Optic Sheath Research Articles

Sinus vein thrombosis conundrum: Persistent empty sella vs. flexible optic nerve sheath

IntroductionOur objective was to investigate the potential effect of thrombotic burden on pituitary gland height, bony sella and optic sheath width, taking into consideration the various venous sites and dominant drainage pattern. Patients and MethodsThis retrospective cohort study followed patients diagnosed with cerebral sinus vein thrombosis in a single primary healthcare center between the years 2000 and 2022. Data was collected from both CT/V and MR/V scans available on the local PACS system. Dural sinuses were divided into main anatomical sites and scored for patent, partially or totally blocked lumen. Dominant drainage flow was noted for each patient. For most scans, pituitary mid height, maximal depth and AP width of the bony sella and dorsum sella to tuberculum sella distance were assessed. Optic sheath width was measured for both sides at the maximal retrobulbar diameter. Regression methods, including linear mixed models, and non-parametric tests were used to analyze the data. Results90 patients (mean age, 44 years ±16.8, 54 women) were evaluated. Overall thrombus burden did not correlate with pituitary mid-height, however a relationship was observed between the change (from presentation) in the superficial thrombus score and the average width of the optic nerve sheath; the width of the optic sheath tended to decrease as thrombus burden improved and vice versa (p = 0.010). ConclusionsThrombus recanalization had a favorable effect on the optic nerve sheath diameter but did not appear to reverse the flattening of the pituitary gland, regardless of temporal improvement.

Automatic Optic Nerve Assessment From Transorbital Ultrasound Images: A Deep Learning-based Approach.

Transorbital Ultrasonography (TOS) is a promising imaging technology that can be used to characterize the structures of the optic nerve and the potential alterations that may occur in those structures as a result of an increase in intracranial pressure (ICP) or the presence of other disorders such as multiple sclerosis (MS) and hydrocephalus. In this paper, the primary objective is to develop a fully automated system that is capable of segmenting and calculating the diameters of structures that are associated with the optic nerve in TOS images. These structures include the optic nerve diameter sheath (ONSD) and the optic nerve diameter (OND). A fully convolutional neural network (FCN) model that has been pre-trained serves as the foundation for the segmentation method. The method that was developed was utilized to collect 464 different photographs from 110 different people, and it was accomplished with the assistance of four distinct pieces of apparatus. An examination was carried out to compare the outcomes of the automatic measurements with those of a manual operator. Both OND and ONSD have a typical inaccuracy of -0.12 0.32 mm and 0.14 0.58 mm, respectively, when compared to the operator. The Pearson correlation coefficient (PCC) for OND is 0.71, while the coefficient for ONSD is 0.64, showing that there is a positive link between the two measuring tools. A conclusion may be drawn that the technique that was developed is automatic, and the average error (AE) that was reached for the ONSD measurement is compatible with the ranges of inter-operator variability that have been discovered in the literature.

CHARACTERISTIC OF PATIENTS WITH ORBITAL MENINGIOMA IN DR. KARIADI GENERAL HOSPITAL SEMARANG

Abstract
 Introduction & Objectives : Meningioma is a neoplasm arising from arachnoid cap cells in the meninges. They can arise in the orbit as primary or secondary orbital meningioma. The characteristic and risk factors of orbital meningioma are essential to acknowledge. The aim of this study is to describe the characteristic and risk factors of patients with orbital meningioma in Dr.Kariadi Hospital.
 Methods : A retrospective study was held from the medical record of patients with a diagnosis of meningioma between January 2020-December 2022. The data of 58 patients included age, sex, duration of proptosis, length of proptosis, history of seizure, diplopia, history of contraceptive and trauma, RAPD, fundus examination, and CT-Scan results.
 Results : Most of the meningioma patients had female 98,27%, 70,68% in the fourth decade of life. The visual acuity of 25,88% of patients >6/18, and 22,41% were blind. Around 72,41% of proptosis occurred ≥ 1 year, 87,93% had signs of headache, only 1,72% underwent seizure, 8,62% had double vision, and 5,17% had a history of head trauma. Relative afferent pupillary defect occurred in 53,44% of the affected eye with 20,68% atrophic papil and 15,51% edema papil. CT-Scan result of 86,2% had sphenoid meningioma, and only 13,79% had optic sheath meningioma. Most of the patients (72,41%) used 3 months cycle hormonal injection contraceptive.
 Conclusion : The characteristic of orbital meningioma patients in DR.Kariadi Hospital were mostly women in the fourth decade of life, had proptosis and headache as primary signs and 3 months of intramuscular hormonal contraceptives were suspected to have a correlation.

