Intracranial Anatomy Research Articles

Elevated systemic venous pressures as a possible pathology in prepubertal pediatric idiopathic intracranial hypertension.

Pediatric idiopathic intracranial hypertension (IIH) is a rare and challenging condition. As implied by the nomenclature, the etiologies remain unknown, and multiple etiologies are being investigated. In this study, we explored the potential role of increased systemic or cerebral venous pressure in the pathogenesis. An observational cohort study following the STROBE guidelines, including prepubertal children with clinical symptoms and imaging findings consistent with IIH referred to the neurosurgical department, was conducted. The patients underwent a comprehensive diagnostic protocol, including MRI, continuous intracranial pressure (ICP) monitoring, and endovascular venography with venous pressure measurements. The study included 11 consecutive patients (six boys and five girls) with an average age of 2.3years, and an average BMI of 18.4. Among these, one patient was found to have venous stenosis with a gradient; the other 10 patients presented with normal intracranial anatomy. All patients exhibited elevated venous pressures, with an average superior sagittal sinus pressure of 18.9mmHg, average internal jugular vein pressure of 17.0mmHg, and average central venous pressure of 15.9mmHg. Daytime ICP averaged 12.9mmHg, whereas nighttime ICP averaged 17.2mmHg with either A- or B-waves in 10 of the 11 patients. Despite pathological ICP, only three patients had papilledema. All patients had an increased systemic venous pressure, indicating a possible pathological factor for prepubertal IIH. Additionally, our findings show that young children often only partly meet the Friedman criteria due to a lack of papilledema, emphasizing the need for pediatric-specific diagnostic criteria. Further large-scale studies are needed to confirm these findings and to explore the underlying reasons for this increase in venous pressure and potential new treatment avenues.

Diagnostic Dilemmas in Fetal Scalp Cystic Lesions: A Case Series

AbstractFetal Scalp cystic lesions are occasionally encountered during the routine mid trimester scan. Some may be benign scalp cysts like an epidermal or dermal cyst, and some may contain neural tissue with associated calvarial defects like meningocele or encephalocele. Prenatally, differentiating them and arriving at an exact diagnosis is challenging. This case study describes seven cases diagnosed with fetal scalp cysts and normal intracranial anatomy. Seven cases with normal intracranial anatomy were included. Out of seven cases, four turned out to be scalp cysts, two turned out to be meningocele, and one was atretic encephalocele. Of four cases of scalp cysts, three regressed spontaneously and one required surgical excision. All instances of meningocele and encephalocele required surgical correction. In the case of fetal scalp cystic lesions, the presence of normal intracranial anatomy and head circumference, the absence of other associated anomalies, and the use of high frequency ultrasound transducers to rule out calvarial defects can aid in delineating the diagnosis of benign fetal scalp cysts.

GRAVEN: a database of teaching method that applies gestures to represent the neurosurgical approach’s blood vessels and nerves

BackgroundIn this era of rapid technological development, medical schools have had to use modern technology to enhance traditional teaching. Online teaching was preferred by many medical schools. However due to the complexity of intracranial anatomy, it was challenging for the students to study this part online, and the students were likely to be tired of neurosurgery, which is disadvantageous to the development of neurosurgery. Therefore, we developed this database to help students learn better neuroanatomy.Main bodyThe data were sourced from Rhoton’s Cranial Anatomy and Surgical Approaches and Neurosurgery Tricks of the Trade in this database. Then we designed many hand gesture figures connected with the atlas of anatomy. Our database was divided into three parts: intracranial arteries, intracranial veins, and neurosurgery approaches. Each section below contains an atlas of anatomy, and gestures represent vessels and nerves. Pictures of hand gestures and atlas of anatomy are available to view on GRAVEN (www.graven.cn) without restrictions for all teachers and students. We recruited 50 undergraduate students and randomly divided them into two groups: using traditional teaching methods or GRAVEN database combined with above traditional teaching methods. Results revealed a significant improvement in academic performance in using GRAVEN database combined with traditional teaching methods compared to the traditional teaching methods.ConclusionThis database was vital to help students learn about intracranial anatomy and neurosurgical approaches. Gesture teaching can effectively simulate the relationship between human organs and tissues through the flexibility of hands and fingers, improving anatomy interest and education.

Composition of encephalic arteries and origin of the basilar artery are different between vertebrates.

