Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure (ICP) without a discernible structural cause. Historically referred to as pseudotumor cerebri, IIH primarily affects young women with obesity, reflecting its close association with metabolic and hormonal imbalances. Clinical manifestations include headaches, visual disturbances, and papilledema, which, if untreated, can lead to irreversible vision loss.Pathophysiological insights reveal a complex interplay of venous hypertension, glymphatic dysfunction, cerebrospinal fluid (CSF) dynamics, and metabolic and hormonal contributions. Transverse sinus stenosis exemplifies this complexity, acting as both a cause and consequence of elevated ICP. Dysfunction in the glymphatic system, impaired CSF reabsorption, and obesity-related hormonal dysregulation further elucidate IIH's multifactorial nature. Innovations like venous sinus stenting and pharmacological interventions targeting pathways like glucagon-like peptide-1 (GLP-1) show promise in managing refractory cases.Advances in diagnostics have refined IIH identification, integrating neuro-ophthalmological assessments, lumbar puncture, and imaging modalities such as magnetic resonance imaging (MRI), magnetic resonance venography (MRV), and optical coherence tomography (OCT). These tools enhance the detection of key findings like transverse sinus stenosis, optic nerve sheath dilation, and papilledema severity. Emerging non-invasive methods offer safer, real-time monitoring potential, including ultrasound-based optic nerve sheath diameter (ONSD) measurement and machine learning-based ICP estimation.Despite the significant and recent advances, challenges in standardizing diagnostic criteria and therapeutic approaches persist. This review integrates recent research to highlight critical developments, underscoring unresolved questions on pathophysiology and advocating for a multidisciplinary approach for the diagnosis. Future directions include hybrid diagnostic strategies and leveraging artificial intelligence to refine non-invasive monitoring and therapeutic precision.
Paediatric movement disorders (PMDs) encompass a wide range of diseases resulting from countless aetiologies. These are distinct from their adult counterparts, with a far greater proportion of genetic mutations, perinatal injuries, metabolic disorders, and in many cases, undefined neurodevelopmental abnormalities. Given the complexity of both the diagnostic process and management pathway of PMDs, early identification is critical to guide appropriate intervention in a timely manner. Through early recognition and management, clinicians positively impact neurodevelopment, quality of life, and long-term functional outcomes in children with PMDs.Effective management of PMDs necessitates the cooperation of an extensive multidisciplinary team of healthcare professionals, including neurologists, physiotherapists, occupational therapists, psychologists, and neurosurgeons. Each specialist brings their own perspective and expertise to best manage these complex patients.The initial treatment of paediatric movement disorders is widely centred on pharmacotherapy, with medications guided by underlying aetiology and symptoms. As such, medical management can be seen as treating either the manifestation and symptoms of the movement disorder, or in the case of autoimmune or inflammatory aetiologies, the underlying disease process. As a result, by the time patients have been referred for a neurosurgical opinion they have often trialled a number of different pharmacotherapies.Surgical intervention in paediatric movement disorders is considered when conservative treatment has failed to provide adequate symptom control or when the disorder significantly impairs the child's quality of life. The decision to proceed with surgery is multifaceted, involving careful patient selection, multidisciplinary evaluation, and consideration of the specific movement disorder phenotype.This chapter integrates contemporary literature to propose a reliable framework with which neurosurgeons can approach paediatric movement disorders, with a specific focus on neurosurgical options, including deep brain stimulation (DBS), pallidotomy, and rhizotomy.
Blast injuries present a unique challenge in trauma care due to their complex pathophysiology and potential to cause multisystem damage. Unlike conventional trauma, explosions generate a combination of penetrating, blunt, thermal, and barotrauma injuries, requiring a multidisciplinary approach. The increasing prevalence of terrorist attacks, military conflicts, and industrial explosions has contributed to a global rise in blast-related casualties, affecting both military personnel and civilians.This chapter integrates clinical experience, current evidence, and established guidelines to provide a comprehensive framework for evaluating and managing blast injuries. Key areas discussed include the epidemiology, classification, injury mechanisms, and organ-specific impact of blast trauma, with a focus on neurotrauma, pulmonary injuries, cardiovascular compromise, auditory and ocular trauma, and musculoskeletal damage.Additionally, we present a pragmatic protocol for initial trauma bay management, emphasizing early recognition, timely interventions, and coordinated multidisciplinary care. Given the complexity of blast injuries, we advocate for the establishment of a research consortium to refine current management strategies and optimize patient outcomes. Through a deeper understanding of blast physics, injury patterns, and treatment approaches, clinicians can improve survival and long-term recovery for both military and civilian blast victims.
As the leading cause of disability and death in children, paediatric traumatic brain injury (pTBI) is a clinical concern that impacts children on a global scale [1]. The incidence of TBI varies dramatically both between and within countries, ranging between 47 and 280 per 100,000 children, and is generally more common in males [1]. All ages are affected by TBI throughout childhood, though typically two peaks during infancy (0-2 years) and adolescence (15-18 years) are the most common intervals [1]. Mild TBIs (mTBIs) are the most frequently diagnosed, accounting for between 75 and 90% of cases, with a vast majority demonstrating no pertinent radiological findings and discharged home without follow-up.
Pineal parenchymal tumors (PPTs) are rare central nervous system neoplasms encompassing a histologically diverse group ranging from WHO grade 1 to 4 lesions. This chapter provides a comprehensive review of the epidemiology, clinical presentation, diagnostic workup, histopathological and molecular features, and treatment strategies of PPTs, with emphasis on surgical approaches and prognostic factors.An extensive review of recent literature was performed, incorporating updated WHO 2021 classifications and data from large multicenter cohorts. Particular attention was given to the inclusion of newly recognized tumor types, such as desmoplastic myxoid tumor of the pineal region, SMARCB1-mutant.PPTs present variably by age and histological subtype. Pineocytomas typically occur in adults and have excellent outcomes following gross total resection. Pineoblastomas, the most aggressive form, are predominantly pediatric and carry a high risk of CSF dissemination and poor prognosis without aggressive multimodal therapy. Pineal parenchymal tumors of intermediate differentiation and papillary tumors show variable behavior and benefit from maximal safe resection and selective adjuvant therapy. Surgical management remains the cornerstone of treatment, with the infratentorial supracerebellar approach favored for midline lesions. Endoscopic-assisted techniques are increasingly used for resection and biopsy, particularly in the presence of obstructive hydrocephalus. Endoscopic third ventriculostomy (ETV) offers an effective minimally invasive solution for hydrocephalus management. Prognostic outcomes are strongly influenced by tumor subtype, extent of resection, and use of adjuvant therapy.Conclusions: PPTs require individualized, multidisciplinary management strategies. Gross total resection remains the optimal surgical goal when safe, while the role of adjuvant therapy is determined by tumor type and grade. Future directions include improving the molecular characterization of rare subtypes and refining endoscopic and minimally invasive techniques. Multicenter studies are needed to establish evidence-based treatment protocols and better define prognostic markers.
