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Background: Lumboperitoneal shunts have been used as a valuable CSF diversion tool in the pediatric age group. This retrospective study reports the indications, outcomes, and possible complications of lumboperitoneal shunts placed in children. Results: A total of 19 patients are included in our study. 12 children were males (63.2%) and 7 were females (36.8%). The mean age at LP shunt placement was 5.7 years (6 months–12 years), and most of the children were in the school-age group 11 (57.9%). Idiopathic intracranial hypertension was the most identifiable cause in 9 cases (47.4%), and headache was the most common presenting symptom in 6 patients. The mean follow-up was 36.1 months (17–61 months). Two patients underwent shunt revision due to catheter migration, and three patients (15.8%) developed acquired Chiari malformation for whom the lumboperitoneal shunt was removed and replaced with a ventriculoperitoneal shunt; all the patients are doing well till the last follow-up. Conclusion: Lumboperitoneal shunt insertion is a safe and valuable CSF diversion tool in children for various indications on the top of it is idiopathic intracranial hypertension. Long-term follow-up is required for the possibility of acquired Chiari malformation, and the presence of a horizontal–vertical valve could avoid this possible problem. [ABSTRACT FROM AUTHOR]

Background: Marble bone disease or osteopetrosis is an extremely rare hereditary condition that causes abnormal bone density and fragility due to impaired osteoclastic action. This causes the body to produce an abnormal amount of bone that are evident in radiographic findings and cause problems with the body systems, particularly the nervous system. Osteopetrosis has 3 types of genetic inheritance either malignant autosomal recessive (ARO) which occur in childhood, intermediate ARO which occur in adolescence, and benign autosomal dominant osteopetrosis which occur in adults. Complications from increased bone density like elevated intracranial pressure (ICP), compressing neural tissues, especially the cranial nerves (CNs), spinal cord, and brainstem, are common problems. Aim: The aim of this study is to evaluate neurosurgical problems caused by osteopetrosis focusing on the effectiveness of different treatment modalities and their outcomes. Conclusion: Marble bone disease or osteopetrosis is a rare hereditary disorder with multiple neurological impacts. Increased ICP and CNs compression are the most common. We studied 5 cases of adult osteopetrosis, 3 of them treated surgically. Two of the surgically treated cases had lumbo-peritonieal shunt, while the third case treated by optic nerve decompression. The remaining 2 cases were treated conservatively. The outcome of the surgically treated cases wasn't good. [ABSTRACT FROM AUTHOR]

To measure the normal reference value of optic nerve sheath diameter (ONSD) and its correlation with eyeball transverse diameter (ETD), age and sex in Chinese adults by CT. The data of healthy adults who underwent head scan in Baotou Central Hospital from March 2022 to May 2023 were retrospectively collected. The ETD of both eyes and the ONSD (ONSD3mm, ONSD10mm) at 3 mm and 10 mm behind the eyeball were measured, and the relationship between ONSD and age, sex and ETD was analyzed by linear regression. A total of 360 subjects were included, 180 males and 180 females, aged 48.5 (33.00, 63.00) years. The average ONSD3mm, 10 mm and ETD of 360 included subjects were 5.28 (95% CI 5.23–5.32) mm, 4.34 (95% CI 4.30–4.37) mm and 22.47 (95% CI 22.38–22.56) mm, respectively. Univariate linear regression analysis showed that gender (P < 0.001) and ETD (P < 0.001) were the influencing factors of the mean ONSD. Further multivariate linear regression analysis also showed that gender (P < 0.001) and ETD (P < 0.01) were associated with ONSD values. The comparison of parameters between different genders showed that the values of all parameters in males were greater than those in females, and the difference between the two groups was statistically significant (P < 0.001). In addition, we further measured the ONSD/ETD values, which averaged 0.24 (0.23–0.24) at 3 mm and 0.19 (0.19–0.20) at 10 mm. The average ONSD3mm, 10 mm and ETD of healthy Chinese adults were 5.28 (95% CI 5.23–5.32) mm, 4.34 (95% CI 4.30–4.37) mm and 22.47 (95% CI 22.38–22.56) mm, respectively. At the same time, it is found that gender and ETD are the influencing factors of ONSD, and the diameter of ONSD is different between men and women. [ABSTRACT FROM AUTHOR]