Monitoring of optic sheath diameter during acute migraine attack: an objective criteria for the severity of disease.

The etiology of migraine can be complex and multifactorial but not clear, also, intracranial pressure has been already associated with migraine attacks. This study aimed to monitor intracranial pressure during migraine attack to understand the possible relations with disease and severity. A prospective randomized study was designed. Patients with a definitive diagnosis of migraine underwent ultrasonography for optic nerve sheath diameter (ONSD) measurement before treatment and were re-measured after the attack was resolved. The severity of the migraine was assessed with Headache Impact Test-6 (HIT-6) and Migraine Disability Assessment (MIDAS) questionnaire before the treatment and after the symptoms regressed. ONSD values and scores from the questionnaires were compared before and after the migraine attack. The study included 11 (52.4%) women and 10 (47.6%) men, and 42 eyes were evaluated. ONSD was detected as 4.23 ± 0.26 mm in the right eye and 4.10 ± 0.32 mm in the left eye during the migraine attack and decreased to 3.65 ± 0.41 mm in the right eye and 3.50 ± 0.33 mm in the left eye after the attack was treated (p < 0.001, both). A similar statistical improvement was found in HIT-6 and MIDAS scores with ONSD after treatment (p < 0.001). A significant positive correlation was found between the ONSD value in both eyes and HIT-6/MIDAS scores during the migraine attack, and also, after the migraine attack. A subjective increase of ONSD values during the migraine attack decreased after the disease resolved, also changes in ONSD values were significantly correlated with the severity of symptoms.

Diameters of the optic sheath and superior ophthalmic vein can expand and contract at positional changes: a magnetic resonance imaging study.

This study aimed to explore the diameters of the optic sheath (OSD) and superior ophthalmic vein (SOVD) in response to positional changes using magnetic resonance imaging (MRI). Fifty adult outpatients who presented to the hospital underwent thin-slice coronal T2-weighted MRI in the supine position followed by the prone position. The OS and SOV were well delineated in all the patients. The OSD in the anterior orbit was measured in the supine and prone positions on both sides. In addition, the SOVD in the anterior and posterior orbits was measured in the supine and prone positions on both sides. The OSD demonstrated an increase on both sides in 100% of the cases. The SOVD demonstrated an increase on both sides in 94% of the cases, whereas the remaining 6% demonstrated a decrease. The OSD measured at the anterior orbit and the SOVD at the anterior and posterior orbits significantly increased on both sides with positional changes from the supine to the prone position. OSD and SOVD may expand and contract in response to alterations in the intracranial pressure and venous flow patterns. MRI examination in the supine position combined with positional changes can help to better understand the OS and SOV as dynamic structures.

Optic sheath diameter and microstructural changes of the optic nerve in idiopathic intracranial hypertension Optic nerve DTI changes in IIH

