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Background: Today, invasive intracranial pressure (ICP) measurement remains the standard, but its invasiveness limits availability. Here, we evaluate a novel ultrasound-based optic nerve sheath parameter called the deformability index (DI) and its ability to assess ICP noninvasively. Furthermore, we ask whether combining DI with optic nerve sheath diameter (ONSD), a more established parameter, results in increased diagnostic ability, as compared to using ONSD alone. Methods: We prospectively included adult patients with traumatic brain injury with invasive ICP monitoring, which served as the reference measurement. Ultrasound images and videos of the optic nerve sheath were acquired. ONSD was measured at the bedside, whereas DI was calculated by semiautomated postprocessing of ultrasound videos. Correlations of ONSD and DI to ICP were explored, and a linear regression model combining ONSD and DI was compared to a linear regression model using ONSD alone. Ability of the noninvasive parameters to distinguish dichotomized ICP was evaluated using receiver operating characteristic curves, and a logistic regression model combining ONSD and DI was compared to a logistic regression model using ONSD alone. Results: Forty-four ultrasound examinations were performed in 26 patients. Both DI (R = − 0.28; 95% confidence interval [CI] R < − 0.03; p = 0.03) and ONSD (R = 0.45; 95% CI R > 0.23; p < 0.01) correlated with ICP. When including both parameters in a combined model, the estimated correlation coefficient increased (R = 0.51; 95% CI R > 0.30; p < 0.01), compared to using ONSD alone, but the model improvement did not reach statistical significance (p = 0.09). Both DI (area under the curve [AUC] 0.69, 95% CI 0.53–0.83) and ONSD (AUC 0.72, 95% CI 0.56–0.86) displayed ability to distinguish ICP dichotomized at ICP ≥ 15 mm Hg. When using both parameters in a combined model, AUC increased (0.80, 95% CI 0.63–0.90), and the model improvement was statistically significant (p = 0.02). Conclusions: Combining ONSD with DI holds the potential of increasing the ability of optic nerve sheath parameters in the noninvasive assessment of ICP, compared to using ONSD alone, and further study of DI is warranted. [ABSTRACT FROM AUTHOR]

This letter is a response to another letter to the editor regarding the noninvasive assessment of intracranial pressure (ICP) using the deformability index (DI) and optic nerve sheath diameter (ONSD). The authors of this letter conducted a study to determine if the association between DI, ONSD, and ICP found in pediatric studies could also be found in adults with traumatic brain injury (TBI). They agree that further study is needed to understand the factors that may affect optic nerve sheath parameters. The authors also discuss the potential effects of cardiac output and ventilatory parameters on these parameters and suggest that future studies should explore these relationships. They mention that the association between optic nerve sheath parameters and ICP is less established in aneurysmal subarachnoid hemorrhage (aSAH) compared to TBI and that they are currently conducting a study on this topic. They argue against excluding patients with traumatic subarachnoid hemorrhage (tSAH), intraventricular hemorrhage (IVH), or external ventricular drainage from future research on this topic. Finally, they discuss the limitations of the standardized A-scan technique for measuring ONSD and suggest that it may not be feasible in patients with moderate to severe TBI. The authors conclude by acknowledging their sources of support and declaring any conflicts of interest. [Extracted from the article]