Background: Chiari I malformation, characterized by the displacement of cerebellar tonsils, and Chiari 1.5, involving cerebellar tonsils and brainstem displacement, share symptoms with Idiopathic Intracranial Hypertension, including headache, paresthesia, vision issues, shoulder/arm pain, diplopia, numbness, and motor weakness. Historically, papilledema marked IIH, but there are reports of papilledema in patients with Chiari I/1.5, leading to uncertainty about the most effective treatment strategies. We aim to address this gap by summarizing all reported cases of Chiari I/1.5 with papilledema. Methods: Three primary electronic databases (PubMed, EMBASE, and SCOPUS) were screened to identify case reports and case series of patients with Chiari malformation presenting with papilledema. All variables such as year and region of study, age, sex, symptoms, diagnostic information, treatment details, and follow-up duration, were recorded and analyzed. Study quality for each study included was assessed according to four scales: selection, ascertainment, causality, and reporting. Results: 27 patients from 21 studies were included. Symptoms included headache (76.4%), decreased visual acuity (70.8%), and visual field loss (29.2%). 44.4% had lumbar punctures, and 40.7% received medical management. Of those managed medically, 41.7% fully recovered. Notably, none of 21 patients who underwent surgical decompression without improvement had prior lumbar puncture (0% vs. 64.3%, n = 9; p = 0.003) or medical management (0% vs. 57.1%, n = 8; p = 0.011) compared to those with symptom improvement. Conclusion: Chiari malformation with papilledema exhibits varied symptoms. Medical management should be considered initially, offering standalone effectiveness and potential improvement for subsequent decompression if medication alone does not lead to recovery. [ABSTRACT FROM AUTHOR]

Background: Idiopathic intracranial hypertension (IIH) is increasingly prevalent, yet longitudinal outcome data are scarce. This study aimed to characterise demographic and longitudinal clinical changes in a cohort of patients with IIH. Methods: Retrospective cohort analysis on adult patients diagnosed with IIH (Friedman criteria) enrolled in the neuro-ophthalmology database (NODE) across two tertiary centres. Baseline demographic data was obtained at first assessment, with clinical and paraclinical outcomes collected longitudinally. Multivariable statistical analysis identified factors associated with poorer visual outcomes. Results: A total of 221 patients were included. 91.8% were female (ratio 11:1). Mean age at presentation was 29.2 ± 8.1 years with mean body mass index (kg/m2) at diagnosis of 38.7 ± 9.4. Headache was the most common symptom. Papilloedema was found in 95.5% of patients at baseline. Mean CSF opening pressure was 32.67 ± 6.85cmCSF (range 25–76). Visual outcomes remained stable over time. Trajectory plots showed no deviations in visual acuity, while regression models found no associations with sex, site or age. A higher retinal nerve fibre layer thickness and greater baseline Frisen grade were associated with worse outcomes. Baseline papilloedema grade and CSF opening pressure emerged as early prognostic indicators, aiding risk stratification for those with a greater probability of persistent optic nerve abnormalities including higher retinal nerve fibre layer elevation and sustained atrophic changes over time. Conclusions: This study offers insights into visual outcomes in IIH, emphasising the importance of early recognition, risk stratification, and intervention in those with a more severe clinical phenotype at presentation. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) can analyze imaging motifs, review large datasets, and integrate a wide array of clinical parameters. AI applications including machine learning and deep learning systems have been proposed to aid in the diagnosis of intracranial stroke, ischemic optic neuropathy, demyelinating diseases, and idiopathic intracranial hypertension. We review and update the recent literature on the potential role of AI in neuro-ophthalmology focusing on imaging. We discuss ongoing innovations in AI of relevance in neuro-ophthalmology (e.g. clinical decision support systems and prognosis predictions). There are also challenges in integrating AI into the practice of neuro-ophthalmology for the safety and efficacy of clinical medicine and potential ethical questions regarding AI enabled patient care. Given the manpower shortage of neuro-ophthalmology, however, the potential role of AI in neuro-ophthalmology may help to bridge the gap and unmet need for timely and appropriate neuro-ophthalmic care in the future. [ABSTRACT FROM AUTHOR]