Abstract Objective: We aim to investigate whether increased perioptic cerebrospinal fluid (CSF) pressure causes changes in the optic sheath diameter and microstructure of the optic nerve in patients with idiopathic intracranial hypertension (IIH). We also aim to investigate the relationship between optic sheath diameter and the optic nerve microstructural changes. Methods: Our retrospective study is a neuroimaging study of CSF opening pressure-confirmed IIH cases and controls, including 1.5 T magnetic resonance imaging (MRI) and diffusion tensor brain imaging. Optic sheath diameters were measured from axial T2-weighted images. The optic nerve was evaluated by range of interest (ROI) with diffusion tensor imagine (DTI) and compared with the healthy control. DTI findings were correlated with optic sheath diameters. Results: The ADC and RD values obtained from the left optic nerve were significantly increased compared to the healthy group. The FA values obtained from the right and left optic nerves were decreased considerably compared to the healthy group. We found that perioptic CSF distance increased in cases with IIH and there was a negative correlation between CSF distance and both optic nerve AD values. Conclusion: Patients with IIH have significant DTI changes in the optic nerve microstructure, which is related to the optical sheath diameter. It may be possible to detect optic nerve damage early with microstructural changes before permanent vision loss develops and to monitor nerve damage with DTI parameters. Early recognition of optic nerve damage due to intracranial high pressure with DTI parameters is important in preventing permanent vision loss.

Primary Tumours of The Optic Disc and The Optic Disc Sheath

Primary optic nerve and optic nerve sheath tumors constitute approximately 8% of intraorbital tumors and although most of them are benign, they are manifested by findings that significantly affect visual function such as vision loss, visual field defect and proptosis. Tumors originating from the optic nerve trunk are mostly benign optic nerve glioma, but rarer tumors such as ganglioglioma, medulloepithelioma, hemangioblastoma, melanocytoma and high-grade glioblastomas such as malignant optic nerve glioma can also be detected. Tumors originating from the optic nerve sheath usually have optic nerve sheath meningioma (ONSM), of those with intraorbital and intracanalicular origin are classified as primary and intracranial ONSMs are classified as secondary tumors. Optic glioma, ONSM, and hemangioblastomas can be seen sporadically or as a component of Type 1 and Type 2 Neurofibromatosis (NF) and Von Hippel-Lindau (VHL) syndromes, respectively. Treatment with systemic chemotherapy, surgical resection and radiotherapy methods should be considered when progressive vision loss, visual field defect and cosmetically intolerable proptosis develop in optic nerve and nerve sheath tumors, which can have a quiet course for years in terms of visual function. While systemic chemotherapy is accepted as the main treatment method in optic gliomas, more successful results are obtained with specialized treatment methods such as stereotactic fractionated radiotherapy in ONSMs.

Delineation of the central retinal artery using computed tomography: a pilot study.

The prospective study aimed to examine the central retinal artery (CRA) using computed tomography (CT). Seventy adult outpatients comprising 32 men and 38 women, at a mean age of 60.6 ± 13.3years, were enrolled in the study. The patients underwent contrast-enhanced CT. The scan timing was set to start 5.0s after the circle of Willis began to be delineated. The ophthalmic arteries (OphAs) were comfortably delineated in all. In 97% of the patients, the CRA was delineated from the original site on the OphA to a more distal segment coursing on the optic sheath. Unilateral and bilateral CRA delineations were observed in 44% and 53% of cases, respectively. The delineated CRAs demonstrated highly variable morphologies in terms of the course and length on the optic sheath. In addition, the distance between the original site of the CRA and the posterior limit of the bulb was measured. The mean distance was 18.6 ± 5.0mm on the right and 17.8 ± 4.3mm on the left, respectively. No significant right-to-left differences in the measurements (p > 0.05) were observed. If optimal scan timing is adopted, the CRA segments coursing on the optic sheath can be delineated using contrast-enhanced CT. CT may be a useful diagnostic modality for the CRAs and associated pathological conditions.