Intracranial arterial anatomy is lacking for most mammalian and non-mammalian model species, especially concerning the origin of the basilar artery (BA). Enhancing the knowledge of this anatomy can improve animal models and help understanding anatomical variations in humans. We have studied encephalic arteries in three different species of birds and eight different species of mammals using formalin-fixed brains injected with arterial red latex. Our results and literature analysis indicate that, for all vertebrates, the internal carotid artery (ICA) supplies the brain and divides into two branches: a cranial and a caudal branch. The difference between vertebrates lies in the caudal branch of the ICA. For non-mammalian, the caudal branch is the origin of the BA, and the vertebral artery (VA) is not involved in brain supply. For mammals, the VA supplies encephalic arteries in two different ways. In the first type of organization, mostly found in ungulates, the carotid rete mirabile supplies the encephalic arteries, the caudal branch is the origin of the BA, and the VA is indirectly involved in carotid rete mirabile blood supply. The second type of encephalic artery organization for mammals is the same as in humans. The caudal branch of the ICA serves as the posterior communicating artery, and the BA originates from both VAs. We believe that knowledge of comparative anatomy of encephalic arteries contributes to a better understanding of animal models applicable to surgical or radiological techniques. It improves the understanding of rare encephalic variations that may be present in humans.

Fluorophores in Endoscopic Neurosurgery.

The complexity of intracranial anatomy and pathologies warrants the optimization of multimodal techniques to ensure safe and effective surgical treatment. Endoscopy is being more widely implemented in intracranial procedures as an important visualization tool, as it can offer panoramic views of deep structures while reducing the invasiveness of approaches. Fluorophores are frequently utilized to augment the identification of intracranial anatomic landmarks and pathologies. This chapter discusses the integration of these two surgical adjuncts, highlighting the key fluorophores used in endoscopic neurosurgery and their clinical applications.

Intracranial Anatomy and Surgical Techniques for Extended Orbital Exenteration for Sinonasal Malignancy with Orbital Apex Extension

Gross total tumor resection for sinonasal malignancy with orbital apex extension requires orbital exenteration and bony skull base resection around the orbital apex with sufficient margins. With a detailed discussion of the anatomy, we describe our surgical procedure for extended orbital exenteration with orbital apex resection for sinonasal malignancy.

A feasibility study of several 3D printing methods for applications in epilepsy surgery.

To describe the process of 3-dimensional printing in epilepsy surgery using three different methods: Low-Force Stereolithography (SLA), Filament-Deposition Modeling (FDM), and Polyjet Stratasys, while comparing them in terms of printing efficiency, cost, and clinical utility.,MRI and CT images of patient anatomy have been limited to review in the 2-dimensional plane, which provides only partial representation of intricate intracranial structures. There has been growing interest in 3D printing of physical models of this complex anatomy to be used as an educational tool and for surgical visualization. One specific application is in epilepsy surgery where there are challenges in visualizing complex intracranial anatomy in relation to implanted surgical tools. MRI and CT data from patients with refractory epilepsy from a single center that underwent surgery are converted into 3D volumes, or stereolithography files. These were then printed using three popular 3D printing methods: SLA, FDM, and Polyjet. Faculty were surveyed on the impact of 3D modeling on the surgical planning process. All three methods generated physical models with an increasing degree of resolution, transparency, and clinical utility directly related to cost of production and accurate representation of anatomy. Polyjet models were the most transparent and clearly represented intricate implanted electrodes but had the highest associated cost. FDM produced relatively inexpensive models that, however, were nearly completely opaque, limiting clinical utility. SLA produced economical and highly transparent models but was limited by single material capacity. Three-dimensional printing of patient-specific anatomy is feasible with a variety of printing methods. The clinical utility of lower-cost methods is limited by model transparency and lack of multi-material overlay respectively. Polyjet successfully generated transparent models with high resolution of internal structures but is cost prohibitive. Further research needs to be done to explore cost-saving methods of modeling.

A Clinical Approach to Semiautomated Three-Dimensional Fetal Brain Biometry-Comparing the Strengths and Weaknesses of Two Diagnostic Tools: 5DCNS+TM and SonoCNSTM.

