Relationship between intracranial pressure and neurocognitive function among older adults after radical resection of rectal cancer

BACKGROUND Older patients are prone to postoperative cognitive decline after laparoscopic rectal cancer surgery,which may be associated with increased intraoperative intracranial pressure(ICP).This study investigated the correlation between intra-operative ICP changes,as indicated by measurements of the optic nerve sheath diameter(ONSD)using ultrasonography,and subsequent cognitive function to provide better patient care.AIM To evaluate changes in ICP and associated postoperative neurocognition in older adults after laparoscopic radical resection for rectal cancer.METHODS We included 140 patients who visited the Mianyang Central Hospital for malig-nant rectal tumors,measured their ONSDs before surgery and 30 and 60 minutes after the Trendelenburg position during surgery,and evaluated the patients’cog-nitive function 1 day before surgery and 1,4,and 7 days after surgery.The Mini-Mental State Examination(MMSE)and confusion assessment method(CAM)scores of the patients with different ONSDs were compared at different times after surgery.RESULTS In patients with an ONSD greater than 5.00 mm(group A1),the MMSE scores at 1 day and 4 days after surgery were significantly lower than those of patients with an ONSD less than or equal to 4.00 mm(group A2)(P<0.05).The CAM scores of group A1 were significantly higher than those of group A2(P<0.05).The MMSE scores of group A1 on days 1 and 4 after surgery were significantly lower than those 1 day before and 7 days after surgery(P<0.05),while the CAM scores 1 day and 4 days after surgery were significantly higher than those 1 day before and 7 days after surgery.CONCLUSION Decline in cognitive function among older adults after the procedure may be related to intracranial hypertension during surgery.

Prediction and optimization of flue pressure in sintering process based on SHAP

Sinter is the core raw material for blast furnaces.Flue pressure,which is an important state parameter,affects sinter quality.In this paper,flue pressure prediction and optimization were studied based on the shapley additive explanation(SHAP)to predict the flue pressure and take targeted adjustment measures.First,the sintering process data were collected and processed.A flue pressure prediction model was then constructed after comparing different feature selection methods and model algorithms using SHAP+extremely random-ized trees(ET).The prediction accuracy of the model within the error range of±0.25 kPa was 92.63%.SHAP analysis was employed to improve the interpretability of the prediction model.The effects of various sintering operation parameters on flue pressure,the relation-ship between the numerical range of key operation parameters and flue pressure,the effect of operation parameter combinations on flue pressure,and the prediction process of the flue pressure prediction model on a single sample were analyzed.A flue pressure optimization module was also constructed and analyzed when the prediction satisfied the judgment conditions.The operating parameter combination was then pushed.The flue pressure was increased by 5.87%during the verification process,achieving a good optimization effect.

A Flexible Smart Healthcare Platform Conjugated with Artificial Epidermis Assembled by Three‑Dimensionally Conductive MOF Network for Gas and Pressure Sensing

The rising flexible and intelligent electronics greatly facilitate the noninvasive and timely tracking of physiological information in telemedicine healthcare.Meticulously building bionic-sensitive moieties is vital for designing efficient electronic skin with advanced cognitive functionalities to pluralistically capture external stimuli.However,realistic mimesis,both in the skin’s three-dimensional interlocked hierarchical structures and synchronous encoding multistimuli information capacities,remains a challenging yet vital need for simplifying the design of flexible logic circuits.Herein,we construct an artificial epidermal device by in situ growing Cu_(3)(HHTP)_(2) particles onto the hollow spherical Ti_(3)C_(2)T_(x) surface,aiming to concurrently emulate the spinous and granular layers of the skin’s epidermis.The bionic Ti_(3)C_(2)T_(x)@Cu_(3)(HHTP)_(2) exhibits independent NO_(2) and pressure response,as well as novel functionalities such as acoustic signature perception and Morse code-encrypted message communication.Ultimately,a wearable alarming system with a mobile application terminal is self-developed by integrating the bimodular senor into flexible printed circuits.This system can assess risk factors related with asthmatic,such as stimulation of external NO_(2) gas,abnormal expiratory behavior and exertion degrees of fingers,achieving a recognition accuracy of 97.6%as assisted by a machine learning algorithm.Our work provides a feasible routine to develop intelligent multifunctional healthcare equipment for burgeoning transformative telemedicine diagnosis.