Optic Nerve Sheath Diameter as a Predictor of Raised Intracranial Pressure Findings on Orbital Ultrasound

BACKGROUND&#x0D; Several studies have found an association between raised intracranial pressure (ICP) and optic nerve sheath diameter (ONSD) in conditions with severe head injury and intracranial bleeding. Idiopathic intracranial hypertension is also a cause of elevated ICP. Because the meninges and subarachnoid space around the optic nerve are continuous, a rise in ICP can be detected with an increase in ONSD. The objectives of this study were to correlate Optic Nerve Sheath Diameter (ONSD) with features suggestive of raised intracranial pressure on CT / MRI of the Brain and describe the features suggestive of raised intracranial pressure on CT/MRI Brain in clinically suspected patients.&#x0D; METHODS&#x0D; This was a case control study carried out in the Department of Radio-diagnosis at MGMCRI for suspected raised intracranial pressure evaluation. All these patients were subjected to ultrasound examination of the eye and the optic sheath diameter was measured while the patients were in supine posture. ONSD was measured on Mind ray DC8, and/or GE S7 Expert using High frequency linear probe on the closed upper eyelid with adequate aqueous gel as a coupling agent. ONSD was also measured in Philips 1.5T MRI and Ge optima 128 slice CT. Patients were followed up on whether they were treated surgically or medically and if they developed clinical signs of raised ICP such as headache, vomiting, raised blood pressure, double vision, confusion or loss of consciousness.&#x0D; RESULTS&#x0D; The raised ICP was observed in 30.67 % of study patients and the optic nerve sheath distension was observed in 37.33% of patients. The diagnostic accuracy of determining the optic nerve sheath diameter was equal such as area under curve, sensitivity and specificity as 0.833, 66.67% and 100 % respectively in both methods.&#x0D; CONCLUSIONS&#x0D; ONSD has emerged as an interesting option for measuring intracranial hypertension in brain-injured states, owing to its simplicity, non-invasive nature, and accessibility.

Evaluating Headache and Facial Pain in a Headache Diagnostic Laboratory: Experiences from the Danish Headache Center.

Diagnostic tests are not routinely used for the diagnosis of primary headaches. It is possible that laboratory tests could be developed and implemented at tertiary headache centers to be an integrated part of the diagnosis and management of headache patients, and laboratory tests that can be used on-site at headache centers could help in evaluating patients with secondary headache disorders. In this narrative review, we present some of the studies that have been made so far at the Headache Diagnostic Laboratory at the Danish Headache Center that aim to investigate and phenotype primary headaches and investigate secondary headaches as well as improve management. Semi-structured interviews and deep phenotyping, quantitative sensory testing, and provocation studies have been shown to be valuable in categorizing primary and secondary headache subtypes, possible pathophysiology, and defining needs for further research. In patients suspected of increased intracranial pressure, transorbital ultrasound with measurement of the optic sheath diameter may be useful in monitoring patients. The management of headache patients needs to be critically evaluated to optimize treatment continuously. A Headache Diagnostic Laboratory is very useful and should be an integrated part of headache care and management at tertiary headache centers.

Endoscopic Endonasal Optic Nerve Decompression in Idiopathic Intracranial Hypertension: When to Implement Optic Nerve Sheath Fenestration.

Idiopathic intracranial hypertension (IIH) is a syndrome characterized with increased intracranial pressure and normal cerebrospinal fluid (CSF) composition. Treatment is mainly conservative, whereas CSF diversion surgery is the most frequently used surgical intervention. Endoscopic endonasal optic nerve decompression (EOND) is a newer surgical treatment of this patient group. This study presents a single clinic's case series with comparative results of unilateral an bilateral EOND with or without optic nerve fenestration. Sixteen patients with IIH syndrome who underwent 18 EOND procedures by a single neurosurgeon were evaluated with MRI and digitally subtracted angiography preoperatively. Both preoperative and postoperative visual acuity and perimetry and fundoscopy examinations were routinely performed. All patients underwent sphenoidotomy using the endoscopic binostril approach; however, unilateral or bilateral optic nerve decompression and accompanying optic sheath fenestration was determined on a case-by-case basis, after which all patients were also evaluated for the outcome of headaches. Most of the patients were female, and the mean age was 30.28 ± 9.78 years. CSF pressure was increased in all patients (406.43 ± 112.91 mm of H 2 O), and the follow-up period was 61.72 ± 21.67 months. In patients with unilateral EOND, visual fields improved in 83%, visual acuity in 70%, headache in 75%, and papilledema in 27% of cases. In patients with bilateral EOND, perimetry improved in 86%, visual acuity in 43%, headache in 50%, and papilledema in 57% of cases. EOND is an effective surgical option in the treatment of IIH. Bilateral decompression is preferable in patients with bilateral visual involvement, and optic nerve fenestration may prove to be helpful in patients with IIH whose primary complaint is headache.