Objective: Elevated intracranial pressure (ICP), a common complication in traumatic brain injuries (TBI), can lead to optic nerve sheath diameter (ONSD) enlargement and flow spectrum changes from the internal carotid artery (ICA) to middle cerebral artery (MCA). This study will investigate the use of Cervical-Cerebral Arterial Ultrasound (CCAU) for non-invasive ICP assessment and evaluating the related indices' clinical utility in TBI patients with decompressive craniotomy (DC). Methods: ONSD and flow spectrum changes were measured within 24 h after DC in 106 patients via ultrasonic ONSD measurement and CCAU, simultaneously. Intracranial pressures were invasively monitored, using a microsensor or ventricular catheter as the gold standard. Patients were classified into two groups, namely the normal group and the elevated group, based on distinct intracranial pressure thresholds of 15 mmHg, 20 mmHg and 22 mmHg. Subsequently, Bland Altman plot used for evaluating agreement between estimate for ICP (ICPe) and invasive ICP (ICPi). Then, the correlation between ONSD, MCAPI (pulsatility index of MCA), PI-ratio (MCAPI/ICAPI), and ICPe was examined through linear regression analysis. Finally, receiver operator characteristic curves (ROC) were also analyzed for different indexes and their combinations (using logistic model). Results: Significant differences were observed between the normal and elevated ICP groups with respect to ONSD, PI-ratio, MCAPI and MCAFVd (diastolic flow velocity of MCA) (p < 0.05). The correlation coefficients for the relationships between ONSD, PI ratio, FVdMCA, and PI with ICPi were 0.62, 0.33, 0.32 and 0.21, respectively, each demonstrating statistical significance (p < 0.05). Analysis of the ROC curves demonstrated that the area under the curve (AUC) for predicting elevated ICPi at thresholds of 15 mmHg, 20 mmHg, and 22 mmHg via combined ultrasonographic measurements of the PI ratio and ONSD was the largest, specifically 0.74 (95% CI: 0.65–0.82), 0.77 (95% CI: 0.69–0.85), and 0.79 (95% CI: 0.70–0.86), respectively. Conclusion: Ultrasonographic measurements of ONSD, PI-ratio, MCAPI and MCAFVd demonstrate a moderate to low weak correlation with ICPi measurements. ICPe is not considered sufficiently precise for noninvasive accurate ICP assessment. The concurrent utilization of CCAU and ONSD measurements may offer superior accuracy for elevated ICP in TBI patients with DC, especially in specificity. Further research is imperative to validate these findings within a more extensive patient population. [ABSTRACT FROM AUTHOR]