《A management algorithm for patients with intracranial pressure monitoring:the Seattle International Severe Traumatic Brain Injury Consensus Conference(SIBICC)》解读

2019年国际专家团基于Delphi方法的反复调查和现场讨论,完成了"A management algorithm for patients with intracranial pressure monitoring:the Seattle International Severe Traumatic Brain Injury Consensus Conference(SIBICC)"(简称"共识"),旨在引导对仅行颅内压监测的颅脑创伤患者实施合理的分级管理。本文对"共识"所涉及的"三阶梯颅内压管理流程"、各级治疗措施的应用原则,以及镇静治疗和颅内压监测停撤的判断流程进行解读,以期将国际颅脑创伤神经重症研究进展介绍给读者。

Intracranial pressure monitoring:Gold standard and recent innovations

Intracranial pressure monitoring (ICP) is based on the doctrine proposed by Monroe and Kellie centuries ago. With the advancement of technology and science, various invasive and non-invasive modalities of monitoring ICP continue to be developed. An ideal monitor to track ICP should be easy to use, accurate, reliable, reproducible, inexpensive and should not be associated with infection or haemorrhagic complications. Although the transducers connected to the extra ventricular drainage continue to be Gold Standard, its association with the likelihood of infection and haemorrhage have led to the search for alternate noninvasive methods of monitoring ICP. While Camino transducers, Strain gauge micro transducer based ICP monitoring devices and the Spiegelberg ICP monitor are the emerging technology in invasive ICP monitoring, optic nerve sheath diameter measurement, venous opthalmodynamometry, tympanic membrane displacement, tissue resonance analysis, tonometry, acoustoelasticity, distortionproduct oto-acoustic emissions, trans cranial doppler, electro encephalogram, near infra-red spectroscopy, pupillometry, anterior fontanelle pressure monitoring, skull elasticity, jugular bulb monitoring, visual evoked response and radiological based assessment of ICP are the non-invasive methods which are assessed against the gold standard.

Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery

BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.

Amendment on the strain measurement of thin-walled human skull shell as intracranial pressure changes

The human skull, composed of tabula extema, tabula intema, and a porous diploe sandwiched in between, is deformed with changing intracranial pressure （ICP）. Because the human skull＇s thickness is only 6 mm, it is simplified as a thin-walled shell. The objective of this article is to analyze the strain of the thin-wailed shell by the stress-strain calculation of a human skull with changing ICP. Under the same loading conditions, using finite element analysis （FEA）, the strains of the human skull were calculated and the results were compared with the measurements of the simulative experiment in vitro. It is demonstrated that the strain of the thin-walled shell is totally measured by pasting the one-way strain foils on the exterior surface of the shell with suitable amendment for data. The amendment scope of the measured strain values of the thin-walled shell is from 13.04% to 22.22%.

Outcomes of high-grade aneurysmal subarachnoid hemorrhage patients treated with coiling and ventricular intracranial pressure monitoring

BACKGROUND High-grade aneurysmal subarachnoid hemorrhage is a devastating disease with a low favorable outcome.Elevated intracranial pressure is a substantial feature of high-grade aneurysmal subarachnoid hemorrhage that can result to secondary brain injury.Early control of intracranial pressure including decompressive craniectomy and external ventricular drainage had been reported to be associated with improved outcomes.But in recent years,little is known whether external ventricular drainage and intracranial pressure monitoring after coiling could improve outcomes in high-grade aneurysmal subarachnoid hemorrhage.AIM To investigate the outcomes of high-grade aneurysmal subarachnoid hemorrhage patients with coiling and ventricular intracranial pressure monitoring.METHODS A retrospective analysis of a consecutive series of high-grade patients treated between Jan 2016 and Jun 2017 was performed.In our center,followed by continuous intracranial pressure monitoring,the use of ventricular pressure probe for endovascular coiling and invasive intracranial pressure monitoring in the acute phase is considered to be the first choice for the treatment of high-grade patients.We retrospectively analyzed patient characteristics,radiological features,intracranial pressure monitoring parameters,complications,mortality and outcome.RESULTS A total of 36 patients were included,and 32(88.89%)survived.The overall mortality rate was 11.11%.No patient suffered from aneurysm re-rupture.The intracranial pressure in 33 patients(91.67%)was maintained within the normal range by ventricular drainage during the treatment.A favorable outcome was achieved in 18 patients(50%)with 6 mo follow-up.Delayed cerebral ischemia and Glasgow coma scale were considered as significant predictors of outcome(2.066 and-0.296,respectively,P<0.05).CONCLUSION Ventricular intracranial pressure monitoring may effectively maintain the intracranial pressure within the normal range.Despite the small number of cases in the current work,high-grade patients may benefit from a combination therapy of early coiling and subsequent ventricular intracranial pressure monitoring.

