Analysis of Radiological Findings and Pathological Correlation in Secondary Intracranial Hypertension

Analysis of Radiological Findings and Pathological Correlation in Secondary Intracranial Hypertension | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of Radiological Findings and Pathological Correlation in Secondary Intracranial Hypertension Beyza Nur Kuzan, Yener Şahin, Tufan Çiftçi, Hediye Pınar Günbey This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4205569/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Background Intracranial hypertension is a potentially fatal entity that can occur due to idiopathic or secondary causes and can be detected by radiological methods. To determine radiological findings of intracranial hypertension secondary to primary intracranial tumors and to reveal the relationship between tumor pathology and radiological findings. Methods This retrospective study included 105 adult patients with a histopathologically confirmed primary intracranial tumor. Tumor characteristics and MRI findings associated with intracranial hypertension were noted. The relationship between tumor type and radiological findings was evaluated. Results Glioblastoma (41.0%) followed by meningioma (29.5%) was the most common primary brain tumor. There was a statistically significant difference between intraaxial tumors and extraaxial tumors in terms of pituitary gland height (p = 0.016) and sinus invasion area of the tumor (p = 0.010). In the subgroup analysis, there was a significant difference between meningioma, the most common extraaxial tumor, and other tumors in terms of pituitary gland height and dural sinus invasion area (p = 0.008 and p = 0.029, respectively). Conclusion It is important to know the radiological findings of secondary intracranial hypertension caused by intracranial masses and to keep in mind that it may be associated with tumor pathology and some secondary intracranial hypertension findings may be detected more frequently in extraaxial tumors. Intracranial hypertension magnetic resonance imaging brain tumor extraaxial tumors Figures Figure 1 Figure 2 Figure 3 Introduction Intracranial hypertension is a condition of increased pressure in the cranium, characterized by constant pressure and internal balance and the absence of expansion due to identifiable or unidentifiable causes 1 . In cases where autoregulation cannot be achieved and compensation limits are exceeded, this condition may result in intracranial pressure increase syndrome (ICHS), which may present with herniation conditions in which anatomical structures are displaced secondary to pressure increase 2 . Intracranial hypertension may occur secondary to causes such as intracranial mass or hemorrhage, or it may occur idiopathically without any detectable cause 3 . Although the gold standard in the diagnosis of intracranial hypertension is the documentation of increased pressure with invasive methods, procedural difficulties, false positive and false negative results, and patient noncompliance are among the limitations of the procedure 4 . Because clinical history and symptoms may also be variable, imaging modalities are essential in diagnosis. Currently, computed tomography (CT) and magnetic resonance imaging (MRI) can both investigate the cause of intracranial hypertension and detect anatomical changes secondary to hypertension 5,6 . Among the radiologic findings of intracranial hypertension, findings related to the optic nerve and enlargement of the arachnoid spaces have been reported in MRI examinations 7,8 . Changes in the height of the pituitary gland with enlargement of the cerebrospinal fluid (CSF) distance can be seen in cases of intracranial hypertension 9 . Narrowing the venous sinuses may also occur secondary to intracranial hypertension and has been recorded as the most common radiologic finding in some studies 10,11 . Our study aimed to demonstrate intracranial hypertension secondary to intracranial tumors with radiological findings in our patients and to reveal the relationship between tumor pathology and intracranial hypertension. Methods Patient Selection This is a retrospective study of adult patients diagnosed histopathologically with intracranial tumors in our hospital between September 2021 and April 2022. In patients with intracranial tumors, demographic data were obtained through the hospital