Search Results (398)

Glioblastoma (GBM) remains one of the most treatment-resistant human malignancies, largely due to the interplay between disrupted fluid dynamics, immune evasion, and the structural complexity of the tumor microenvironment; in addition to these, treatment resistance is also driven by intratumoral heterogeneity, glioma stem cell persistence, hypoxia-induced metabolic and epigenetic plasticity, adaptive oncogenic signaling, and profound immunosuppression within the tumor microenvironment. Emerging evidence shows that dysfunction of the glymphatic system, mislocalization of aquaporin-4, and increased intracranial pressure compromise cerebrospinal fluid–interstitial fluid exchange and impair antigen drainage to meningeal lymphatics, thereby weakening immunosurveillance. GBM simultaneously remodels the blood–brain barrier into a heterogeneous and permeable blood–tumor barrier that restricts uniform drug penetration yet enables tumor progression. These alterations intersect with profound immunosuppression mediated by pericytes, tumor-associated macrophages, and hypoxic niches. Advances in imaging, including DCE-MRI, DTI-ALPS, CSF-tracing PET, and elastography, now allow in vivo characterization of glymphatic function and interstitial flow. Therapeutic strategies targeting the fluid-immune interface are rapidly expanding, including convection-enhanced delivery, intrathecal and intranasal approaches, focused ultrasound, nanoparticle systems, and lymphatic-modulating immunotherapies such as VEGF-C and STING agonists. Integrating barrier modulation with immunotherapy and nanomedicine holds promise for overcoming treatment resistance. Our review synthesizes the mechanistic, microenvironmental, and translational advances that position the glymphatic–immune axis as a new frontier in glioblastoma research. Full article

In recent years, Transcranial Color Doppler (TCCD) has gained increasing recognition as a non-invasive neuromonitoring tool. However, there remains a strong tendency to view arterial TCCD as the ‘stethoscope for the brain,’ while the assessment of cerebral venous flow is still underrepresented in clinical protocols. This review aims to explore the emerging role of venous TCCD, particularly when combined with Internal Jugular Vein (IJV) ultrasound, in evaluating cerebral venous outflow in both critically ill and surgical patients. We conducted a narrative review of e-Pub articles from PubMed, MEDLINE, and Scopus, on the pathophysiological factors that impair cerebral venous drainage and their clinical implications in surgical and critical care settings. Based on this evidence, we developed two procedural algorithms that integrate established knowledge of cerebral venous hemodynamics with common clinical conditions affecting venous outflow, including internal jugular central venous catheter placement, mechanical ventilation, and pneumoperitoneum. The algorithms emphasize systematic monitoring of cerebral venous drainage, including assessment of internal jugular vein morphology and Rosenthal’s vein flow, to guide procedural optimization and minimize potential neurological complications. They were informed by validated frameworks, such as the RaCeVa protocol, and are illustrated through two representative clinical case scenarios. Cerebral venous congestion can be induced by multiple established risk factors, including mechanical ventilation, cardiovascular disease, elevated intra-abdominal pressure, the Trendelenburg position, and central venous catheterization. In selected patients, real-time venous TCCD monitoring, combined with IJV assessment, allows early detection of cerebral venous outflow impairment and guides timely hemodynamic and procedural adjustments in both surgical settings and critical care contexts. Venous TCCD neuromonitoring may help prevent intracranial hypertension and its consequent neurological complications. It can guide clinical decisions during procedures that may compromise cerebral venous drainage, such as mechanical ventilation, the placement of large-bore central venous catheters, or laparoscopic and robot-assisted surgeries. Further studies are warranted to validate this strategy and better define its role in specific high-risk clinical scenarios. Full article