(1) Objective: We aimed to evaluate the accuracy and efficacy of AI-assisted biometric measurements of the fetal central nervous system (CNS) by comparing two semiautomatic postprocessing tools. We further aimed to discuss the additional value of semiautomatically generated sagittal and coronal planes of the CNS. (2) Methods: Three-dimensional (3D) volumes were analyzed with two semiautomatic software tools, 5DCNS+™ and SonoCNS™. The application of 5DCNS+™ results in nine planes (axial, coronal and sagittal) displayed in a single template; SonoCNS™ depicts three axial cutting sections. The tools were compared regarding automatic biometric measurement accuracy. (3) Results: A total of 129 fetuses were included for final analysis. Our data indicate that, in terms of the biometric quantification of head circumference (HC), biparietal diameter (BPD), transcerebellar diameter (TCD) and cisterna magna (CM), the accuracy of SonoCNS™ was higher with respect to the manual measurement of an experienced examiner compared to 5DCNS+™, whereas it was the other way around regarding the diameter of the posterior horn of the lateral ventricle (Vp). The inclusion of four orthogonal coronal views in 5DCNS+™ gives valuable information regarding spatial arrangements, particularly of midline structures. (4) Conclusions: Both tools were able to ease assessment of the intracranial anatomy, highlighting the additional value of automated algorithms in clinical use. SonoCNS™ showed a superior accuracy of plane reconstruction and biometry, but volume reconstruction using 5DCNS+™ provided more detailed information, which is needed for an entire neurosonogram as suggested by international guidelines.

A novel 3D surgical neuroanatomy course for medical students: Outcomes from a pilot 6-week elective

BackgroundDeveloping and maintaining a three-dimensional working knowledge of neuroanatomy is an essential skill in neurosurgery. However, conventional 2D head, neck, and neuroanatomy education is typically characterized by the separate rote learning of constituent tissues and often fails to provide learners with a contextual understanding of the relationships between these highly complex and interconnected structures. This can pose a significant challenge to medical students entering neurosurgery who lack a topographic understanding of intracranial anatomy. MethodsWe report on the design and efficacy of a novel 6-part 3D surgical neuroanatomy pilot elective for medical students that utilized a navigation-based pedagogical technique with the goal of providing students with a framework for developing a 3D mental map of the skull base, neurovasculature, ventricular system, and associated brain regions. Students took on the perspective of physically traveling along the paths of key structures with a 360-degree view of surrounding anatomy such that they could appreciate the integration and relative spatial relationships of the varying tissues within the cranium. Mental navigation exercises and pre- and post-course surveys were used to assess students’ baseline and learned familiarity with the different anatomical regions covered. ResultsAt the conclusion of the course, all students were able to successfully complete all of the multifaceted mental navigation exercises. Post-course survey data indicated that respondents perceived significant increases in their knowledge of cranial nerves; anterior, middle, and posterior skull base anatomy; anterior and posterior cranial circulation; and the ventricular system. Conclusion3D navigation-based fly-through instruction is a novel and effective technique for teaching complex anatomy and can provide learners with the foundational skills for developing and maintaining a 3D mental map of intracranial anatomy.

Changes in fetal intracranial anatomy during maternal pregestational and gestational diabetes.

To evaluate the changes in fetal intracranial structures in pregnant women with pregestational diabetes mellitus (DM) and gestational diabetes mellitus (GDM). The study was conducted prospectively with patients who were grouped as pregestational DM (n=110), GDM (n=110), and control (n=110). Fetal ultrasonographic measurements of widths of posterior lateral ventricles (PLV), cavum septum pellucidi (CSP), cisterna magna (CM), thalamus and transcerebellar diameter (TCD) were recorded and compared. Fetal PLV, CSP, and CM widths were higher in pregestational DM and GDM groups than in control group, and also higher in pregestational DM group compared to GDM group (p < 0.001). Fetal TCD in the PGDM group was found to be less than both control and GDM groups (p < 0.001). No difference was found between three groups in terms of fetal thalamus size (p=0.801). Fetal PLV, CSP, and CM values were positively correlated with maternal hyperglycemia, fetal abdominal circumference (AC), and deepest vertical pocket of amniotic fluid (DVP) (p < 0.001). Fetal TCD was negatively correlated with HbA1c and DVP (p=0.002, p=0.38, respectively). The optimal cut-off points to identify pregestational DM and GDM were 5.55 and 5.83 mm for PLV, 5.83 and 6.32 mm for CSP, and 7.26 and 6.62 mm for CM. Maternal hyperglycemia was significantly associated with an increase in the widths of fetal PLV, CSP, and CM and a decrease in fetal TCD.