Changes of Nitric Oxide and Its Relationship with Clinical Features,Intracranial Pressure and Outcome in Acute Head Injury

To investigate the content and dynamics of nitric oxide (NO) in the cerebrospinal fluid (CSF) of patients with acute head injury and to clarify the relationship of NO with clinical features and intracranial pressure (ICP) as well as outcomes, 38 adults with acute head injury were studied. Glasgow Coma Scale (GCS) obtained at admission and Glasgow Outcome Scale (GOS) 3 months after injury was assessed. ICP was surveyed via intraventricular catheter and lumbar puncture and CSF samples were obtained simultaneously. NO was determined with Griess reagents. Results showed that NO peak content in the head injury group was significantly higher than that of the control group. During dynamic research, no peak content of mildly injured cases and severely injured ones appeared in different time windows respectively. The peak value of NO was distinctly higher in the severe group than in the mild group. NO peak value of the raised ICP group was remarkably higher than that of the normal ICP group. The peak value of NO was considerately higher in the poor outcome group than in the good outcome group. When the content of NO was over 6. 5 μmol/L, the rate of poor outcome was increased. There existed a correlation between NO and GCS, ICP and GOS. It is concluded that the content of NO was increased in patients with acute head injury and the changes of NO had different time windows in severely injured patients and mildly injured ones. The more sever the injury, the higher the NO content; and the more serious the secondary brain injury and brain edema, the worse the outcomes. When NO is combined with GCS, GOS and ICP, it increases the accuracy of judgement to the degree of head injury and outcome.

Closed cranial window rodent model for investigating hemodynamic response to elevated intracranial pressure

Background:Elevated intracranial pressure(ICP)occurs in several physiological and pathological conditions,yet long-term sequellae are not common,which implies that blood flow is preserved above ischemic thresholds.Methods:This pilot study sought to confirm this hypothesis using a closed cranial window model in a rat in which ICP was elevated to 120 mmHg for 12 min,and superficial cortical perfusion was measured by laser Doppler flowmetry and laser speckle flowmetry.Results:Following a transient increase,cortical blood flow decreased to between 25%and 75%of baseline.These levels correspond to disrupted metabolism and decreased protein synthesis but did not exceed thresholds for electrical signaling or membrane integrity.This may partially explain how some episodes of elevated ICP remain benign.Conclusion:The closed cranial window model provides a platform for prospective study of physiologic responses to artificially elevated ICP during neurosurgery to promote hemostasis.

Bedside ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure in nontraumatic neurocritically ill patients

BACKGROUND Delay in treatment of raised intracranial pressure(ICP)leads to poor clinical outcomes.Optic nerve sheath diameter(ONSD)by ultrasonography(US-ONSD)has shown good accuracy in traumatic brain injury and neurosurgical patients to diagnose raised ICP.However,there is a dearth of data in neuro-medical intensive care unit(ICU)where the spectrum of disease is different.AIM To validate the diagnostic accuracy of ONSD in non-traumatic neuro-critically ill patients.METHODS We prospectively enrolled 114 patients who had clinically suspected raised ICP due to non-traumatic causes admitted in neuro-medical ICU.US-ONSD was performed according to ALARA principles.A cut-off more than 5.7 mm was taken as significantly raised.Raised ONSD was corelated with raised ICP on radiological imaging.Clinical history,general and systemic examination findings,SOFA and APACHE 2 score and patient outcomes were recorded.RESULTS There was significant association between raised ONSD and raised ICP on imaging(P<0.001).The sensitivity,specificity,positive and negative predictive value at this cut-off was 77.55%,89.06%,84.44% and 83.82% respectively.The positive and negative likelihood ratio was 7.09 and 0.25.The area under the receiver operating characteristic curves was 0.844.Using Youden’s index the best cut off value for ONSD was 5.75 mm.Raised ONSD was associated with lower age(P=0.007),poorer Glasgow Coma Scale(P=0.009)and greater need for surgical intervention(P=0.006)whereas no statistically significant association was found between raised ONSD and SOFA score,APACHE II score or ICU mortality.Our limitations were that it was a single centre study and we did not perform serial measurements or ONSD pre-and post-treatment or procedures for raised ICP.CONCLUSION ONSD can be used as a screening a test to detect raised ICP in a medical ICU and as a trigger to initiate further management of raised ICP.ONSD can be beneficial in ruling out a diagnosis in a low-prevalence population and rule in a diagnosis in a high-prevalence population.