Background and Objectives: Preeclampsia (PE) complicates 2–8% of pregnancies globally, with a higher incidence in developing countries. This condition poses significant risks to maternal and fetal health, contributing substantially to maternal and perinatal mortality, particularly in cases of early-onset PE, which is associated with severe complications. This review aims to synthesize current evidence regarding the predictive utility of ophthalmic artery Doppler for preeclampsia. Current strategies focus on early prediction and prevention to mitigate adverse outcomes and reduce the economic burden of hypertensive disorders in pregnancy. The International Federation of Gynecology and Obstetrics (FIGO) recommends first-trimester screening combining maternal risk factors, mean arterial pressure, serum placental growth factor (PlGF), and uterine artery pulsatility index (UtA-PI). High-risk women are advised to take low-dose aspirin (150 mg daily) until 36 weeks of gestation. Materials and Methods: This review explores an innovative predictive tool for PE: ophthalmic artery (OA) Doppler. Results: As a non-invasive and easily accessible method, OA Doppler provides valuable insights into intracranial vascular resistance, offering potential advantages in early risk assessment, particularly for preterm PE, the most severe form of the disease. Conclusions: Our findings suggest that OA Doppler may serve as a promising adjunct in PE screening, enhancing the early identification of high-risk pregnancies and improving clinical outcomes. Further research is warranted to validate its role in routine prenatal care. Full article

Objective: Traumatic brain injury (TBI) represents a significant clinical problem, with the biomechanical mechanisms of striking from different blunt instruments remaining unclear. This study aims to quantitatively evaluate TBI severity under blunt strikes and to assess the effects of strike velocity and blunt instrument size on biomechanical responses to provide a finite element approach for investigating injury mechanisms and informing clinical diagnosis. Methods: A head finite element model incorporating an outer cortical-cancellous-inner cortical bone structure was developed and verified against a previous cadaveric impact study. Strike velocities and blunt instrument parameters, obtained from experiments in which a long bat (LB) and a short bat (SB) were used to strike a dummy head, were applied as the loading conditions in the finite element simulation. Kinetic energy (KE), internal energy (IE), impact force, von Mises stress on skull, intracranial pressure (ICP), and Head_3ms acceleration were analyzed as indicators of injury severity. Results: Simulated force and ICP responses agreed with cadaveric experimental data within a 9.8% error. With increasing strike velocity (10–30 m/s), KE, IE, impact force, ICP, and Head_3ms all rose, while von Mises stress evolved from localized to dispersed distribution. Head_3ms reached an injury threshold of 80 g at a strike velocity of 10 m/s, and ICP peaks for LB and SB exceeded the brain injury threshold (235 kPa, ≈1760 mmHg) at 12 m/s and 14 m/s, respectively. At the same velocity, LB generated higher KE, IE, impact force, ICP and Head_3ms than SB. At 30 m/s, LB generated 390 J KE and 29.0 kN peak force, which were 50.0% and 11.1% higher than those of SB (260 J, 26.1 kN). Conclusion: This study reveals that increasing strike velocity and employing a larger blunt instrument elevate biomechanical responses, resulting in von Mises stress transitioning from localized concentration to multipolar dispersion. Specifically, when striking the head with the LB at velocities exceeding 12 m/s or with the SB exceeding 14 m/s, the impacts indicate a severely life-threatening level. These findings deepen our understanding of the mechanisms of blunt TBI. The constructed and validated finite element model can be repeatedly used for computer simulations of TBI under various blunt striking conditions, providing a scientific basis for clinical diagnosis and surgical planning. Full article

Background: Idiopathic intracranial hypertension (IIH), also known as primary pseudotumor cerebri, is characterized by increased intracranial pressure (ICP) without an identifiable cause. It can lead to significant morbidity, including permanent vision loss, especially in younger children. The exact cause of IIH is still unclear, but excess adiposity seems to be a key risk factor. Current treatment options are unsatisfactory, but research is exploring novel therapies targeting obesity-related mechanisms. Methods: Narrative review of the literature aimed at summarizing current knowledge regarding the epidemiology, pathophysiology, clinical features, treatment options and long-term outcomes for pediatric IIH, with a particular focus on the link with obesity. Results: The incidence of IIH is rising, mirroring the obesity epidemic. Excess adiposity, predominantly visceral, might cause IIH through several factors such as decreased venous return, hormone dysregulation, inflammation, obstructive sleep apnea, and dysfunction of the glymphatic system. The extent of weight loss required and the most appropriate strategy to achieve it are still uncertain. Given the difficulty in achieving and maintaining weight loss with dietary strategies, bariatric surgery and weight loss medications are emerging as effective options for long-term remission of both obesity and IIH. Conclusions: IIH is a rare and poorly understood disease. At present, weight loss represents the only treatment that addresses the pathophysiology of IIH. The role and potential as standalone or synergistic therapies of weight loss drugs and bariatric surgery for IIH in adolescents require future research. Full article

