Patient-specific CFD modeling of CSF flow in Chiari I malformation: denticulate-ligament-induced compartmentalization explains flow patterns

Patient-specific CFD modeling of CSF flow in Chiari I malformation: denticulate-ligament-induced compartmentalization explains flow patterns | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient-specific CFD modeling of CSF flow in Chiari I malformation: denticulate-ligament-induced compartmentalization explains flow patterns Guillermo L. Nozaleda, Francisco J. Parras-Martos, Carolyna Yamamoto, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7545988/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Mar, 2026 Read the published version in Fluids and Barriers of the CNS → Version 1 posted 15 You are reading this latest preprint version Abstract Computational fluid dynamics (CFD) has been widely used to study cerebrospinal fluid (CSF) flow in Chiari Malformation Type I (CM-I). However, most approaches rely on limited patient-specific detail, and it remains unclear whether such minimal input is sufficient to yield physiologically realistic flow predictions. In this study, we construct a series of MRI-based models of the craniocervical CSF space in a CM-I patient to assess how CFD predictions are influenced by the choice of boundary conditions in the numerical integrations and the inclusion or omission of nerve roots and denticulate ligaments in the anatomical model. Our results reveal that while increasing patient-specific detail in boundary conditions improves agreement with velocity fields measured via phase-contrast MRI, key flow features—most notably anterior–posterior compartmentalization and bidirectional patterns during flow reversal—only emerge when denticulate ligaments are included in the model. In contrast, inclusion of nerve roots has a more localized effect on the velocity field and a modest impact on pressure drops. Our findings not only clarify how more detailed boundary conditions and improved anatomical fidelity affect velocity and pressure predictions, but also provide a mechanistic explanation for flow patterns commonly observed in CM-I that have remained unexplained, highlighting the critical role of denticulate ligaments. keyword1 Keyword2 Keyword3 Keyword4 Full Text Additional Declarations No competing interests reported. Supplementary Files CINEMRI.mp4 Cite Share Download PDF Status: Published Journal Publication published 02 Mar, 2026 Read the published version in Fluids and Barriers of the CNS → Version 1 posted Editorial decision: Revision requested 24 Nov, 2025 Reviews received at journal 19 Nov, 2025 Reviews received at journal 18 Nov, 2025 Reviewers agreed at journal 11 Nov, 2025 Reviewers agreed at journal 07 Nov, 2025 Reviewers agreed at journal 07 Nov, 2025 Reviews received at journal 17 Oct, 2025 Reviews received at journal 15 Oct, 2025 Reviewers agreed at journal 25 Sep, 2025 Reviewers agreed at journal 24 Sep, 2025 Reviewers agreed at journal 24 Sep, 2025 Reviewers invited by journal 24 Sep, 2025 Editor assigned by journal 12 Sep, 2025 Submission checks completed at journal 06 Sep, 2025 First submitted to journal 05 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7545988","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522346831,"identity":"da6b42bf-40c9-4566-b03b-7affb5648ff2","order_by":0,"name":"Guillermo L. 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