Effect of sedative agent selection on morbidity, mortality and length of stay in patients with increase in intracranial pressure

BACKGROUND: To identify the effects of sedative agent selection on morbidity, mortality, and length of stay in patients with suspected increase in intracranial pressure. Recent trends and developments have resulted in changes to medications that were previously utilized as pharmacological adjuncts in the sedation and intubation of patients with suspected increases in intracranial pressure. Medications that were previously considered contraindicated are now being used with increasing regularity without demonstrated safety and effectiveness. The primary objective of this study is to evaluate and compare the use of Ketamine as an induction agent for patients with increased intracranial pressure. The secondary objective was to evaluate and compare the use of Etomidate, Midazolam, and Ketamine in patients with increased intracranial pressure. METHODS: We conducted a retrospective chart review of patients transported to our facility with evidence of intracranial hypertension that were intubated before trauma center arrival. Patients were identifi ed during a 22-month period from January 2014 to October 2015. Goals were to evaluate the impact of sedative agent selection on morbidity, mortality, and length of stay.RESULTS: During the review 148 patients were identifi ed as meeting inclusion criteria, 52 were excluded due to incomplete data. Of those the patients primarily received; Etomidate, Ketamine, and Midazolam. Patients in the Ketamine group were found to have a lower mortality rate after injury stratifi cation. CONCLUSION: Patients with intracranial hypertension should not be excluded from receiving Ketamine during intubation out of concern for worsening outcomes.

Research Progresses in Effects of Analgesics and Sedatives on Intracranial Pressure of Neurointensive Care Patients

At present, there are some concerns and problems to treat neurointensive care patients by using analgesics and sedatives. Conditions of neurointensive care patients change quickly. For neurointensive care patients who cannot have auxiliary examination timely, clinicians judge intracranial conditions mainly through relevant monitoring devices and consciousness and pupil changes of patients. The use of analgesics and sedatives is limited due to worry about influences on consciousness evaluation and judgment and different degrees of inhibition on cardiovascular system and respiratory system. Common sedatives (e.g. benzodiazepines) and common analgesics (e.g. morphine, fentanyl and sufentanil) both may inhibit respiration. The specification often provides taboos for the use of drugs by patients with increase intracranial pressure (ICP) and craniocerebral injuries. Through literature review, the author analyzed influences of analgesics and sedatives on ICP of neurointensive care patients comprehensively.

Increased intracranial pressure and macular thickening:is there a link?

Dear Editor,I am Dr. Hamid Sajjadi, director of Neuro-Ophthalmology at San Jose Eye and Laser Medical Center in California USA and director of Department of Ophthalmology, Acacia Medical Center, Dubai, UAE. I write to present three cases of macular thickening (MT) and micro-papilledema associated with increased intracranial pressure (IICP).

Intracranial Pressure and the Role of the Vagus Nerve: A Hypothesis

There is reason to believe that the vagus nerve carries sensory afferent messages from the intracranial cavity as it does from the other body cavities. Considering the arachnoid granulations as a secretory apparatus instead of an organ transporting cerebrospinal fluid, a simple model can be built. Assuming that the arachnoid granulations produce nitric oxide in accordance with changes in the intracranial pressure, the jugular foramen with the vagus nerve lying just subendothelially is where this message would be received. Other chemical substances from the granulations or other intracranial tissues could of course also act as messengers. This would mean that the brain stem could adjust to changes in intracranial pressure with small changes in cerebral venous resistance. The general idea is that intracranial pressure is a passive function of the intracranial pressure-volume relationship. But the hypothesis suggests that the vagus nerve constantly mediates changes in intracranial pressure to the brain stem that can rapidly adjust cerebral venous resistance. This control is totally intracranial and easily overridden by considerable changes in absorption of spinal fluid or intracranial calamities. This article looks for clues in support of the idea that the vagus nerve mediates intracranial pressure changes to the brain stem.