Background/Objectives: Idiopathic intracranial hypertension (IIH) is an uncommon but clinically important cause of elevated intracranial pressure in children. Conventional MRI findings such as perioptic subarachnoid space (SAS) distension and posterior globe flattening are helpful but may lack sensitivity or specificity in certain cases. Diffusion tensor imaging (DTI), which quantifies white matter microstructure through metrics such as fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD), offers additional diagnostic potential, yet its role in pediatric IIH remains insufficiently defined. Methods: This retrospective case–control study included 26 pediatric patients with IIH and 26 age- and sex-matched controls who underwent brain MRI with DTI between 2010 and 2025. DTI parameters were measured in major white matter tracts, and conventional MRI findings associated with raised intracranial pressure were recorded. Associations between DTI metrics and conventional imaging markers were analyzed using standardized statistical tests. Results: Children with IIH demonstrated significantly reduced FA and increased MD and RD values in several key white matter regions, particularly within the optic radiation, splenium of the corpus callosum, and posterior limb of the internal capsule. FA values showed a negative correlation with perioptic SAS width, while RD and MD were positively correlated with posterior globe flattening and empty sella grade. Receiver operating characteristic analysis identified FA in the optic radiation as the strongest discriminator between IIH and controls (AUC = 0.83). Inter-observer reliability for FA measurements was excellent (ICC = 0.91). Conclusions: Pediatric IIH appears to be associated with pressure-related microstructural alterations in white matter, detectable through DTI. Among the diffusion metrics, FA demonstrated the strongest diagnostic potential and may serve as a complementary tool to conventional MRI. Validation in larger, prospective pediatric cohorts is required to establish its clinical utility. Full article

Cystic Echinococcosis (CE) is a rare but serious parasitic disease caused by Echinococcus granulosus sensu lato, representing only 1–2% of all hydatid disease cases. Due to its nonspecific clinical presentation, its diagnosis and management pose significant challenges. This study aimed to provide a comprehensive overview of intracranial CE cases reported globally over the past 35 years, focusing on demographic characteristics, clinical presentation, diagnostic approaches, treatment modalities, and outcomes. Methods: A systematic review was conducted in accordance with PRISMA guidelines and was registered in PROSPERO (CRD 42024608624). Relevant studies published between 1990 and 2024 were identified from PubMed, Scopus, and Web of Science databases. Results: After screening and eligibility assessment, 392 studies involving 718 intracranial CE cases were included. The majority of patients were children (65%) and male (59.2%). The most frequent presenting symptoms were signs of increased intracranial pressure (79.4%), followed by motor deficits (37.9%) and visual disturbances (23.2%). Most cysts were located in the supratentorial region (88.9%), predominantly in the parietal lobe, and were solitary (88.4%). Surgical intervention was performed in 95.8% of cases, often combined with albendazole therapy. Complete recovery was observed in 85.5% of patients, while 8.7% died—primarily due to cyst rupture-related complications such as septicemia and anaphylaxis. Recurrence was reported in 26% of cases with follow-up. Conclusions: This review presents one of the most extensive analyses of intracranial CE to date. Despite being a rare manifestation, intracranial CE should be considered in the differential diagnosis of space-occupying brain lesions in endemic areas, particularly in paediatric patients. Full article