information system. Five of 139 cases were excluded from the study because their clinical and fundoscopic findings were not compatible with secondary intracranial hypertension. In the fundoscopic examination of the remaining 134 cases, bilateral varying degrees of papilledema were detected, and the cases were defined as increased intracranial tension secondary to an intracranial mass based on clinical and fundoscopic examination findings. Lumbar puncture was not performed in the cases due to invasive nature. Radiologic images were obtained retrospectively through the picture archiving and communication system (PACS, INFINITT Healthcare, Seoul, South Korea). In the postoperative period, the histopathological diagnosis of the tumors of the cases was accessed through the hospital system and noted. The study did not include pediatric patients under 18 or those without preoperative brain MRI examinations. A total of 29 patients with intracranial metastasis after histopathological diagnosis were excluded from the study, and 105 patients with primary intracranial tumors were included in the study. Our study was approved by the Clinical Research Ethics Committee of our hospital (Decision No: 2022/514/240/11). Image Analysis In our study, intravenous (IV) contrast-enhanced brain MRI examinations of patients were evaluated with consensus by two neuroradiologists under the mentorship of a senior neuroradiologist. All images were acquired on a 1.5 T MRI with a slice thickness of 5 millimeters (mm) (Philips Medical Systems, Best, NL).Tumor position (intra-axial versus extra-axial) and location (supratentorial versus infratentorial) were determined and noted in the postcontrast axial series. Tumor areas were measured on consecutive postcontrast axial series, and tumor volume was calculated using the Cavalieri method (total area x [number of slices + gap]) 12 (Fig. 1 ). In the postcontrast series, the distance of the tumor to the venous sinuses and possible invasion status were evaluated, and in cases with invasion, the invaded venous sinus and invaded tumor area were measured (Fig. 2 ). Findings related to intracranial hypertension were evaluated on T2-weighted axial slices. Accordingly, the development of tortuosity and the presence of optic nerve protrusion in the globe were noted. The optic nerve sheath diameter was measured 3 mm distal to the posterior part of the globe and recorded. Transverse diameters of bilateral Meckel's caves were measured. Pituitary gland height was measured on midsagittal T2-weighted sections and categorized into five groups according to Yuh 13 et al.’s classification of pituitary gland height (Fig. 3 ). The presence of arachnoid granulation was also evaluated and recorded in the axial T2-weighted series. Statistical Analysis The Shapiro–Wilk test and Kolmogorov–Smirnov test were used to analyze compliance with normal distribution. Quantitative data were presented as mean ± standard deviation and median (minimum-maximum), and categorical data were presented as frequency (percentage). The comparisons of distributions of continuous variables among the groups were executed with the T-test or Mann–Whitney U test. The cross tables of categorical variables were analyzed with chi-square or Fisher's exact tests. The significance level was taken as p < 0.050. Data were analyzed with the IBM SPSS version 23 (IBM Corp, Armonk, NY, USA). Results The study included 105 adult patients with histopathologically confirmed primary brain tumors. The age of the patients ranged from 19 to 85 years, with a mean of 50.1 ± 14.9 years. In the study, 54 (51.4%) of the patients were male and 51 (48.7%) were female. The most common primary brain tumor was glioblastoma (41.0%), and the tumor distribution is presented in Table 1 . Table 1. Distribution of tumors according to histopathological diagnosis Frequency (n) Percent (%) Glioblastoma 43 41.0 Meningioma 31 29.5 Astrocytoma 6 5.7 Lymphoma 4 3.8 Ependymoma 3 2.9 Schwannoma 3 2.9 Medulloblastoma 2 1.9 Oligodendroglioma 2 1.9 Gliosarcoma 3 2.9 Hemangioblastoma 2 1.9 Ganglioglioma 1 1.0 Nonneoplastic tumors 5 4.8 Total 105 100.0 Of the tumors, 63(60.0%) were intra-axial and 42(40.0%) were extra-axial. Intra-axial tumors were significantly (p = 0.016) more common in males (39/54) than in females (24/51). In 91 (86.7%) cases, the tumor was located supratentorial, whereas in 