Modelling glioma progression, mass effect and intracranial pressure in patient anatomy

Abstract

Increased intracranial pressure is the source of most critical symptoms in patients with glioma, and often the main cause of death. Clinical interventions could benefit from non-invasive estimates of the pressure distribution in the patient's parenchyma provided by computational models. However, existing glioma models do not simulate the pressure distribution and they rely on a large number of model parameters, which complicates their calibration from available patient data. Here we present a novel model for glioma growth, pressure distribution and corresponding brain deformation. The distinct feature of our approach is that the pressure is directly derived from tumour dynamics and patient-specific anatomy, providing non-invasive insights into the patient's state. The model predictions allow estimation of critical conditions such as intracranial hypertension, brain midline shift or neurological and cognitive impairments. A diffuse-domain formalism is employed to allow for efficient numerical implementation of the model in the patient-specific brain anatomy. The model is tested on synthetic and clinical cases. To facilitate clinical deployment, a high-performance computing implementation of the model has been publicly released.

Retrospective longitudinal assessment of optic nerve sheath diameter in patients with malignant glioma

“…4 Patients with GBM may, moreover, experience high ICP due to tumor volume, venous outflow obstruction, or hydrocephalus, but we found a significant correlation especially with edema in agreement with current literature. 1 Unsurprisingly, we found frontal tumors to be larger at diagnosis and associated with more edema as well as higher ONSD as compared to other localizations. Also frontal localization was associated with higher prevalence of clinical signs of raised ICP.…”

“…Glioblastoma (GBM) is one of the highly malignant tumors of the central nervous system with rapid growth and association with elevated intracranial pressure (ICP). Intracranial hypertension may occur, among others, with progressive tumor volume, tumor‐associated perifocal edema, venous flow obstruction due to infiltration of draining blood vessels, or hydrocephalus 1 . A general approximation of ICP via morphological imaging is not possible, 2 but specific pathologies associated with elevated ICP such as hydrocephalus are accessible to CT or MR imaging.…”

“…Identifying patients at risk due to elevated ICP with the need of immediate intervention as opposed to those in whom it would be reasonable to schedule surgery electively is important for patient management. Recent efforts have been undertaken to model glioma progression, local or generalized mass effect, and intracranial pressure to individual patient anatomy 1,11 . Still, no predictive variables have been established for decision‐making regarding urgent surgery 12 …”

“…In this first-of-its kind study, we observed a significant increase of ONSD preoperatively, likely associated with edema. Postoperatively, ONSD decreased significantly 1 | INTRODUCTION Glioblastoma (GBM) is one of the highly malignant tumors of the central nervous system with rapid growth and association with elevated intracranial pressure (ICP). Intracranial hypertension may occur, among others, with progressive tumor volume, tumor-associated perifocal edema, venous flow obstruction due to infiltration of draining blood vessels, or hydrocephalus.…”

“…Recent efforts have been undertaken to model glioma progression, local or generalized mass effect, and intracranial pressure to individual patient anatomy. 1,11 Still, no predictive variables have been established for decision-making regarding urgent surgery. 12 This study retrospectively assessed available MR imaging of patients with GBM with regards to pre-and postoperative ONSD and correlated them to clinical data in order to better identify patients at risk of raised ICP.…”