Optic nerve sheath diameter and pulsatility index for the diagnosis and follow-up in pediatric traumatic brain injury: a prospective observational cohort study.

Invasive neuromonitoring could be difficult in children with traumatic brain injury (TBI). This study aimed to determine whether noninvasive intracranial pressure (nICP), calculated via pulsatility index (PI) and optic nerve sheath diameter (ONSD) had correlated with each other and patient outcome. All moderate-severe TBI patients were eligible. Patients with a diagnosis of intoxication that did not affect the mental status or cardiovascular system were enrolled as controls. The PI measurements were routinely performed bilaterally on the middle cerebral artery. A software (QLAB's Q-Apps) was used to calculate PI, which further placed the ICP equation of Bellner et al. Linear probe with a 10MHz frequency transducer to measure ONSD, which further placed the ICP equation of Robba et al. All measurements were performed by a point-of-care ultrasound certified pediatric intensivist under the supervision of a neurocritical care specialist, before and 30min after a hypertonic saline (HTS) infusion for every 6h when the patient's mean arterial pressure, heart rate, body temperature, hemoglobin, and blood CO2 levels were within normal ranges. The secondary outcome was the effect of hypertonic saline (HTS) on nICP. Delta-sodium values of each HTS infusion were calculated as a difference between pre- and post-measurements. Twenty-five TBI patients (200 measurements) and 19 controls (57 measurements) were included. Median nICP-PI and nICP-ONSD on admission were significantly higher in the TBI group (11.03 (9.98-12.63), p = 0.004, and 13.14 (12.27-14.64), p < 0.001, respectively). Median nICP-ONSD of severe TBI patients were higher than moderate TBI patients (13.58 (13.14-15.71) and 12.30 (9.83-13.14), respectively, p = 0.013). The median nICP-PI was the same across the type of injury (falls and motor vehicle accidents), while the median nICP-ONSD of the motor vehicle accident group was higher than falls. The first nICP-PI and nICP-ONSD measurements in PICU and admission pGCS were negatively correlated (r = - 0.562, p = 0.003 and r = - 0.582, p = 0.002, respectively). The mean nICP-ONSD during the study period and admission pGCS and GOS-E peds score significantly correlated. However, the Bland-Altman plots showed significant bias between the two methods of ICP except after 5th dose of HTS. All nICP values significantly decreased in time, and it was most obvious after the 5th dose of HTS. No significant correlations were found between delta sodium levels and nICP. Noninvasive estimation of ICP is helpful for the management of pediatric severe TBI patients. nICP driven by ONSD is more consistent with clinical findings of increased ICP but not useful as a follow-up tool in acute management because of slow circulation of CSF around the optic sheath. The correlation between admission GCS scores and GOS-E peds score favors ONSD as a good candidate for determining disease severity and predicting long-term outcomes.

Effect of General Anesthesia on MR Optic Nerve Sheath Diameter in the Pediatric Population.