Background: Optic nerve sheath diameter (ONSD) is a promising noninvasive parameter for intracranial pressure (ICP) assessment. However, in the setting of aneurysmal subarachnoid hemorrhage (aSAH), several previous studies have reported no association between ultrasonically measured ONSD and ICP. In this study, we evaluate ONSD in patients with aSAH using a novel method of automated real-time ultrasonographic measurements and explore whether factors such as having undergone surgery affects its association to ICP.We prospectively included adult patients with aSAH undergoing invasive ICP monitoring. ONSD was obtained using a prototype ultrasound machine with software for real-time automated measurements at the bedside. Correlation between ONSD and ICP was explored, and the ability of ONSD to discriminate dichotomized ICP was evaluated. Abovementioned analyses were performed for the whole cohort and repeated for subgroups by whether the basal cisterns had been surgically entered before ultrasound examination.Twenty-six ultrasound examinations were performed in 20 patients. There was a positive correlation between ONSD and ICP (R = 0.43; p = 0.03). In the subgroup where the basal cisterns had not been surgically entered before ultrasound examination, there was a stronger correlation (R = 0.55; p = 0.01), whereas no correlation was seen in the subgroup where the basal cisterns had been surgically entered (R = − 0.16; p = 0.70). ONSD displayed an ability to discriminate ICP dichotomized at ≥ 15 mm Hg (area under the curve [AUC] = 0.84, 95% confidence interval [CI] 0.65–0.96). Subgroup analysis revealed a perfect discriminatory ability (AUC = 1, 95% CI 0.81–1) where the basal cisterns had not been surgically entered and no discriminatory ability (AUC = 0.47, 95% CI 0.16–0.84) where the basal cisterns had been surgically entered before ultrasound examination.Automatically measured ONSD correlated well with ICP and displayed a perfect discriminatory ability in patients with aSAH in whom the basal cisterns had not been entered surgically before ultrasound examination, and may be a clinically valuable noninvasive marker of ICP in these patients. Caution should be exercised in using ONSD in patients in whom the basal cisterns have been entered surgically before ONSD measurements, as no association was observed in this subgroup.Methods: Optic nerve sheath diameter (ONSD) is a promising noninvasive parameter for intracranial pressure (ICP) assessment. However, in the setting of aneurysmal subarachnoid hemorrhage (aSAH), several previous studies have reported no association between ultrasonically measured ONSD and ICP. In this study, we evaluate ONSD in patients with aSAH using a novel method of automated real-time ultrasonographic measurements and explore whether factors such as having undergone surgery affects its association to ICP.We prospectively included adult patients with aSAH undergoing invasive ICP monitoring. ONSD was obtained using a prototype ultrasound machine with software for real-time automated measurements at the bedside. Correlation between ONSD and ICP was explored, and the ability of ONSD to discriminate dichotomized ICP was evaluated. Abovementioned analyses were performed for the whole cohort and repeated for subgroups by whether the basal cisterns had been surgically entered before ultrasound examination.Twenty-six ultrasound examinations were performed in 20 patients. There was a positive correlation between ONSD and ICP (R = 0.43; p = 0.03). In the subgroup where the basal cisterns had not been surgically entered before ultrasound examination, there was a stronger correlation (R = 0.55; p = 0.01), whereas no correlation was seen in the subgroup where the basal cisterns had been surgically entered (R = − 0.16; p = 0.70). ONSD displayed an ability to discriminate ICP dichotomized at ≥ 15 mm Hg (area under the curve [AUC] = 0.84, 95% confidence interval [CI] 0.65–0.96). Subgroup analysis revealed a perfect discriminatory ability (AUC = 1, 95% CI 0.81–1) where the basal cisterns had not been surgically entered and no discriminatory ability (AUC = 0.47, 95% CI 0.16–0.84) where the basal cisterns had been surgically entered before ultrasound examination.Automatically measured ONSD correlated well with ICP and displayed a perfect discriminatory ability in patients with aSAH in whom the basal cisterns had not been entered surgically before ultrasound examination, and may be a clinically valuable noninvasive marker of ICP in these patients. Caution should be exercised in using ONSD in patients in whom the basal cisterns have been entered surgically before ONSD measurements, as no association was observed in this subgroup.Results: Optic