Background: Maintaining an adequate mean arterial pressure (MAP) and cerebral perfusion pressure to ensure proper perfusion and oxygen delivery to all major organs is crucial—especially for neurosurgical patients after subarachnoid hemorrhage or traumatic brain injury—for preventing secondary brain damage or delayed cerebral ischemia. Currently, most neurosurgical intensive care units rely on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) values to guide therapy. Fluid resuscitation and norepinephrine are standard treatments for achieving a CPP between 60 and 70 mmHg; however, patients sometimes experience norepinephrine-refractory hypotension. In such cases, vasopressin is often the preferred medication; it is widely utilized and has gained interest in treating septic shock or refractory hypotension following cardiac surgery or hypovolemic shock. Recent studies have also shown the significant impact of vasopressin on resuscitation after traumatic brain injury (TBI) and its effect on CPP during ICU care. Nevertheless, little is known about how vasopressin affects cerebral perfusion and oxygenation, especially in patients with subarachnoid hemorrhage. Methods: This preliminary retrospective single-arm study examined how vasopressin affects P_btO₂ and cerebral blood flow using the non-invasive QuantixND^® device. After administering vasopressin for treating catecholamine-refractory hypotension, MAP, CPP, ICP, P_btO₂, and cerebral blood flow were measured over a 20-min period. Results: In this small cohort, vasopressin sufficiently improved MAP and CPP over a 20 min period following AVP bolus administration with a slight decline at later time points. The ICP decreased throughout this period, indicating some level of autoregulation. In contrast, cerebral blood flow did not improve despite the rise in CPP, and P_btO₂ levels remained below 20 mmHg. Conclusions: We conclude that vasopressin could be a viable option for maintaining MAP and CPP, but caution should be exercised in patients with already impaired cerebral perfusion. Furthermore, relying solely on CPP as the therapeutic guide in subarachnoid hemorrhage patients appears to be at least questionable. Full article

Invasive mechanical ventilation (MV) is often a lifesaving intervention in patients with traumatic brain injury (TBI) to optimize gas exchange and prevent secondary brain injury, thereby avoiding the deleterious effects of both hypoxia and hyperoxia, as well as hypocapnia and hypercapnia. However, MV in these patients represents a unique clinical challenge, as it must take into account multiple parameters, including cerebral autoregulation and autoregulatory reserves, brain compliance, cerebral dynamics such as intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral blood flow (CBF), as well as systemic hemodynamics and respiratory system mechanics. Moreover, the detrimental effects of MV on extracranial organs and systems are well established, with the lungs being the most vulnerable, particularly when non-protective ventilation strategies involving high tidal volumes (TV) and inspiratory pressures are applied. Currently, the optimal ventilation approach in patients with TBI, with or without LI, remains incompletely defined. While protective ventilation practices are recommended for a large number of critically ill patients, their application in individuals with acute brain injury (ABI) may adversely affect cerebral and systemic hemodynamics, as well as brain physiology, potentially leading to secondary damage and poor clinical outcomes. Because the consequences of TBI, such as secondary brain damage and lung complications, begin shortly after the primary event, the role of prehospital MV in these patients is crucial. However, existing data from the out-of-hospital setting are scarce. Thus, in the present review, we aim to summarize the available evidence on MV in patients with TBI, with an emphasis on the prehospital setting. Full article

Background: Obstructive sleep apnea (OSA) is recognized as a systemic disorder associated with several comorbidities, including renal dysfunction, which may improve with continuous positive airway pressure (C-PAP) therapy. Sleep fragmentation and nocturnal hypoxia characteristic of OSA have been implicated in carcinogenesis, particularly affecting hypoxia-sensitive urinary tract tissues. This study aimed to assess the prevalence of different cancer types among patients with concurrent OSA and malignancy and to characterize the clinical profiles of those with urinary tract cancer. Methods: We retrospectively analyzed 50 patients with both OSA and cancer from the Vercelli Hospital Registry. Cancer diagnoses were collected at the time of OSA diagnosis, prior to C-PAP initiation. Results: Among the cohort (70% males) of OSA-cancer patients, urinary tract cancers were the most frequent (34%), followed by breast (14%), colorectal (12%), lung (10%), laryngeal and skin (8%), intracranial (6%), hematologic and parotid (4%), and other cancers (2%); 10% had multiple cancer sites. Patients with urinary tract cancer were mainly male (88%, p = 0.0043) and displayed better respiratory indices, frequent hypertension, and higher C-PAP adherence. Conclusions: These findings suggest a possible link between OSA-related hypoxia and carcinogenesis in urinary tract tissues and support increased clinical surveillance and further research to determine potential protective effects of C-PAP therapy. Full article