Papilledema is thought to be the hallmark sign of increased intracranial pressure (ICP). Distension of the subarachnoid space within the optic nerve sheath is also commonly reported in MR studies as an indirect sign of increased ICP. General anesthesia and positive pressure ventilation might result in changes in optic sheath diameter (OSD) observed on clinical brain MRI. Retrospective. One hundred forty-five patients (154 MRI scans, 7.3 years ± 5.1); 97 studies in the anesthesia group (4.4 years ± 3.4) of which 22 had papilledema, and 57 in the non-anesthesia group (12.3 years ± 3.2), of which 28 had papilledema. 1.5T or 3.0T volumetric T2 images. T2 images were obtained from different vendors. OSD, optic nerve diameter (OND), and peri-optic cerebrospinal fluid (CSF) were measured manually on T2-weighted MR images for various population subgroups (with and without anesthesia; with or without papilledema). The correlation between these measurements and the clinical diagnosis of papilledema was evaluated via receiver operating characteristic (ROC) analysis. Chi-square test; Mann-Whitney Test; Spearman's test and ROCs; Interclass correlation coefficient, P = 0.05. General anesthesia resulted in significantly larger mean OSD in patients with or without papilledema (7.3 ± 1.0 mm vs. 6.1 ± 1.1 mm and 6.7 ± 1.0 mm vs. 5.4 ± 0.9 mm, respectively). In the non-anesthesia group, the average OSD values (6.1 ± 1.1 mm) were significantly higher in papilledema patients compared to non-papilledema patients (5.4 ± 0.9 mm), with larger peri-optic CSF rim (1.6 ± 0.4 mm vs. 1.3 ± 0.3 mm). In the anesthesia group, OND was significantly larger in papilledema patients (3.4 ± 0.4 mm vs. 3.1 ± 0.5 mm), though the average peri-optic CSF rim did not reach a significance in papilledema compared with non-papilledema patients (2.0 ± 0.3 mm vs. 1.8 ± 0.4 mm, P = 0.06). In patients with general anesthesia, peri-optic CSF rim had a limited correlation with increased ICP. In the pediatric population, imaging findings of increased OSD on brain MRI might be related to general anesthesia rather than increased ICP. The interpretation of optic nerve sheath distention should be reported cautiously in conjunction with anesthesia status, especially in the pediatric population. 4 Technical Efficacy: 5.

A comparative analysis of demographic, clinical and imaging features of myelin oligodendrocyte glycoprotein antibody positive, aquaporin 4 antibody positive, and double seronegative demyelinating disorders - An Indian tertiary care center prospective study.

The aim of the study was to study the demographical, clinical, radiological features, and outcome of anti-myelin oligodendrocyte glycoprotein (MOG) antibody spectrum disorder and compare these features with patients negative for anti-MOG antibody. MOG antibody-associated disease (MOGAD) and aquaporin-4 (AQP4) antibody-related diseases are immunologically distinct pathologies. Our aim was to compare the clinical and radiological features of MOG antibody-related diseases with AQP4 antibody-related diseases and seronegative demyelinating diseases (Non-multiple sclerosis). This was a prospective and cohort study conducted at an apex tertiary care institute in the northern part of India from Jan 2019 to May 2021. We compared clinical, laboratory, and radiological findings of patients with MOGAD, AQP4 antibody-related diseases, and seronegative demyelinating disease. There were a total of 103 patients - 41 patients of MOGAD, 37 patients of AQP4 antibody-related diseases and 25 seronegative demyelinating disease. Bilateral optic neuritis was the most frequent phenotype in patients with MOGAD (18/41) whereas myelitis was the most common phenotype in the AQP4 (30/37) and seronegative groups (13/25). Cortical, juxtacortical lesions, anterior segment optic neuritis, optic sheath enhancement, and conus involvement in myelitis were radiological findings that separated MOGAD from AQP4 related diseases. Nadir Expanded Disability Status Scale (EDSS) and visual acuity were similar across the groups. Last follow-up EDSS was significantly better in the MOG antibody group as compared to AQP4 antibody group (1 [0-8] vs. 3.5 [0-8]; P = 0.03). Encephalitis, myelitis, and seizures were more common in the younger population (<18 vs. >18 years) in MOGAD (9 vs. 2, P = 0.001; 9 vs. 7, P = 0.03; 6 vs. 0, P = 0.001). We identified several clinical and radiological features that can help physicians to distinguish MOGAD from AQP4-immunoglobulin G+neuromyelitis optica spectrum disorder. Differentiation is vital as treatment response might vary among both groups.