Managing an open nasofrontal encephalocele after birth

Encephaloceles are relatively uncommon in western countries. Most of the reported cases involve occipital encephaloceles. Open frontal encephaloceles comprise a rare entity. Most of them will be detected during early prenatal diagnostic, whereas the majority of the pregnancies will be terminated after the consent of the parents. Open frontal encephaloceles pose a great challenge to neurosurgeons as well as anesthesiologists, as these infants present with a microcephaly, non-physiological intracranial anatomy, and low birth weight, thus making the infant prone to excessive blood loss, hypothermia, and death. Neonates born with an incomplete cutaneous coverage are exposed to an imminent threat to life due to the risk of meningitis, necessitating surgical repair in the first days of life. We represent a rare case of an open nasofrontal encephalocele managed surgically in the first day of life. Surgery did not influence the neurological outcome of the patient.

New frontiers in intracranial imaging with HF-OCT: Ex vivo human cerebrovasculature evaluation and in vivo intracranial arteries dynamic visualization

Optical coherence tomography (OCT) technology is a well-established diagnostic tool in multiple fields of medicine. Intravascular OCT has been used for more than a decade for the clinical imaging of coronary arteries, however, its use for the imaging of the human cerebrovasculature has been delayed by the challenges posed by the elevated vascular tortuosity. A novel high-frequency OCT (HF-OCT) probe designed for neurovascular use was evaluated in tortuous, ex vivo, human intracranial anatomy and, using an in vivo canine model, for the dynamic imaging of intracranial arteries and the subarachnoid trabecula (SAT). Using four cadavers, we investigated HF-OCT probe navigation and imaging performances in human anterior arterial circulation (from the M4 segment to internal carotid artery), in the posterior arterial circulation (from the P4 segment to vertebrobasilar junction) and in a broad range of venous sinuses. HF-OCT was able to gain distal access through elevated tortuosity and generate high-quality imaging data depicting vessel morphology, the vessel wall pathology (e.g., atherosclerotic disease and dissecting lesions), and the subarachnoid trabecula (SAT). Using an in vivo canine model, the HF-OCT probe was used to record stationary dynamic data in multiple intracranial vascular locations. Data showed the motion of the arteries and the SAT, including collisions between vessels, membranes, and the interaction between the SAT and the blood vessels. HF-OCT data allowed for the quantification of the dynamics of the vessels and the SAT, including vessel lateral motion with respect to the parenchyma, and collisions between large and small arteries. Results showed that the HF-OCT probe can overcome delivery obstacles in tortuous cerebrovascular anatomy and provide high-quality and high-resolution imaging at multiple distal locations, including M4 and P4 segments of the anterior and posterior circulations. HF-OCT has the potential to facilitate a better understanding of fine anatomical details of the cerebrovascular and perivascular environment, neurovascular disease, and collect real time information about the dynamics of the subarachnoid space and arteries and become a valuable diagnostic tool.

Intracranial Magnetic Resonance Venography of Superior Sagittal Sinus, Straight Sinus and Cerebral Venous Channels: Normal Anatomy and Variations in North Indian Population

Abstract The intracranial dural venous sinuses can be injured leading to thrombosis with in the dural sinuses causing headache, abnormal vision, weakness of the face and limbs on one side of the body, and seizures.Magnetic Resonance Venography (MRV) is one of the preferred methods of evaluation of the cerebral venous sinus anatomy, variations and pathology, particularly in the diagnosis of venous sinus thrombosis. The purpose of this study is to evaluate the use of MRV to depict the normal intracranial venous anatomy and its variants in North Indian population which can help to avoid potential pitfalls in the diagnosis of dural venous sinus thrombosis, venous infarcts and venous hemorrhage. Aim:The purpose of this study is to evaluate the use of MRV to depict the normal intracranial venous anatomy and its variants in North Indian population, which can help to avoid potential pitfalls in the diagnosis of dural venous sinus thrombosis, venous infarcts and venous hemorrhage. Materials:The present study was undertaken in the Departments of Anatomy and Radiodiagnosis at a North Indian tertiary care teaching hospital over a period of two years. Magnetic Resonance Venograms (MRV) of patients attending the radiology department were used to study the normal anatomy and variations in the dural venous sinuses. 50 MRV scans of which 26 were of females and 24 of male, were included in the study. Anatomical variations and variations in drainage of the dural venous sinuses were assessed and statistical analysis was done. Results:For both superior sagittal sinus drainage and straight sinus drainage, the proportion of veins draining in right and left transverse sinuses and confluence of sinuses was significantly different in the two age groups (p&lt;0.001) in both males and females. Partial splitting of superior sagittal sinus in anterior one third or posterior one third was also seen. Statistically significant findings were observed regarding the laterality for vein of Labbe &amp; vein of Trolard. Conclusion:MR venography is an excellent diagnostic technique to visualise anatomy and anatomic variations of venous sinuses as observed in our study. The partial splitting of superior sagittal sinus in either anterior one third or posterior one third as seen in our study, can cause misdiagnosis of thrombosis. Hence, knowledge of normal anatomy and anatomic variations in the intracranial venous sinuses is very important to diagnose cerebral venous sinus thrombosis accurately.