14 (13.3%) cases, it was located infratentorial, and the MRI findings of the cases are summarized in Table 2 . The MRI findings of intra-axial and extra-axial tumors are summarized in Table 3 . There were statistically significant differences between intra-axial tumors and extra-axial tumors in terms of pituitary gland height (p = 0.016) and tumor sinus invasion area (p = 0.010). In the analysis comparing meningioma (73.8%), the most common extra-axial tumor, with other tumors, there was a significant difference between meningioma and non-meningioma tumors in terms of pituitary gland height and dural sinus invasion area (p = 0.008 and p = 0.029, respectively). Table 2 Position, location and intracranial hypertension findings of intracranial tumors Variable Patient (N = 105) Percent (%) Tumor position Intraaxial 63 60.0 Ekstraaxial 42 40.0 Tumor location Supratentorial 91 86.7 Infratentorial 14 13.3 Optic nerve tortuosity No 86 81.9 Unilateral 0 0.0 Bilateral 19 18.1 Optic disc protrusion No 105 100 Unilateral 0 0.0 Bilateral 0 0.0 Pitutiary gland height 0-Normal 13 12.4 1-Mild height loss 55 52.4 2-Partial empty sella 34 32.4 3-Empty sella 3 2.9 Dural sinus invasion No 82 78.1 Yes 23 21.9 Table 3 Comparison of intracranial hypertension findings according to position of intracranial tumors Variable Intraaxial Ekstraaxial P Tumor volume 32,9 68,5 0.294 Left optic nerve sheath diameter 4.42 4.39 0.817 Right optic nerve sheath diameter 4.46 4,38 0.487 Left Meckel cave diameter 4.86 4.80 0.652 Right Meckelcave diameter 4.85 4.85 0.981 Dural sinus invasion (+/-) 10/53 (15.9%) 13/29 (31.0%) 0.112 Dural sinus invasion area 2.57 8.25 0.010 Pitutiary gland height 3.71 3.19 0.016 Discussion This study evaluated the radiological findings of secondary intracranial hypertension in patients with primary intracranial tumors and the relationship between these findings and tumor type. Our study found that decreased pituitary gland height, one of the secondary intracranial hypertension findings, was more common in extraaxial tumors than intraaxial tumors, regardless of tumor volume. Morphologic changes related to pituitary gland height have been previously discussed in the literature with different results 14,15 and there are few studies on intracranial hypertension secondary to intracranial tumors. Our study found no statistically significant volume difference between intraaxial and extraaxial tumors; therefore, no significant relationship was found between tumor volume and pituitary gland height. In our study, a statistically significant difference was found in pituitary gland height between the groups in comparing meningioma, the most common extraaxial tumor, and other tumors, which is consistent with the literature. Kim et al. 15 reported that slow-growing extraaxially located meningiomas cause empty sella appearance more frequently than other tumors, even though they do not have direct sella invasion. This may be explained by the involvement of dural surfaces in meningiomas, which may affect CSF circulation. Chronic hypertension due to impaired CSF absorption causes weakening of the diaphragm sella and collapse over time, reducing the height of the pituitary gland. On the other hand, it is difficult to make comparisons in aggressive, rapidly progressing intraparenchymal tumors since survival may be relatively shorter. In the comparison of intraaxial and extraaxial tumors in terms of sinus invasion, extraaxial tumors caused dural sinus invasion more frequently, and the superior sagittal sinus invasion was the most common. In the analysis comparing meningioma, the most common extraaxial tumor, with other tumors, there was a significant difference in the area of dural sinus invasion between meningioma and other tumors. Although there is no volume difference between intraaxial and extraaxial tumors, the fact that secondary hypertension findings are more common in extraaxial tumors may be explained by impaired CSF absorption secondary to dural sinus invasion 15 . Currently, the most commonly accepted theory in the pathogenesis of idiopathic intracranial hypertension (IIH) is decreased CSF absorption 16 . In the literature, it has been reported that CSF absorption decreased in 4 of 5 cases (80%) as a result of intrathecal contrast administration in IIH patients 17 . In our study, we think the decrease in pituitary gland height