Serial perioperative optic nerve sheath measurements for early diagnosis of the transurethral resection of prostate syndrome: an open label pilot study

BackgroundUltrasound imaging of optic sheath nerve diameter [ONSD] is reported to reflect changes consistent with intracranial pressure changes seen in traumatic brain injury and also in documented serum hyponatremia. We hypothesized that hyponatremia and hypervolemia seen during trans urethral resection of prostate [TURP] surgery may also have some association with different ONSD readings from the baseline perioperatively, resulting in early detection of TURP syndrome. In this prospective observational study, 50 adult male patients scheduled for TURP surgery meeting inclusion criteria were included and the ONSD measurements were serially recorded perioperatively. Patients with measurements ≥ 5.2 mm with either clinical symptoms or electrolyte changes suggested TURP syndrome were taken as true positive.ResultsThe sensitivity, specificity, area under the curve, positive predictive, and negative predictive value at 95%CI of ONSD for early detection of TURP syndrome was {100% [15.81 to 100.00%], 91.67% [80.02 to 97.68%], 0.96 [0.86 to 0.99%], 33.33% [4.33 to 77.72%], 100% [91.96 to 100.00%]} with a diagnostic accuracy of 95.83%. In univariate logistic regressions, the duration of surgery had a positive association with TURP syndrome [odd ratio 1.066, β coefficient 0.064, p = 0.015]. In multivariate logistic regression, we could not validate the association between these factors and TURP syndrome [p > 0.050].ConclusionsThe ONSD measurements have good diagnostic accuracy for detecting TURP syndrome, but we advocate more multi-centric studies with large sample sizes to validate this association in the multivariate regression model.

AML-173 Pseudotumor Cerebri (PTC) in Patients With Acute Leukemia (AL)

Pseudotumor cerebri (PTC) is characterized by headache, vision changes, and fundus papilledema. Primary PTC is often seen in obese women (childbearing age) and secondary with medications such as all-trans retinoic acid (ATRA). We analyze clinical presentation, and outcomes of PTC in patients with acute leukemia (AL) treated at a general hospital. Single-center retrospective study. We reviewed cases of AL patients with PTC at Memorial Hermann Hospital, Texas Medical Center between January 2013 and April 2022. Three (2.3%) of 127 patients (AML=85, APL=29, ALL= 13) had PTC. Fit non-APL patients received induction chemotherapy (IC) with purine analogs-cytarabine-anthracycline. Unfit patients received a hypomethylating agent and venetoclax. APL patients received IC with arsenic trioxide and ATRA. Patients suspected of having APL were started on ATRA, and discontinued with a negative PML-RARA FISH test. We describe the incidence, risk factors, clinical presentation, and outcomes of AL patients with PTC. Mean age was 42 years. Mean BMI was 42. All were white women. Two had AML, and one Philadelphia chromosome-positive ALL. AML patients received 3 doses of ATRA discontinued after negative PML-RARA FISH. One AML patient had PTC at presentation. The other developed PTC 3 months later. One AML patient had PTC 30 years before being treated for 6 months with acetazolamide; PTC recurred 3 months after her diagnosis. All patients had headaches, blurry vision, and papilledema with brain MRI showing optic sheath distension, globe flattening, and papilla cupping, all features suggestive of PTC. In two, the opening lumbar puncture pressures were elevated at 30 and 35 cm H2O. Cerebrospinal fluid cytology and flow cytometry were negative for leukemia. Two patients (AML=1, ALL=1) received intrathecal (IT) chemotherapy for CNS prophylaxis. All patient's symptoms improved with acetazolamide. LP done for IT chemotherapy helped to alleviate symptoms. No patient with APL (29 patients) developed PTC during treatment with ATRA. PTC is a rare diagnosis that can complicate the clinical course of AL patients. In addition to ATRA-induced PTC, clinicians should consider primary PTC, seen most often in morbidly obese women of childbearing age.