Brain topography on adult ultrasound images: Techniques, interpretation, and image library.

Many studies have explored the possibility of using cranial ultrasound for discerning intracranial pathologies like tumors, hemorrhagic stroke, or subdural hemorrhage in clinical scenarios where computer tomography may not be accessible or feasible. The visualization of intracranial anatomy on B-mode ultrasound is challenging due to the presence of the skull that limits insonation to a few segments on the temporal bone that are thin enough to allow transcranial transmission of sound. Several artifacts are produced by hyperechoic signals inherent in brain and skull anatomy when images are created using temporal windows. While the literature has investigated the accuracy of diagnosis of intracranial pathology with ultrasound, we lack a reference source for images acquired on cranial topography on B-mode ultrasound to illustrate the appearance of normal and abnormal structures of the brain and skull. Two investigators underwent hands-on training in Cranial point-of-care ultrasound (c-POCUS) and acquired multiple images from each patient to obtain the most in-depth images of brain to investigate all visible anatomical structures and pathology within 24hours of any CT/MRI imaging done. Most reproducible structures visible on c-POCUS included bony parts and parenchymal structures. Transcranial and abdominal presets were equivalent in elucidating anatomical structures. Brain pathology like parenchymal hemorrhage, cerebral edema, and hydrocephalus were also visualized. We present an illustrated anatomical atlas of cranial ultrasound B-mode images acquired in various pathologies in a critical care environment and compare our findings with published literature by performing a scoping review of literature on the subject.

Bedside Ultrasound for Ventricular Size Monitoring in Patients with PEEK Cranioplasty: A Preliminary Experience of Technical Feasibility in Neurotrauma Setting

BackgroundPosttraumatic hydrocephalus is a known complication after traumatic brain injury, particularly affecting patients undergoing decompressive craniectomy. Posttraumatic hydrocephalus monitoring in these patients represents a common issue in neurosurgical practice. Patients require periodical assessments by means of computed tomography (CT) scans. This study presents a preliminary institutional series in which ultrasound was used as a bedside imaging technique to monitor ventricular size in patients harboring a polyetheretherketone (PEEK) cranioplasty. Exploiting the PEEK cranioplasty permeability to echoes, we evaluated the feasibility of this bedside imaging method in monitoring hydrocephalus evolution, determining effects of ventriculo-peritoneal shunt, and excluding complications.MethodsEight patients with traumatic brain injury harboring PEEK cranioplasty following decompressive craniectomy were prospectively evaluated. Ultrasound measurements were compared with CT scan data taken the same day, and ventricular morphometry parameters were compared.ResultsUltrasound images through the PEEK cranioplasty were of high quality and intracranial anatomy was distinctly evaluated. A strong correlation was observed between ultrasound and CT measurements. Concerning distance between lateral ventricles frontal horns (IFH) and the diameter of the third ventricle (TV), we found a strong correlation between transcranial sonography and CT measurements in preventriculoperitoneal shunt (rho = 0.92 and p = 0.01 for IFH; rho = 0.99 and p = 0.008 for TV) and in postventriculoperitoneal shunt examinations (rho = 0.95 and p = 0.03 for IFH; rho = 0.97 and p = 0.03 for TV). The mean error rate between transcranial sonography and CT scan was 1.77 ± 0.91 mm for preoperative IFH, 0.65 ± 0.27 mm for preoperative TV, 2.18 ± 0.82 mm for postoperative IFH, and 0.48 ± 0.21 mm for postoperative TV.ConclusionsTranscranial ultrasound could represent a simplification of the follow-up and management of ventricular size of patients undergoing PEEK cranioplasty. Even if this is a small series, our preliminary results could widen the potential benefits of PEEK, not only as effective material for cranial reconstruction but also, in selected clinical conditions, as a reliable window to explore intracranial content and to monitor ventricular sizes and shunt functioning.