Background: Acute and critical neurological diseases are often accompanied with elevated intracranial pressure (ICP), leading to insufficient cerebral perfusion, which may cause severe secondary lesion. Existing ICP monitoring techniques often fail to effectively meet the demand for real-time noninvasive ICP monitoring and warning. This study aimed to explore the use of electrical impedance tomography (EIT) to provide real-time early warning of elevated ICP by observing cerebral perfusion. Methods: An intracranial hypertension model was prepared by injecting autologous un-anticoagulated blood into the brain parenchyma of twelve Landrace swine. Invasive ICP monitoring was used as a control method, and a high-precision EIT system was used to acquire and analyze the changing patterns of cerebral perfusion EIT image parameters with respect to ICP. Four EIT parameters related to cerebral perfusion were extracted from the images, and their potential application in detecting ICP elevation was analyzed. Results: When ICP increased, all EIT perfusion parameters decreased significantly (P < 0.05). When the subjects were in a state of intracranial hypertension (ICP > 22 mmHg), the correlation between EIT perfusion parameters and ICP was more significant (P < 0.01), with correlation coefficients ranging from −0.72 to −0.83. We tested the objects when they were in baseline ICP and in ICP of 15–40 mmHg. Under both circumstances, ROC curve analysis showed that the comprehensive model of perfusion parameters based on the random forest algorithm had a sensitivity and specificity of more than 90% and an area under the curve (AUC) of more than 0.9 for detecting ICP increments of both 5 and 10 mmHg. Conclusion: This study demonstrates the feasibility of using perfusion EIT to detect ICP increases in real time, which may provide a new method for real-time non-invasive monitoring of patients with increased ICP. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to determine the angulation of the dural venous sinuses in soft tissue, to evaluate differences between types of tissue, and to discuss the potential influence of these angulations on intracranial venous hemodynamics and related pathologies. Angulations formed in different segments of the transverse, sigmoid, and superior sagittal sinuses were measured in 13 adult human cadaveric heads (26 sides). After the soft tissues were removed, measurements were also taken from the underlying bone. The overall angulation of the transverse sinus was assessed using two reference points, while the lengths and widths of the dural venous sinuses were measured using microcalipers. Statistical analyses were performed considereing sides, sex, and types of tissue. The mean angulation of the superior sagittal sinuses - transverse sinus junction was 116 degrees. The mean angulations of the transverse sinus - sigmoid sinus junction in medial and superior views were 108 degrees and 114 degrees, respectively. The mean angulations of the entire transverse sinus at two different points were 45 degrees and 44 degrees, respectively. There were statistically significant differences in angulation in some variables when they were adjusted for sides and sex, but not types of tissue. Angulation is a paramount factor in venous hemodynamics. Certain angulations of the dural venous sinuses differed significantly between sides and sexes, but not between types of tissue. Future research should investigate the effects of these angulations on intracranial venous circulation and their relevance to related pathologies. [ABSTRACT FROM AUTHOR]

Background and objective: Neurobrucellosis is a rare neurological disorder characterized by diverse clinical manifestations. Although several relevant cases were reported, our understanding of this disorder is limited. In this study, we presented the clinical and imaging characteristics of four cases of neurobrucellosis. Methods: Four patients with neurobrucellosis were diagnosed and treated in the West China Hospital of Sichuan University and Chengdu Shangjin Nanfu Hospital, from January 2020 to September 2023. Data on demographics, clinical phenotypes and symptoms, cerebrospinal fluid investigations, radiological investigations, and therapies were collected and reviewed. This study was approved by and conducted in accordance with the recommendations of West China Hospital's ethics -.1clinical manifestations of neurobrucellosis in these patients included meningitis, meningoencephalitis, encephalitis, cranial neuropathy, intracranial hypertension, radiculitis, peripheral neuropathy, myelitis, and other psychiatric symptoms. Brucella species were isolated from blood or cerebrospinal fluid (CSF) in four patients; three patients had elevated CSF protein levels, and two had elevated CSF leukocyte counts. All four patients had abnormal imaging findings, including meningeal signs, abnormal cortex and subcortical white matter signals, and signal abnormalities in the vertebral body and spinal cord. All patients were treated with rifampicin (450 mg once daily) and minocycline (100 mg twice daily) for at least 12 weeks, and their clinical symptoms showed significant improvements. Conclusion: This report reviews four cases of neurobrucellosis. All four patients had headache, fever, seizure, cranial nerve damage, low back pain, along with imaging abnormalities, and were successfully treated with antibiotics. The symptoms of neurobrucellosis can be insidious, mild, and non-specific, characterized by various clinical manifestations and atypical imaging findings. This complexity increases the risk of misdiagnosis and missed diagnosis; thus, careful identification, extended treatment, and close follow-up are required. [ABSTRACT FROM AUTHOR]