Surgical Approaches for Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension and Review of the Literature

Idiopathic Intracranial Hypertension is one of the causes of blindness in the modern world. It affects usually overweight female patients in their childbearing age. Unfortunately, there are no clear quidelines in respect of the best possible approach to treat this rare condition. Conservative treatment which means weight loss, acetazolamide prescription and close follow up and on the other hand surgical treatments are the main options. Ventriculoperitoneal shunt to relieve intracranial pressure and Optic Sheath Fenestration are both surgical options that can be also combined treat patients and save their vision decline [1,2]. In this study, we retrospectively reviewed different techniques of optic sheath fenestration and measured the outcome and the complication rate of each one.

The Endoscopic-Assisted Supraorbital Approach for Resection of Anterior Skull Base Meningiomas: A Large Single-Center Retrospective Surgical Study.

Objective The endoscopic-assisted supraorbital approach (eSOA) constitutes a minimally invasive strategy for removing anterior skull base meningiomas (ASBM). We present the largest retrospective single-institution and long-term follow-up study of eSOA for ASBM resection, providing further insight regarding indication, surgical considerations, complications, and outcome. Methods We evaluated data of 176 patients operated on ASBM via the eSOA over 22 years. Results Sixty-five tuberculum sellae (TS), 36 anterior clinoid (AC), 28 olfactory groove (OG), 27 planum sphenoidale, 11 lesser sphenoid wing, seven optic sheath, and two lateral orbitary roof meningiomas were assessed. Median surgery duration was 3.35 ± 1.42 hours, being significantly longer for OG and AC meningiomas ( p <0.05). Complete resection was achieved in 91%. Complications included hyposmia (7.4%), supraorbital hypoesthesia (5.1%), cerebrospinal fluid fistula (5%), orbicularis oculi paresis (2.8%), visual disturbances (2.2%), meningitis (1.7%) and hematoma and wound infection (1.1%). One patient died due to intraoperative carotid injury, other due to pulmonary embolism. Median follow-up was 4.8 years with a tumor recurrence rate of 10.8%. Second surgery was chosen in 12 cases (10 via the previous SOA and two via pterional approach), whereas two patients received radiotherapy and in five patients a wait-and-see strategy was adopted. Conclusion The eSOA represents an effective option for ASBM resection, enabling high complete resection rates and long-term disease control. Neuroendoscopy is fundamental for improving tumor resection while reducing brain and optic nerve retraction. Potential limitations and prolonged surgical duration may arise from the small craniotomy and reduced maneuverability, especially for large or strongly adherent lesions.

"Hammock" suspending the superior ophthalmic vein: a magnetic resonance imaging study.

The present study aimed to explore the hammock-like structure suspending the superior ophthalmic vein (SOV) using magnetic resonance imaging (MRI). Following conventional MRI examination, 93 outpatients underwent thin-sliced, coronal T2-weighted and contrast imaging of the orbit. SOVs were consistently detected in all 93 patients. In 90.3% of patients, a hammock-like structure suspending the SOV was identified, which was present on both sides in 64.5% of patients. The structure was frequently located in the anterior and middle thirds of the retrobulbar orbit, suspended from the superolateral corner of the orbital walls. The medial edge of the hammocks did not reach the orbital walls; therefore, they partially encased the SOV. The morphology of the hammock was highly variable between patients, although none were tethered to the extraocular muscles. In addition, a septal band connecting the hammock and optic sheath was identified in 36.6% of patients, most frequently located in the posterior third of the retrobulbar orbit. The hammock suspending the SOV and the septal band connecting the hammock and optic sheath may be structures that loosely anchor the SOV to the orbital fat to maintain a constant SOV flow, in addition to preventing excessive bends and obstructions.

MRI signs helpful in the differentiation of patients with anterior ischaemic optic neuropathy and optic neuritis

Background/AimsThe aim of this study was to identify specific MRI characteristics of anterior ischaemic optic neuropathy (AION) and optic neuritis (ON) that would aid in the differentiation between these two...