In-silico molecular enrichment and clearance of the human intracranial space

The mechanisms of intracranial solute transport are fundamental to human brain health, with alterations often linked to disease and functional impairment, and with distinct opportunities for personalized diagnostics and treatment. However, our understanding of these mechanisms and their interplay remains incomplete, in part due to the complexity of integrating insights across scales, between species and from different modalities. Here, we combine mixed-dimensional modelling, multi-modal magnetic resonance images, and high performance computing to construct and explore a high-fidelity in-silico model of human intracranial molecular enrichment. This model predicts the temporo-spatial spreading of a solute within an image-derived geometric representation of the subarachnoid space, ventricular system and brain parenchyma, including networks of surface perivascular spaces (PVSs). Our findings highlight the significant impact of cerebrospinal fluid (CSF) production and intracranial pulsatility on molecular enrichment following intrathecal tracer injection. We demonstrate that low-frequency vasomotion induces moderate CSF flow in surface PVS networks which substantially enhances tracer enrichment, and that impaired enrichment is a direct natural consequence of enlarged PVSs. This openly available technology platform thus provides an opportunity for integrating separate observations on diffusion in neuropil, vascular dynamics, intracranial pulsatility, CSF production, and efflux, and for exploring drug delivery and clearance in the human brain.