observed most frequently in meningioma cases is related to the dural sinus invasion area. Based on the results of our study, we postulate that intracranial hypertension may be detected more frequently in the chronic period in unoperated extra-axial tumors, especially meningiomas. In this respect, knowing the clinical and radiological findings of intracranial hypertension in cases followed up for intracranial mass will play an important role in early and accurate diagnosis. In addition, endocrine dysfunction has been reported in empty sella cases secondary to intracranial hypertension in the literature, and periodic follow-up of the cases is recommended in terms of endocrine dysfunction 18 . In our study, there was no statistically significant difference between intraaxial and extraaxial tumors in findings related to optic nerve secondary to intracranial hypertension and an increase in Meckel's cave dimensions, which is one of the findings related to the enlargement of CSF distances. Hingwala et al. 19 compared idiopathic intracranial hypertension (IIH) and secondary intracranial hypertension case groups and found a statistically significant difference in the development of posterior globe flattening and optic nerve protrusion in the IIH cases compared to secondary intracranial hypertension group. The same study emphasized that posterior globe flattening alone was more effective regarding the diagnosis of IIH. In our study, no significant difference was found between the groups in optic nerve sheath diameter, and it is known that the results may vary according to the measurement technique and position 14 . The study is limited by its retrospective nature and the small number of cases reported. Another limitation is that the CSF opening pressure of the cases could not be measured with lumbar puncture, which is an invasive procedure, and intracranial hypertension could not be quantified. Comprehensive studies in large case groups are needed to understand the radiological findings and pathological relationship of secondary intracranial hypertension. Conclusion In conclusion, for the identification and follow-up of secondary intracranial hypertension, radiological imaging methods should be used and it should be kept in mind that the findings may be related to tumor pathology. Declarations Ethics approval and consent to participate: This study was approved by the Institutional Review Board. Conflict of interest: Not applicable. Funding: Not applicable. Author Contribution BNK: Conception, design of work, image interpretation, data analysis and manuscript writing. YŞ: data collection, data analysis and manuscript writing. TÇ: data collection, data analysis and manuscript writing. HPG: design of work, image interpretation, data analysis, image interpretation and manuscript writing. All authors have approved the submitted version of the manuscript. Availability of data and materials: Not applicable. References Allen CH, Ward JD. An evidence-based approach to management of increased intracranial pressure. Crit Care Clin . 1998;14(3):485-495. doi:10.1016/S0749-0704(05)70012-9 Nag DS, Sahu S, Swain A, Kant S. Intracranial pressure monitoring: Gold standard and recent innovations. World J Clin Cases . 2019;7(13):1535-1553. doi:10.12998/wjcc.v7.i13.1535 Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology . 2002;59(10):1492-1495. doi:10.1212/01.WNL.0000029570.69134.1B Bershad EM, Humphreis WE, Suarez JI. Intracranial hypertension. Semin Neurol . 2008;28(5):690-702. doi:10.1055/s-0028-1105968 Suzuki H, Takanashi J, Kobayashi K, Nagasawa K, Tashima K, Kohno Y. MR imaging of idiopathic intracranial hypertension. AJNR Am J Neuroradiol . 2001;22(1):196-199. doi:10.1007/978-3-319-68536-6_13 Bidot S, Saindane AM, Peragallo JH, Bruce BB, Newman NJ, Biousse V. Brain Imaging in Idiopathic Intracranial Hypertension. J Neuroophthalmol . 2015;35(4):400-411. doi:10.1097/WNO.0000000000000303 Maralani PJ, Hassanlou M, Torres C, et al. Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension. Clin Radiol . 2012;67(7):656-663. doi:10.1016/j.crad.2011.12.002 Julayanont P, Karukote A, Ruthirago D, Panikkath D, Panikkath R. Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects. J Pain Res . 2016;9:87-99. doi:10.2147/JPR.S60633 Saindane AM, Lim PP, Aiken A, Chen Z, Hudgins PA. Factors determining the clinical significance of an “empty” sella turcica. AJR Am J Roentgenol . 