0081 Physiologic anatomy, use of Infra-Red Thermography in Hypersomnia

Abstract Introduction In the words of Michel Salmon, " Between anatomy and physiology there is room for a functional anatomy and for a physiologic anatomy “. This concept was applied to analyze our (1) Sleep Research 21, 1992,341 (2) Sleep Research 22, 1993, 363, and (3) SLEEP 31, 2008, A219 publications on patients with Hypersomnia who had intracranial and extracranial blood flow evaluations. Methods For “Functional Anatomy”, Intracranial cerebral blood flow was done with Xenon 133 inhalation. For “Physiologic Anatomy”, Extracranial facial blood flow Imaging, Infra-Red thermography was done. 1992,3 and 2008 data was classified: Groups I, II and III. Group I had Intracranial and Extracranial blood flow study, 5% CO2 inhalation. Groups II had Extracranial flow study with 5 % CO2 and 100 % Oxygen inhalation. Groups III had Extracranial flow study 100 % Oxygen inhalation. Response interpretation: Normal response to 5% CO2, vasodilation. For 100% Oxygen / hyperoxia, vasoconstriction. Response is considered as normal or abnormal, if response is absent or paradoxical. Results Group I: All three patients 5% CO2 inhalation, intracranial Functional anatomy vasomotor response normal. Physiological Anatomy response abnormal. Group II, Physiological Anatomy study. 8 patients. CO2 response, 7/8 vasoconstriction, abnormal response. 100% Oxygen challenge, 4/8 had no vasoconstriction, abnormal response. Group III: Physiological anatomy. 7 patients tested with 100% Oxygen challenge. 6/7 abnormal response, (1 vasoconstriction, 4 no response, 2 vasodilation). Total of 18 patients in all groups, physiological anatomy/ Extracranial flow vasomotor response was abnormal in 16/18, (Group I = 3, Group II = 7, and Group III = 6) Conclusion In hypersomnia patients vasomotor testing, Functional Anatomy, intracranial flow vasomotion normal in 3/3 for hypercarbia inhalation. For Physiologic Anatomy, using Infra-Red Thermography to image extracranial facial blood flow (not coupled with metabolism) vasomotion was abnormal in 16/18 patients. 5% CO2 and 100% Oxygen inhalation used as contrast agents is well tolerated and facilitates imaging vasomotor dysfunction in the facial blood flow, trigeminal angiosomes, which can be correlated with hypersomnia. Association between trigeminal system and the hypocretin receptor 1 gene HCRTR1 gene has been reported. Support (If Any) None.

Real-time augmented reality application in presurgical planning and lesion scalp localization by a smartphone.

A smartphone augmented reality (AR) application (app) was explored for clinical use in presurgical planning and lesion scalp localization. We programmed an AR App on a smartphone. The accuracy of the AR app was tested on a 3D-printed head model, using the Euclidean distance of displacement of virtual objects. For clinical validation, 14 patients with brain tumors were included in the study. Preoperative MRI images were used to generate 3D models for AR contents. The 3D models were then transferred to the smartphone AR app. Tumor scalp localization was marked, and a surgical corridor was planned on the patient's head by viewing AR images on the smartphone screen. Standard neuronavigation was applied to evaluate the accuracy of the smartphone. Max-margin distance (MMD) and area overlap ratio (AOR) were measured to quantitatively validate the clinical accuracy of the smartphone AR technique. In model validation, the total mean Euclidean distance of virtual object displacement using the smartphone AR app was 4.7 ± 2.3mm. In clinical validation, the mean duration of AR app usage was 168.5 ± 73.9s. The total mean MMD was 6.7 ± 3.7mm, and total mean AOR was 79%. The smartphone AR app provides a new way of experience to observe intracranial anatomy in situ, and it makes surgical planning more intuitive and efficient. Localization accuracy is satisfactory with lesions larger than 15mm.