nerve sheath diameter (ONSD) is a promising noninvasive parameter for intracranial pressure (ICP) assessment. However, in the setting of aneurysmal subarachnoid hemorrhage (aSAH), several previous studies have reported no association between ultrasonically measured ONSD and ICP. In this study, we evaluate ONSD in patients with aSAH using a novel method of automated real-time ultrasonographic measurements and explore whether factors such as having undergone surgery affects its association to ICP.We prospectively included adult patients with aSAH undergoing invasive ICP monitoring. ONSD was obtained using a prototype ultrasound machine with software for real-time automated measurements at the bedside. Correlation between ONSD and ICP was explored, and the ability of ONSD to discriminate dichotomized ICP was evaluated. Abovementioned analyses were performed for the whole cohort and repeated for subgroups by whether the basal cisterns had been surgically entered before ultrasound examination.Twenty-six ultrasound examinations were performed in 20 patients. There was a positive correlation between ONSD and ICP (R = 0.43; p = 0.03). In the subgroup where the basal cisterns had not been surgically entered before ultrasound examination, there was a stronger correlation (R = 0.55; p = 0.01), whereas no correlation was seen in the subgroup where the basal cisterns had been surgically entered (R = − 0.16; p = 0.70). ONSD displayed an ability to discriminate ICP dichotomized at ≥ 15 mm Hg (area under the curve [AUC] = 0.84, 95% confidence interval [CI] 0.65–0.96). Subgroup analysis revealed a perfect discriminatory ability (AUC = 1, 95% CI 0.81–1) where the basal cisterns had not been surgically entered and no discriminatory ability (AUC = 0.47, 95% CI 0.16–0.84) where the basal cisterns had been surgically entered before ultrasound examination.Automatically measured ONSD correlated well with ICP and displayed a perfect discriminatory ability in patients with aSAH in whom the basal cisterns had not been entered surgically before ultrasound examination, and may be a clinically valuable noninvasive marker of ICP in these patients. Caution should be exercised in using ONSD in patients in whom the basal cisterns have been entered surgically before ONSD measurements, as no association was observed in this subgroup.Conclusions: Optic nerve sheath diameter (ONSD) is a promising noninvasive parameter for intracranial pressure (ICP) assessment. However, in the setting of aneurysmal subarachnoid hemorrhage (aSAH), several previous studies have reported no association between ultrasonically measured ONSD and ICP. In this study, we evaluate ONSD in patients with aSAH using a novel method of automated real-time ultrasonographic measurements and explore whether factors such as having undergone surgery affects its association to ICP.We prospectively included adult patients with aSAH undergoing invasive ICP monitoring. ONSD was obtained using a prototype ultrasound machine with software for real-time automated measurements at the bedside. Correlation between ONSD and ICP was explored, and the ability of ONSD to discriminate dichotomized ICP was evaluated. Abovementioned analyses were performed for the whole cohort and repeated for subgroups by whether the basal cisterns had been surgically entered before ultrasound examination.Twenty-six ultrasound examinations were performed in 20 patients. There was a positive correlation between ONSD and ICP (R = 0.43; p = 0.03). In the subgroup where the basal cisterns had not been surgically entered before ultrasound examination, there was a stronger correlation (R = 0.55; p = 0.01), whereas no correlation was seen in the subgroup where the basal cisterns had been surgically entered (R = − 0.16; p = 0.70). ONSD displayed an ability to discriminate ICP dichotomized at ≥ 15 mm Hg (area under the curve [AUC] = 0.84, 95% confidence interval [CI] 0.65–0.96). Subgroup analysis revealed a perfect discriminatory ability (AUC = 1, 95% CI 0.81–1) where the basal cisterns had not been surgically entered and no discriminatory ability (AUC = 0.47, 95% CI 0.16–0.84) where the basal cisterns had been surgically entered before ultrasound examination.Automatically measured ONSD correlated well with ICP and displayed a perfect discriminatory ability in patients with aSAH in whom the basal cisterns had not been entered surgically before ultrasound examination, and may be a clinically valuable noninvasive marker of ICP in these patients. Caution should be exercised in using ONSD in patients in whom the basal cisterns have been entered surgically before ONSD measurements, as no association was observed in this subgroup. [ABSTRACT FROM AUTHOR]