2013;200(5):1125-1131. doi:10.2214/AJR.12.9013 Wong H, Sanghera K, Neufeld A, Maxner C, Shankar JJS. Clinico-radiological correlation of magnetic resonance imaging findings in patients with idiopathic intracranial hypertension. Neuroradiology . 2020;62(1):49-53. doi:10.1007/s00234-019-02288-9 Kuzan BN, Ilgın C, Kuzan TY, et al. Accuracy and reliability of magnetic resonance imaging in the diagnosis of idiopathic intracranial hypertension. Eur J Radiol . 2022;155:110491. doi:10.1016/j.ejrad.2022.110491 Sonmez OF, Odaci E, Bas O, et al. A stereological study of MRI and the Cavalieri principle combined for diagnosis and monitoring of brain tumor volume. Journal of Clinical Neuroscience . 2010;17(12şü,):1499-1502. doi:10.1016/j.jocn.2010.03.044 Yuh WTC, Zhu M, Taoka T, et al. MR imaging of pituitary morphology in idiopathic intracranial hypertension. Journal of Magnetic Resonance Imaging . 2000;12(6):808-813. doi:10.1002/1522-2586(200012)12:63.0.CO;2-N Rohr AC, Riedel C, Fruehauf MC, et al. MR imaging findings in patients with secondary intracranial hypertension. American Journal of Neuroradiology . 2011;32(6):1021-1029. doi:10.3174/ajnr.A2463 Ji HK, Jung HK, Hyun WK, Ho GH, Chul KJ. Analysis of empty sella secondary to the brain tumors. J Korean Neurosurg Soc . 2009;46(4):355-359. doi:10.3340/jkns.2009.46.4.355 Weisberg LA. Computed tomography in benign intracranial hypertension. Neurology . 1985;35(7):1075-1078. doi:10.1212/wnl.35.7.1075 Martins AN. Resistance to drainage of cerebrospinal fluid: clinical measurement and significance. J Neurol Neurosurg Psychiatry . 1973;36(2):313-318. doi:10.1136/jnnp.36.2.313 Maira G, Anile C, Mangiola A. Primary empty sella syndrome in a series of 142 patients. J Neurosurg . 2005;103(5):831-836. doi:10.3171/jns.2005.103.5.0831 Hingwala DR, Kesavadas C, Thomas B, Kapilamoorthy TR, Sarma PS. Imaging signs in idiopathic intracranial hypertension: Are these signs seen in secondary intracranial hypertension too? Ann Indian Acad Neurol . 2013;16(2):229-233. doi:10.4103/0972-2327.112476 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 09 Apr, 2024 Submission checks completed at journal 04 Apr, 2024 First submitted to journal 02 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4205569","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":287336798,"identity":"8279eafa-5e38-4087-8698-04d19a346994","order_by":0,"name":"Beyza Nur Kuzan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYDCCAzxwJuNjMMXM3EC0FmZjBgYDIMVIvBY2abAWBgJa+G6fPfiY549d4vwZuceqCyr+RPO3A7X8qNiGU4vkubxkYx6e5MTGGXlpt2ecMcidcZixgbHnzG2cWgzO8JhJ80gwJzZL5Jjd5m0zyG0AamFmbMOrxfw3j0F9YhtQSzFIy3witJgx8yQcTuwBamEGadlASIvkGb5kyTkHjhvP4HljLM1zxjh3I1DLQXx+4TvDe/DDmz/VsvPbcww/81TI5c47f/jggx8VuLWAABMPusgBvOqBgPEHIRWjYBSMglEwsgEAsTtVx3/UZ3kAAAAASUVORK5CYII=","orcid":"","institution":"Kartal Dr. Lütfi Kırdar City Hospital","correspondingAuthor":true,"prefix":"","firstName":"Beyza","middleName":"Nur","lastName":"Kuzan","suffix":""},{"id":287336799,"identity":"e0858f0d-d685-4fcc-8bb2-40c335b54b2a","order_by":1,"name":"Yener Şahin","email":"","orcid":"","institution":"Kartal Dr. Lütfi Kırdar City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yener","middleName":"","lastName":"Şahin","suffix":""},{"id":287336800,"identity":"79bdb275-4ca7-4d43-9f81-8ff00038abee","order_by":2,"name":"Tufan Çiftçi","email":"","orcid":"","institution":"Kartal Dr. Lütfi Kırdar City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tufan","middleName":"","lastName":"Çiftçi","suffix":""},{"id":287336801,"identity":"1de59efd-305b-471d-bdf3-d45b3380c14f","order_by":3,"name":"Hediye Pınar Günbey","email":"","orcid":"","institution":"Kartal Dr. Lütfi Kırdar City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hediye","middleName":"Pınar","lastName":"Günbey","suffix":""}],"badges":[],"createdAt":"2024-04-02 09:37:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4205569/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4205569/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54369007,"identity":"f87fdcf4-6762-4085-9ada-74858153f2f8","added_by":"auto","created_at":"2024-04-09 12:57:43","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":15709,"visible":true,"origin":"","legend":"\u003cp\u003e54 y, male. Tumor areas measurements was shown on postcontrast axial series.