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Simulating cerebral edema and delayed fatality after traumatic brain injury using triphasic swelling biomechanics
Andrew V Basilio1, Peng Xu1, Yukou Takahashi2
1Biomedical Engineering, Columbia University, New York, New York.
Traffic Injury Prevention
|October 25, 2019
Summary
This study models brain swelling after traumatic brain injury (TBI) to predict mortality. The simulation showed increased intracranial pressure (ICP) correlating with a high probability of death following fatal impacts.
Area of Science:
- Biomechanics
- Computational modeling
- Neuroscience
Background:
- Finite element (FE) models, such as the Global Human Body Models Consortium (GHBMC), aid in developing automotive safety systems to mitigate injuries from motor vehicle crashes (MVCs).
- Traumatic brain injury (TBI) can lead to cerebral edema, increasing intracranial pressure (ICP) and impairing cerebral blood supply, contributing to mortality.
- Current models often do not account for post-injury physiological changes like edema.
Purpose of the Study:
- To develop and validate a computational model for simulating post-traumatic cerebral edema and predicting subsequent mortality.
- To investigate the relationship between brain swelling, increased ICP, and patient outcomes after TBI using triphasic biomechanics.
Main Methods:
- Utilized triphasic biomechanics to model brain tissue as a charged deformable porous solid matrix, solvent, and ions, simulating fluid uptake driven by osmotic pressure.
- Integrated the Global Human Body Models Consortium (GHBMC) finite element model into FEBio software.
- Simulated impact-related cell death based on maximum principal strain (MPS) from crash simulations, incorporating ensuing swelling, ischemia, and ICP elevation.
Main Results:
- Simulated post-traumatic volume changes in brain elements ranged from 30% compaction to over 200% swelling.
- Predicted ICP values reached 8.55 kPa (64.1 mmHg) in a fatal impact scenario, correlating with a 99% probability of death.
- Demonstrated a feasible approach to simulate post-injury swelling and its effects on ICP.
Conclusions:
- This study presents the first simulation of post-traumatic brain swelling to predict patient outcomes.
- The novel approach, incorporating swelling, ischemia, and cell death, enhances the fidelity of predicting outcomes after MVCs.
- The model successfully predicted clinically relevant ICP increases, indicating high mortality likelihood in severe impact scenarios, though further validation is required.