This letter is a response to another letter to the editor, discussing factors that were missed in assessing optic nerve sheath diameter and deformability index in patients with severe traumatic brain injury. The authors agree that preexisting eye conditions and seizure activity can affect the correlation between optic nerve sheath parameters and intracranial pressure. However, they argue that excluding patients with preexisting glaucoma may lead to a sample that more accurately reflects the potential future use of optic nerve sheath parameters in assessing intracranial pressure. They also mention that the incidence of seizure activity in their cohort remains undetermined, but the deep sedation of the patients makes clinically relevant seizure activity less likely. Additionally, they clarify that the deformability index has no specific unit as it is derived from a mathematical model. The authors conclude by stating their contributions and acknowledging their sources of support and conflicts of interest. [Extracted from the article]

Background: In Western countries, the typical cervical spine fracture (CS-Fx) patient has historically been a young male injured in a road traffic accident. Recent reports and daily clinical practice clearly indicate a change in the typical patient from a young male to an elderly male or female with comorbidities. This study aimed to establish contemporary population-based epidemiological data of traumatic CS-Fx for use in health-care planning and injury prevention. Methods: This is a population-based retrospective database study (with prospectively collected data) from the Southeast Norway health region with 3.0 million inhabitants. We included all consecutive cases diagnosed with a CS-Fx between 2015 and 2019. Information regarding demographics, preinjury comorbidities, trauma mechanisms, injury description, treatment, and level of hospital admittance is presented. Results: We registered 2153 consecutive cases with CS-Fx during a 5-year period, with an overall crude incidence of CS-Fx of 14.9/100,000 person-years. Age-adjusted incidences using the standard population for Europe and the World was 15.6/100,000 person-years and 10.4/100,000 person-years, respectively. The median patient age was 62 years, 68% were males, 37% had a preinjury severe systemic disease, 16% were under the influence of ethanol, 53% had multiple trauma, and 12% had concomitant cervical spinal cord injury (incomplete in 85% and complete in 15%). The most common trauma mechanisms were falls (57%), followed by bicycle injuries (12%), and four-wheel motorized vehicle accidents (10%). The most common upper CS-Fx was C2 odontoid Fx, while the most common subaxial Fx was facet joint Fx involving cervical level C6/C7. Treatment was external immobilization with a stiff neck collar alone in 65%, open surgical fixation in 26% (giving a 3.7/100,000 person-years surgery rate), and no stabilization in 9%. The overall 90-day mortality was 153/2153 (7.1%). Conclusions: This study provides an overview of the extent of the issue and patient complexity necessary for planning the health-care management and injury prevention of CS-Fx. The typical CS-Fx patient was an elderly male or female with significant comorbidities injured in a low-energy trauma. The overall crude incidences of CS-Fx and surgical fixation of CS-Fx in Southeast Norway were 14.9/100,000 person-years and 3.7/100,000 person-years, respectively. [ABSTRACT FROM AUTHOR]

To investigate if viruses are involved in the pathogenesis of vestibular schwannomas (VS), we have screened biopsies from VS patients using different molecular techniques. Screening for the presence of known viruses using a pan-viral microarray assay (ViroChip) indicated the presence of several viruses including human endogenous retrovirus K (HERV-K) and human herpes virus 2 (HHV2). But with the exception of HERV-K, none of the findings could be verified by other methods. Whole transcriptome sequencing showed only the presence of HERV-K transcripts and whole genome sequencing showed only the presence of Epstein-Barr virus, most likely originating from infiltration of lymphocytes. We therefore conclude that it is less likely that viruses are involved in the pathogenesis of vestibular schwannomas. [ABSTRACT FROM AUTHOR]

Purpose: This article provides a review of the transcriptomic expression profiling studies that have been performed on meningiomas so far. We discuss some future prospects and challenges ahead in the field of gene expression profiling. Methods: We performed a systematic search in the PubMed and EMBASE databases in May 2010 using the following search terms alone or in combination: 'meningioma', 'microarray analysis', 'oligonucleotide array sequence analysis', or 'gene expression profiling'. Only original research articles in English that had used RNA hybridized to high-resolution microarray chips to generate gene expression profiles were included. Results: We identified 13 articles matching the inclusion criteria. All studies had been performed during the last decade. Conclusions: The main results of the studies can be grouped in three categories: (1) several groups have identified meningioma-specific genes and genes associated with the three WHO grades, and the main histological subtypes of grade I meningiomas; (2) one publication has shown that the general transcription profile of samples of all WHO grades differs in vivo and in vitro; (3) one report provides evidence that microarray technology can be used in an automated fashion to classify tumors. Due to lack of consensus on how microarray data are presented, possible general trends found across the studies are difficult to extract. This could obstruct the discovery of important genes and pathways universally involved in meningioma biology. [ABSTRACT FROM AUTHOR]