Stroke is the second-largest cause of death and disability worldwide, and many patients require intensive care for airway compromise, hemodynamic instability, cerebral edema, or systemic complications. This review summarizes key aspects of ICU management in both acute ischemic stroke (AIS) and hemorrhagic stroke (HS). Priorities are airway protection, oxygenation, individualized blood pressure targets, and strict control of temperature and glucose. Neurological monitoring and prompt management of intracranial pressure (ICP), together with timely surgical interventions (hemicraniectomy or hematoma evacuation), are central to acute care. Seizures are treated promptly, while routine prophylaxis is not recommended. Prevention of aspiration pneumonia, venous thromboembolism, infections, and other intensive care unit (ICU) complications is essential, along with early nutrition, mobilization, and rehabilitation. Prognosis and decisions about intensity of care require shared discussions with families and involvement of palliative services, when appropriate. Many practices remain based on observational data or extrapolation from other populations, underlining the need for stroke-specific clinical trials. Outcomes are consistently better when patients are managed in specialized stroke or neurocritical care units with a multidisciplinary treatment approach Full article

Optical coherence tomography (OCT) is a non-invasive imaging tool that is currently used in the evaluation and management of neuro-ophthalmic disorders. The detailed ability to visualize the optic nerve head, peripapillary retinal nerve fiber layer, and the macula, including the ganglion cell layer, allows for both qualitative and quantitative analysis of optic nerve diseases. This review covers the technical aspects of OCT and related imaging techniques in neuro-ophthalmology and discusses its use in common optic nerve head diseases such as optic disc drusen, optic disc coloboma, and elevated intracranial pressure. It also explores emerging OCT angiography applications in these disorders. Full article

Background: Severe traumatic brain injury (TBI) often leads to elevated intracranial pressure (ICP) that requires aggressive management. Inducing burst suppression with deep sedation is an established therapy for refractory intracranial hypertension. Traditionally, barbiturate coma has been used to achieve burst-suppression EEG in TBI patients, but alternative sedative agents (propofol, midazolam, ketamine, dexmedetomidine) are increasingly utilized in modern neurocritical care. This review compares barbiturates with these alternatives for inducing burst suppression in adult TBI, focusing on protocols, mechanisms, efficacy in controlling ICP, safety profiles, and impacts on neurological outcomes. Methods: A search of the literature was performed, including clinical trials, observational studies, and guidelines on deep sedation for ICP control in adult TBI. Studies comparing high-dose barbiturates to other sedatives (propofol, midazolam, ketamine, dexmedetomidine) in the context of burst suppression or severe TBI management were included. Data on sedative protocols (dosing and EEG targets), mechanisms of action, ICP-lowering efficacy, complications, and patient outcomes were extracted and analyzed qualitatively. Results: High-dose barbiturates (e.g., pentobarbital or thiopental) and propofol are both effective at inducing burst-suppression EEG and reducing ICP via cerebral metabolic suppression. Barbiturate coma remains a third-tier intervention reserved for ICP refractory to other treatments. Propofol infusion has become first-line for routine ICP control due to rapid titratability and shorter half-life, though it can also achieve burst suppression at high doses. Midazolam infusions provide sedation and seizure prophylaxis but yield less metabolic suppression and ICP reduction compared to barbiturates or propofol, and are associated with longer ventilation duration and delirium. Ketamine, once avoided for fear of raising ICP, has shown neutral or lowering effects on ICP when used in ventilated TBI patients, thanks to its analgesic properties and maintenance of blood pressure; however, ketamine alone does not reliably produce burst-suppression patterns. Dexmedetomidine offers sedative and anti-delirium benefits with minimal respiratory depression, but it is generally insufficient for deep burst-suppressive sedation and has only a modest effect on ICP. In comparative clinical evidence, propofol and barbiturates both effectively lower ICP, but neither has demonstrated clear improvement in long-term neurological outcome when used prophylactically. Early routine use of barbiturate coma may increase complications (hypotension, immunosuppression), and thus, current practice restricts it to refractory cases. Modern sedation protocols emphasize using the minimal necessary sedation to maintain ICP < 22 mmHg, with continuous EEG monitoring to titrate therapy to a burst-suppression target (commonly 2–5 bursts per minute) when deep coma is employed. Conclusions: In adult TBI patients with intracranial hypertension, propofol-based sedation is favored for first-line ICP control and can achieve burst suppression if needed, whereas high-dose barbiturates are reserved for ICP crises unresponsive to standard measures. Compared to barbiturates, alternative agents (propofol, midazolam, ketamine, dexmedetomidine) offer differing advantages: propofol provides potent, fast-acting metabolic suppression; midazolam adds anticonvulsant sedation for prolonged use at the cost of slower wake-up; ketamine supports hemodynamics and analgesia; dexmedetomidine aids lighter sedation and delirium control. The choice of agent is guided by the clinical scenario, balancing ICP reduction needs against side effect profiles. While all sedatives can transiently reduce ICP, careful monitoring and a tiered therapy approach are essential, as no sedative has conclusively improved long-term neurological outcomes in TBI. EEG monitoring for burst suppression and meticulous titration is required when employing barbiturate or propofol coma. Ongoing research into optimal combinations and protocols may further refine sedation strategies to improve safety and outcomes in severe TBI. Full article

