{"doi":"10.1016/j.neumar.2025.100148","title":"Cranial pulsatility as a biomarker of cerebrovascular health: A narrative review on the Windkessel model and its clinical application","abstract":"The cerebral Windkessel (CWK) effect describes the damping mechanism of arterial pulsations within the cranio-spinal environment, a fundamental process in neuroprotection. Dysfunction of this mechanism leads to increased cranial pulsatility and has been implicated in the pathophysiology of several brain disorders. Therefore, cranial pulsatility emerges as a potential biomarker of cerebrovascular health. Herein, we synthesize the scientific evidence on cranial pulsatility, based on the CWK model, and elucidate its implications for the diagnosis, monitoring, and treatment of cerebrovascular and neurodegenerative diseases. A scoping review was conducted across the PubMed®, Scopus®, and Web of Science™ databases using keywords related to the Windkessel effect, pulsatility, and intracranial pressure. Following predefined eligibility criteria, two independent reviewers selected the articles, resulting in the inclusion of 32 original studies for analysis. The results demonstrate that CWK failure, reflected by an elevated pulsatility index and percussion wave/tidal wave ratio, is a common pathophysiological feature in conditions such as hydrocephalus, idiopathic intracranial hypertension, and hypertension. Longitudinal evidence suggests elevated pulsatility as a potential predictor of long-term cognitive decline. Additionally, the efficacy of therapies, such as antihypertensive treatments, can be assessed by their specific effects on these markers of cerebral pulsatility. Therefore, cranial pulsatility, underpinned by the CWK model, transcends the concept of a mere physical phenomenon to stand out as a promising, clinically applicable biomarker. Its non-invasive monitoring offers a strategic tool for the early detection of vascular impairment, risk stratification, and guidance of neuroprotective therapies, representing a potential advancement in preventive medicine.","journal":"NeuroMarkers.","year":2025,"id":535797,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9589,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1419993,"name":"Luciano Magno de Almeida Faria","orcid":"0000-0003-1375-2335","position":1,"is_corresponding":false},{"id":1420479,"name":"Filipe Lírio Malta","orcid":null,"position":2,"is_corresponding":false},{"id":1420480,"name":"Paulo Sergio Almeida","orcid":null,"position":3,"is_corresponding":false},{"id":1419994,"name":"Gabriel Augusto Novaes","orcid":"0000-0002-4538-332X","position":4,"is_corresponding":false},{"id":1420481,"name":"J. Quaresma","orcid":null,"position":5,"is_corresponding":false},{"id":1420482,"name":"Mateus Argolo","orcid":null,"position":6,"is_corresponding":false},{"id":1420483,"name":"Rafael Mendes Pereira","orcid":null,"position":7,"is_corresponding":false},{"id":1419992,"name":"Alinne Alves Oliveira","orcid":"0000-0002-5616-2434","position":0,"is_corresponding":true}],"reference_count":59,"raw_metadata":null,"created_at":"2026-07-19T02:52:00.885532Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}