MeSH terms

  • Adult
  • Algorithms
  • Arnold-Chiari Malformation / cerebrospinal fluid
  • Arnold-Chiari Malformation / diagnostic imaging
  • Arnold-Chiari Malformation / physiopathology*
  • Cerebrospinal Fluid / physiology*
  • Cranial Fossa, Posterior / diagnostic imaging
  • Cranial Fossa, Posterior / physiology*
  • Female
  • Humans
  • Hydrodynamics
  • Magnetic Resonance Imaging
  • Middle Aged
  • Pilot Projects
  • Pressure
  • Subarachnoid Space / diagnostic imaging
  • Subarachnoid Space / physiology*

Grants and funding

This work was supported by a Center of Excellence grant (209951) awarded to the Center for Biomedical Computing from the Norwegian Research Council. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.