Venous anomalies in hypoplastic posterior fossa: unsolved questions.

Anomalous intracranial venous anatomy is described in patients with syndromic craniosynostosis andis of significant importance when it comes to surgical morbidity. However, it is still controversial its origin, type ofcirculation in each syndrome, how it behaves over time, when it can be interrupted and wether it needs to bestudied. The purpose of this paper is to discuss these issues by reviewing the literature. A literature search was performed using the PubMed database with a focus on papers including detaileddescriptions of the venous outflow in complex and syndromic craniosynostosis. Search details used were thefollowing: ("veins"[MeSH Terms] OR "veins"[All Fields] OR "venous"[All Fields]) AND ("abnormalities"[Subheading]OR "abnormalities"[All Fields] OR "anomalies"[All Fields]) AND syndromic[All Fields] AND ("craniosynostoses"[MeSH Terms] OR "craniosynostoses"[All Fields] OR "craniosynostosis"[All Fields]). Studies that exposed details ofvenous anomalies found in syndromic or complex craniosynostosis were selected. Of a total of 211 articles found, 11 were selected for this review. Of these, 5 were case reports, 5retrospective studies, and only 1 prospective study. From the 6 series of cases presented, 5 discussed therelationship between jugular foramen stenosis (JFS) and collateral venous drainage. The authors discuss data fromthe literature for each leading question presented: 1-collateral circulation: is it an intrinsic trouble, a consequenceof stenosis of the cranial base foramina or related to raised intracranial pressure (ICP)?; 2-what venousanomalies should we search for, and what is the best exam to study them?; 3-collateral circulation changes withtime?; 4-can neurosurgeons interrupt the collateral circulation?; 5-should we study all complex types ofcraniosynostosis? The importance of the study of the venous outflow in patients with complex craniosynostosis is evidentin the literature. The real relationship between intracranial hypertension, hypoplastic skull base foramen, Chiari Imalformation, hydrocephalus, and venous collateral circulation remains unknown. Prospective studies focusing onmolecular biology analysis will possibly solve all of these leading questions.

Research advances in neonatal cerebral sinovenous thrombosis.

Neonatal cerebral sinovenous thrombosis (CSVT) is a cerebrovascular disease with a seriously underestimated incidence rate. Due to a lack of specific clinical manifestations and the low sensitivity of conventional imaging examinations, it has long been considered a rare disease in neonates. In recent years, the development of magnetic resonance technology has improved the diagnostic rate of CSVT. This article reviews the research advances in intracranial venous anatomy of neonates and clinical manifestations, imaging features, treatment, and prognosis of CSVT and deep venous thrombosis, in order to improve the understanding and to make correct diagnosis and treatment of neonatal CSVT.

Casper Versus Precise Stent for the Treatment of Patients with Idiopathic Intracranial Hypertension

PurposeWe hypothesized that due to its specific characteristics, the CasperTM RX carotid stent (CP) might be particularly suitable for venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH). To test this theory, we compared it to the commonly used Precise Pro RXTM stent (PP).MethodsA total of 15 patients with IIH (median age 28.7 years) were reviewed retrospectively. Technical aspects as well as peri- and postinterventional complication rates were examined in patients treated with CP (n = 10) and the PP (n = 5). Improvements in cerebrospinal fluid opening pressure (CSF OP), transstenotic pressure gradient (TSPG) and clinical symptoms were also assessed.ResultsStent delivery was easier and more successful with the CP than the PP (difficult/failed stent delivery 0.0% versus 57.1%) and consequently achieved with less attempts (≥ 2: 0.0% versus 40.0%). No severe peri- or postinterventional complications or instances of in-stent thrombosis and/or stenosis were observed during follow-up. Improvement of CSF OP and TSPG immediately after VSS as well as at 6‑month follow-up was comparable between the CP and PP group. Both groups showed substantial and similar decreases in intensity and frequency of headache. Almost all patients with other IIH-related symptoms showed either improvement or complete resolution of those symptoms after VSS. All patients who were available for interview (n = 12/15) reported a substantial improvement in quality of life.ConclusionVSS using the CP seems to be safe and effective. The CP may reduce the risk of difficult or failed stent delivery in patients with challenging intracranial venous anatomy.