Is there a role for computational fluid dynamics (CFD) in neurovascular compression syndrome?

Abstract

Introduction – CFD uses complex algorithms to predict flow of fluids through a tube & also predicts its impact on walls. It is increasingly being used for prediction of aneurysmal wall thickness, flow, wall shear stress and to decide clip strategy. This is an experimental study, which analyses use of CFD in neurovascular compression syndrome and probable future applications. We analysed CFD findings in 12 cases retrospectively to know fluid dynamics of vessels and its implications. Methodology – Twelve patients – 7 cases of trigeminal neuralgia and 5 of hemifacial spasm who were to be treated by MVD, were enrolled. CFD i.e. WSSv (wall shear stress vector), WSSm (magnitude), SL (stream line) and Pressure, was done in all prospectively. Results – CFD of superior cerebellar artery, anterior inferior cerebellar artery and vertebral artery was done in each case at the contact site and immediate pre + post contact location. Comparitively High WSSm correlated maximally at nerve vessel contact junction (NVCj) and also high SL at the NVCj comparing with nerve vessel contact proximal (NVCp), WSSv showed wide variations and pressure change was in-conclusive. Conclusion – At contact site, the high WSSm& SL might be a reliable indicator of a neurovascular conflict zone. To conclusively validate the findings we need large number of patients and control group.