Modelling the effect of ventricular expansion on white matter in normal pressure hydrocephalus

Martina Del Giovane, Vahid Darvishi, Michael C B David, Magdalena A Kolanko, Gregory Scott, Karl A Zimmerman, Valentina Giunchiglia, Anastasia Gontsarova, Adam Hampshire, Paresh A Malhotra, Mazdak Ghajari, Christopher Carswell, David J Sharp

Brain, 2026

Abstract

The mechanism by which idiopathic normal pressure hydrocephalus (iNPH) causes cognitive impairment, gait dysfunction and urinary incontinence is unclear. The key radiological feature is ventriculomegaly, and symptoms can be treated with surgery. We hypothesise that ventricular expansion causes clinical effects by stretching and/or compressing white matter tracts. We define disease-specific white matter abnormalities, explore their relationship to clinical features and test whether they can be explained by a computational model of ventricular expansion in iNPH. In this observational study, diffusion tensor imaging with Tract-Based Spatial Statistics analysis was used to investigate white matter abnormalities in 22 patients with iNPH (14 males, mean age=71.91, SD=7.06), 28 with Alzheimer's disease (AD) (18 males, mean age=74.80), 23 with moderate-severe traumatic brain injury (TBI) (15 males, mean age=69.87) and 30 healthy controls (16 males, mean age=73.80). We developed a finite-element biomechanical model of hydrocephalus, which predicts patterns of white matter stretch and compression generated to deform from healthy to iNPH brain, and studied their effect on the extracted…

Cite as (BibTeX)

@article{giovane-2026-modelling-the-effect-of,
  title={Modelling the effect of ventricular expansion on white matter in normal pressure hydrocephalus},
  author={Martina Del Giovane and Vahid Darvishi and Michael C B David and Magdalena A Kolanko and Gregory Scott and Karl A Zimmerman and Valentina Giunchiglia and Anastasia Gontsarova and Adam Hampshire and Paresh A Malhotra and Mazdak Ghajari and Christopher Carswell and David J Sharp},
  journal={Brain},
  year={2026},
  doi={10.1093/brain/awag312}
}