Early antiplatelet therapy used for acute ischemic stroke and intracranial hemorrhage

In this editorial we comment on the article published by Zhang et al in the recent issue of World Journal of Clinical Cases.We evaluate their claims on the benefit of use of Aspirin in the early management of patients with ischemic stroke.We also comment on their contention of using aspirin in the early management of patients with intracranial hemorrhage,a practice not seen in modern medicine.Large clinical trials such as the International Stroke Trial and the Chinese Acute Stroke Trial have shown the benefit of Aspirin use within 48 h of patients with Acute Ischemic Stroke.The findings were corroborated in the open-label trial performed by Zhang et al in a smaller sample group of 25 patients where they showed improvement in functional scores at 90 days without an increase in adverse events.As such,this intervention is also recommended by the American Heart Association stroke guidelines from 2021.With regard to Intracranial hemorrhage,traditional practice has been to discontinue or avoid antiplatelet therapy in these patient groups.However,no studies have been done to evaluate this management strategy that is more borne out of the mechanism behind Aspirin’s effect on the coagulation pathway.Zhang et al evaluate the benefits of Aspirin on patients with low-volume intracranial hemorrhage,i.e.,less than 30 mL on computed tomo-graphy imaging,and show no increase in mortality.The caveat of this finding is that all outcomes were pooled into one group for results,and the number of patients was low.While more studies with larger patient groups are required,the data from Zhang et al suggests that patients with small-volume intracranial hemorrhages may benefit from Aspirin administration in the acute phase of management.

Neurovascular compression and decompression of the intracranial vagus for blood pressure

BACKGROUND： Previous researches demonstrated that neurovascular decompression could cure hypertension; however, whether it could effectively control refractory hypertension after hypertensive cerebral hemorrhage should be further studied. OBJECTIVE： To observe the effect of neruovascular compression on intracranial vagus for blood pressure of dogs and investigate the effect of neurovascular decompression on blood pressure of patients with hypertensive cerebral hemorrhage. DESIGN： Randomized controlled animal study, clinical effects and retrospective analysis. SETTING： Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA. MATERIALS： The experiment was carried out in the Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA from May to October 2006. A total of 15 healthy adult dogs of both genders were randomly divided into experimental group （n =10） and control group （n =5）. Clinical observation： A total of 41 patients with hypertensive cerebral hemorrhage were selected from the Department of Neurosurgery, General Hospital of Nanjing Military Area Command of Chinese PLA and the Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA from October 1999 to October 2006. Among them, one patient had brain stem hemorrhage. There were 27 males and 14 females aged from 41 to 66 years. Inclusion criteria： All patients were diagnosed with CT examination once or several times. Volume of hematoma ranged from 50 to 120 mL and had obviously operative indication. All patients provided consents. In addition, another 281 patients with hypertensive cerebral hemorrhage who received traditionally internal and surgical therapies in our departments of neurosurgery, neurology and emergency room were selected in the control group. METHODS： ①Animal experiments： 20 cm autochthonous great saphenous vein was taken from dogs in the experimental group and coincided with tip of facial artery to form arterial loop so as to oppress left vagus and lateral bulb abdomen. In addition, 20 cm autochthonous great saphenous vein was taken from dogs in the control group and coincided with tip of facial artery to establish arterial loop so as to oppress left cerebellum to observe changes of blood pressure before and at 1, 2, 3 and 4 weeks after operation. ②Clinical observation： Among 41 patients with hypertensive cerebral hemorrhage including one with brain stem hemorrhage, they received microvascular decompression of vagus immediately after getting rid of intracerebral hematoma and stopping bleeding to observe its effect of depressurization. ALL patients and their relatives provided consents. ③A total of 281 patients with hypertensive cerebral hemorrhage who discharged after the treatment of traditionally internal and surgical therapies were studied retrospectively to observe changes of blood pressure after routine treatment and compare the results with neurovascular decompression. MAIN OUTCOME MEASURES： ①Changes of blood pressure of experimental dogs; ②effect of vascular decompression of vagus for blood pressure of patients with hypertensive cerebral hemorrhage after cleating intracerebral hematoma; ③different effects ofneurovascular decompression and routinely internal and surgical therapies on hypertension. RESULTS： ①Results of animal experiments： Nine dogs in the experimental group survived. At 1, 2, 3 and 4 weeks after operation, blood pressure of dogs in the experimental group was （139.77 ±4.06）, （149.11 ±4.90）, （148.10±4.16）, （147.76±4.15） mm Hg （1mm Hg=0.133 kPa）, which was higher than that of dogs in the control group [（117.20±2.74）, （116.65±3.74）, （116.26±1.8）, （115.81±3.76） mm Hg, P 〈 0.01]. ②Results of clinical observation： Among 41 patients, 8 （20%） cases died during the operation. In addition,among other 33 （80%） survival patients, 11 （33%） cases had normal blood pressure; blood pressure of 14 （43%） cases was improved or closed to nonnal value; blood pressure of 8 （24%） cases was not changed obviously as compared with that before operation. ③ The restllts demonstrated that, by using traditionally internal and surgical therapies, among 281 patients with hypertensive cerebral hemorrhage, blood pressure of about 15% cases was recovered or closed to normal value. Those mentioned above did not have history of hypertension before hemorrhage. However, patients who had history of hypertension before hemorrhage received the traditionally internal or surgical therapies, and the blood pressure was not improved to the normal value after the treatment. CONCLUSION： ① Neurovascular compression in left intracranial vagus can cause obvious increase of blood pressure of dogs, and the increasing volume was 30 mm Hg. ② Vascular decompression of vagus has a great effect on refractory hypertension, and the improvement of blood pressure is superior to traditionally internal and surgical therapies in clinic.

