Dynamic analysis on distribution of intracranial pressure and herniation risk in patients with traumatic brain injury

doi:10.13418/j.issn.1001-165x.2019.06.013

Chinese Journal of Clinical Anatomy ›› 2019, Vol. 37 ›› Issue (6) : 673-679. DOI: 10.13418/j.issn.1001-165x.2019.06.013

LI Na¹， LIU Yin¹， XIONG Kun², BIN Shi-zhen¹

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Abstract

Objective　Finite element (FE) simulation models of two patients with moderate traumatic brain injury who developed hematoma were established according to the patients CT images and the data of intracranial pressure. The effect of intracranial pressure (ICP) caused by hematoma after brain injury was analyzed.　Methods　The finite element simulation models of adult head and molecular dynamics method were used to analyze the relationship between hematoma swelling and increasing of intracranial pressure, to extract and fold the hematoma. The CT images and intracranial pressure values were used to add dilatometry curves, to get the brain tissue pressure distribution map and brain tissue strain map, to calculate the difference of brain tissue pressure on areas which brain herniation happened. 　Results　The pressure values, the clinical mid-line shift displacements of the simulation models were in good fitness with the ventricular probe pressure of clinical patients and the mid-line of CT images, the error rates against the clinical data were 4% and 2% for the two patients. The simulation indicated that, in coronal views of the left temporo-occipital lobe, there was no substantial pressure difference between each side of the gyrus cinguli below the falx, with values of 1400 Pa and 1320 Pa respectively. However, the pressure in the temporal lobe above the tentorium was larger than that in the lobulus quadrangularis cerebelli, with values of 2504 Pa and 1360 Pa respectively. In sagittal views of the left temporo-occipital lobe, there was no substantial pressure difference between the anterior cerebellar lobe and posterior ambient cistern. There was bigger effective strain of tentorium cerebelli of left hematoma patients than that of right side patients.　Conclusions　We conclude that a hematoma in the fronto-temporal and basal ganglia regions of left side patients is most likely to cause anterior transtentorial herniation. The pressure caused by hematoma of right side is replaced by the strain of tentorium cerebelli, thus reducing the herniation risk. This research can make a better understanding of distribution of intracranial pressure caused by hematoma effect on motivation of brain injury, can also provide dynamic reference for injured prognosis.

Key words

Brain injury / / Impact biomechanics / / Intracranial pressure / Transtentorial herniation

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LI Na, LIU Yin, XIONG Kun, BIN Shi-zhen. Dynamic analysis on distribution of intracranial pressure and herniation risk in patients with traumatic brain injury[J]. Chinese Journal of Clinical Anatomy. 2019, 37(6): 673-679 https://doi.org/10.13418/j.issn.1001-165x.2019.06.013

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