title: Is posture-related craniospinal compliance shift caused by jugular vein collapse? A theoretical analysis.
abstract: BACKGROUND
  Postural changes are related to changes in cerebrospinal fluid (CSF) dynamics. While sitting up leads to a decrease in cranial CSF pressure, it also causes shifts in the craniospinal CSF volume and compliance distribution. We hypothesized that jugular vein collapse in upright posture is a major contributor to these shifts in CSF volume and compliance.
  
  
  METHODS
  To test this hypothesis, we implemented a mathematical lumped-parameter model of the CSF system and the relevant parts of the cardiovascular system. In this model, the CSF and the venous system are each divided into a cranial and a spinal part. The pressures in these cranial and spinal portions differ by the posture-dependent hydrostatic pressure columns in the connecting vessels. Jugular collapse is represented by a reduction of the hydrostatic pressure difference between cranial and spinal veins. The CSF pressure-volume relationship is implemented as a function of the local CSF to venous pressure gradient. This implies that an increase in CSF volume leads to a simultaneous displacement of blood from adjacent veins. CSF pulsations driven by the cardiovascular system are introduced through a pulsating cranial arterial volume.
  
  
  RESULTS
  In upright posture, the implemented CSF pressure-volume relationship shifts to lower cranial CSF pressures compared to the horizontal position, leading to a decrease in cranial CSF pressure when sitting up. Concurrently, the compliance of the spinal compartment decreases while the one of the cranial compartment increases. With this, in upright posture only 10% of the CSF system's compliance is provided by the spinal compartment compared to 35% in horizontal posture. This reduction in spinal compliance is accompanied by a caudal shift of CSF volume. Also, the ability of the spinal CSF compartment to compensate for cerebral arterial volume pulsations reduces in upright posture, which in turn reduces the calculated craniospinal CSF flow pulsations.
  
  
  CONCLUSIONS
  The mathematical model enabled us to isolate the effect of jugular collapse and quantify the induced shifts of compliance and CSF volume. The good concordance of the modelled changes with clinically observed values indicates that jugular collapse can be considered a major contributor to CSF dynamics in upright posture.
authors.affiliation: Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland. mgehlen@ethz.ch.|The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland. mgehlen@ethz.ch.
authors.forename: Manuel
authors.identifier: http://orcid.org/0000-0001-6393-9136
authors.initials: M
authors.lastname: Gehlen
authors.affiliation: The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland.|Neuroscience Center Zurich, and the Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Vartan
authors.initials: V
authors.lastname: Kurtcuoglu
authors.affiliation: Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid Daners
mesh_terms: D000465:Algorithms; D001794:Blood Pressure / Q000502:physiology; D002555:Cerebrospinal Fluid / Q000502:physiology*; D006801:Humans; D007601:Jugular Veins / Q000502:physiology*; D008954:Models, Biological; D011187:Posture / Q000502:physiology*; D011312:Pressure
keywords: Cerebrospinal fluid dynamics; Compliance; Craniospinal; Posture