Epidural Blood Patches Performed with Miethke Sensor Reservoir for Continuous Intracranial Pressure Monitoring

An epidural blood patch (EBP) is a procedure performed by injecting autologous blood into a patient’s epidural space, usually at the site of a suspected CSF leak. It is typically performed in patients with characteristic postural headaches due to low intracranial pressure. We report a case of a young female with an implanted Miethke Sensor Reservoir, which was used for continuous intracranial pressure (ICP) monitoring during a two-level epidural blood patch. ICP increased only with thoracic injection, suggesting thoracic EBP may have greater efficacy than lumbar EBP in treating SIH and PDPH when the site of CSF leak is unknown.

Resolution of idiopathic intracranial hypertension after sustained lowering of cerebrospinal fluid pressure

Idiopathic intracranial hypertension(IIH) is a syndrome of headache due to raised intracranial pressure(ICP) where the cerebrospinal fluid(CSF) is normal and there is no alternative pathology on imaging. The aetiology is unknown. This review questions many of the prevailing views regarding aetiology and treatment of IIH. It explores the concept that there is a vicious cycle of fluctuating raised ICP leading to secondary compression of the transverse sinuses and further elevation of ICP. It also raises the question as to whether this vicious cycle could be relieved by prolonged drainage of CSF as seen in Lumbar puncture induced low-pressure headache or alternatively a lumbar drain.

Knowledge domain and emerging trends in the rupture risk of intracranial aneurysms research from 2004 to 2023

BACKGROUND Intracranial aneurysms(IAs)pose significant health risks,attributable to their potential for sudden rupture,which can result in severe outcomes such as stroke and death.Despite extensive research,the variability of aneurysm behavior,with some remaining stable for years while others rupture unexpectedly,remains poorly understood.AIM To employ bibliometric analysis to map the research landscape concerning risk factors associated with IAs rupture.METHODS A systematic literature review of publications from 2004 to 2023 was conducted,analyzing 3804 documents from the Web of Science Core Collection database,with a focus on full-text articles and reviews in English.The analysis encompassed citation and co-citation networks,keyword bursts,and temporal trends to delineate the evolution of research themes and collaboration patterns.Advanced software tools,CiteSpace and VOSviewer,were utilized for comprehensive data visualization and trend analysis.RESULTS Analysis uncovered a total of 3804 publications on IA rupture risk factors between 2006 and 2023.Research interest surged after 2013,peaking in 2023.The United States led with 28.97%of publications,garnering 37706 citations.Notable United States-China collaborations were observed.Capital Medical University produced 184 publications,while Utrecht University boasted a citation average of 69.62 per publication.“World Neurosurgery”published the most papers,contrasting with“Stroke”,the most cited journal.The PHASES score from“Lancet Neurology”emerged as a vital rupture risk prediction tool.Early research favored endovascular therapy,transitioning to magnetic resonance imaging and flow diverters.CONCLUSION This study assesses global IA research trends and highlights crucial gaps,guiding future investigations to improve preventive and therapeutic approaches.