Traumatic brain injury (TBI) is a significant public health concern and its rising prevalence in road traffic accidents underscores the need for deeper understanding and tailored investigation. This study explores the feasibility of employing the female finite element head model (FeFEHM) to analyse biomechanical responses in two distinct road traffic accident scenarios, focusing on strain and stress distribution in critical brain structures. Two collision scenarios from the German In-Depth Accident Study (GIDAS) were reconstructed using validated Total Human Model for Safety (THUMS) simulations. The extracted skull kinematics were applied to the FeFEHM in ABAQUS to compute maximum principal strain, von Mises stress, and intracranial pressure across key brain regions, including the corpus callosum and pituitary gland. Simulations revealed strain concentrations in the parietal and temporal lobes, while the mid-body region was the most affected in the corpus callosum. Pituitary gland deformation was minimal under both loading conditions. Our findings align qualitatively with reported injury sites and injury risk was consistent with those observed in the real-world crashes. The findings highlight the potential of integrating sex-specific biomechanical models into crash biomechanics workflows. Future work should extend this approach across larger datasets and impact scenarios to support its implementation in regulatory and engineering contexts, since the actual sample size prevents conclusions regarding sex-specific biomechanics. Full article

The real-time, precise monitoring of physiological signals such as intracranial pressure (ICP) and arterial blood pressure (BP) holds significant clinical importance. However, traditional methods like invasive ICP monitoring and invasive arterial blood pressure measurement present challenges including complex procedures, high infection risks, and difficulties in continuous measurement. Consequently, learning-based prediction utilizing observable signals (e.g., BP/pulse waves) has emerged as a crucial alternative approach. Existing models struggle to simultaneously capture multi-scale local features and long-range temporal dependencies, while their computational complexity remains prohibitively high for meeting real-time clinical demands. To address this, this paper proposes a physiological signal prediction method combining composite feature preprocessing with multiscale modeling. First, a seven-dimensional feature matrix is constructed based on physiological prior knowledge to enhance feature discriminative power and mitigate phase mismatch issues. Second, a network architecture CNN-LSTM-Attention (CBAnet), integrating multiscale convolutions, long short-term memory (LSTM), and attention mechanisms is designed to effectively capture both local waveform details and long-range temporal dependencies, thereby improving waveform prediction accuracy and temporal consistency. Experiments on GBIT-ABP, CHARIS, and our self-built PPG-HAF dataset show that CBAnet achieves competitive performance relative to bidirectional long short-term Memory (BiLSTM), convolutional neural network-long short-term memory network (CNN-LSTM), Transformer, and Wave-U-Net baselines across Root Mean Square Error (RMSE), Mean Absolute Error (MAE), and Coefficient of Determination (R²). This study provides a promising, efficient approach for non-invasive, continuous physiological parameter prediction. Full article