Working with patients with intracranial aneurysms, we have developed a clinical suspicion that there may be differences in the rupture rate of aneurysms depending on the aneurysm’s anatomical location. The aim of the study was to examine the anatomical distribution of ruptured and unruptured intracranial aneurysms in a defined population. We retrospectively included all patients with an aneurysm treated in our institution between 1 January 1990 and 31 December 1999, and collected the relevant data from the individual patient files. With the Koivisto categories for aneurysm location, we gathered the aneurysms into four categories: ACA, MCA, ICA, and VBA. Four hundred forty-four aneurysms were included in the study: 361 in SAH patients and 83 in patients without SAH. ACA aneurysms were over-represented in the ruptured group (36.0% vs. 9.6%, p < 0.0001). MCA aneurysms were more frequent in the unruptured group (51.8% vs. 29.6%, p < 0.0002). Ruptured ACA aneurysms were over-represented among males ( p < 0.0001), whereas ruptured ICA aneurysms were more frequent among females ( p < 0.0001). Ruptured aneurysms in the posterior circulation were more frequently found on the left side ( p < 0.0001). This study shows that the anatomical distribution of aneurysms is different in SAH patients compared with patients with unruptured aneurysms. Haemodynamic features of the vessel of origin may explain the differences we have found. Furthermore, this study suggests that it is of particular importance to treat patients with incidentally found ACA aneurysms. [ABSTRACT FROM AUTHOR]

Meningiomas of WHO grade I can usually be cured by surgical resection. However, some tumors may, despite their benign appearance, display invasive growth behavior. These tumors constitute a difficult clinical problem to handle. By histology alone, bone invasive meningiomas may be indistinguishable from their noninvasive counterparts. In this study we have examined the protein spectra in a series of meningiomas in search of protein expression patterns that may distinguish between bone invasive and noninvasive meningiomas. Tumor tissue from 13 patients with fibrous (6 invasive and 7 noninvasive) and 29 with meningothelial (10 invasive and 19 noninvasive) grade I meningiomas were analyzed by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI). Multivariate statistical methods were applied for data analyses. Comparing the protein spectra from invasive and noninvasive fibrous meningioma we found 22 peaks whose intensities were significantly different between the two groups ( P < 0.001). Based on the expression pattern of these peaks we were able to perfectly separate the two entities (area under ROC curve = 1.0). In meningothelial meningioma the same comparison yielded six significantly differentially expressed peaks ( P < 0.001), which to a large degree separated the invasive from noninvasive tissue (area under ROC curve = 0.873). By analyzing the protein spectra in benign meningiomas we could differentiate between invasive and noninvasive growth behavior in both fibrous and meningothelial meningiomas of grade I. A possibility for early identification of invasive grade I meningiomas may have a strong influence on the follow-up policy and the issue of early or late radiotherapy. [ABSTRACT FROM AUTHOR]

Background: The vast majority of hospital admitted patients with traumatic brain injury (TBI) will have intracranial injury identified by neuroimaging, requiring qualified staff and hospital beds. Moreover, increased pressure in health care services is expected because of an aging population. Thus, a regular evaluation of characteristics of hospital admitted patients with TBI is needed. Oslo TBI Registry – Neurosurgery prospectively register all patients with TBI identified by neuroimaging admitted to a trauma center for southeast part of Norway. The purpose of this study is to describe this patient population with respect to case load, time of admission, age, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival. Methods: Data for 5 years was extracted from Oslo TBI Registry – Neurosurgery. Case load, time of admission, age, sex, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival was compiled and compared. Results: From January 1st, 2015 to December 31st, 2019, 2153 consecutive patients with TBI identified by neuroimaging were registered. The admission rate of TBI of all severities has been stable year-round since 2015. Mean age was 52 years (standard deviation 25, range 0–99), and 68% were males. Comorbidities were common; 28% with pre-injury ASA score of ≥3 and 25% used antithrombotic medication. The dominating cause of injury in all ages was falls (55%) but increased with age. Upon admission, the head injury was classified as mild TBI in 46%, moderate in 28%, and severe (Glasgow coma score ≤ 8) in 26%. Case load was stable without seasonal variation. Majority of patients (68%) were admitted during evening, night or weekend. 68% was admitted to intensive care unit. Length of hospital stay was 4 days (median, interquartile range 3–9). 30-day survival for mild, moderate and severe TBI was 98, 94 and 69%, respectively. Conclusions: The typical TBI patients admitted to hospital with abnormal neuroimaging were aged 50–79 years, often with significant comorbidity, and admitted outside ordinary working hours. This suggests the necessity for all-hour presence of competent health care professionals. [ABSTRACT FROM AUTHOR]