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4205569/v1/05cc9fb6311127fbd1ad854e.jpg"},{"id":54369010,"identity":"48cc77c4-fdc8-488c-8b27-81b015652873","added_by":"auto","created_at":"2024-04-09 12:57:43","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16323,"visible":true,"origin":"","legend":"\u003cp\u003e58 y, male. In the postcontrast series, possible venous sinus invasion status were evaluated, and in cases with invasion, the invaded venous sinus and invaded tumor area were measured.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4205569/v1/055efdb7748cfc4562bb2fea.jpg"},{"id":54369016,"identity":"65f9f109-c2cb-4d08-ae80-542497f5d2cd","added_by":"auto","created_at":"2024-04-09 12:57:45","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":431233,"visible":true,"origin":"","legend":"\u003cp\u003e61 y, male. Findings related to intracranial hypertension were evaluated on T2-weighted series. The decrease in pituitary gland height is shown in figure \u003cstrong\u003eA\u003c/strong\u003e, enlargement of bilateral Meckel's caves is shown in \u003cstrong\u003eB\u003c/strong\u003e, increased fluid in the bilateral optic nerve sheaths is shown in \u003cstrong\u003eC\u003c/strong\u003e, and tortuosity development is shown in \u003cstrong\u003eD\u003c/strong\u003e.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4205569/v1/02c3560f4a1b78906c3f7ede.png"},{"id":54369052,"identity":"6896aba3-d99d-42f0-b801-4860df214aad","added_by":"auto","created_at":"2024-04-09 12:57:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":703158,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4205569/v1/3ee966e7-2d16-46f3-bece-788bc3dbe55b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAnalysis of Radiological Findings and Pathological Correlation in Secondary Intracranial Hypertension\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntracranial hypertension is a condition of increased pressure in the cranium, characterized by constant pressure and internal balance and the absence of expansion due to identifiable or unidentifiable causes\u003csup\u003e1\u003c/sup\u003e. In cases where autoregulation cannot be achieved and compensation limits are exceeded, this condition may result in intracranial pressure increase syndrome (ICHS), which may present with herniation conditions in which anatomical structures are displaced secondary to pressure increase \u003csup\u003e2\u003c/sup\u003e. Intracranial hypertension may occur secondary to causes such as intracranial mass or hemorrhage, or it may occur idiopathically without any detectable cause\u003csup\u003e3\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough the gold standard in the diagnosis of intracranial hypertension is the documentation of increased pressure with invasive methods, procedural difficulties, false positive and false negative results, and patient noncompliance are among the limitations of the procedure\u003csup\u003e4\u003c/sup\u003e. Because clinical history and symptoms may also be variable, imaging modalities are essential in diagnosis. Currently, computed tomography (CT) and magnetic resonance imaging (MRI) can both investigate the cause of intracranial hypertension and detect anatomical changes secondary to hypertension\u003csup\u003e5,6\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAmong the radiologic findings of intracranial hypertension, findings related to the optic nerve and enlargement of the arachnoid spaces have been reported in MRI examinations\u003csup\u003e7,8\u003c/sup\u003e. Changes in the height of the pituitary gland with enlargement of the cerebrospinal fluid (CSF) distance can be seen in cases of intracranial hypertension\u003csup\u003e9\u003c/sup\u003e. Narrowing the venous sinuses may also occur secondary to intracranial hypertension and has been recorded as the most common radiologic finding in some studies\u003csup\u003e10,11\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur study aimed to demonstrate intracranial hypertension secondary to intracranial tumors with radiological findings in our patients and to reveal the relationship between tumor pathology and intracranial hypertension.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient Selection\u003c/h2\u003e \u003cp\u003eThis is a retrospective study of adult patients diagnosed histopathologically with intracranial tumors in our hospital between September 2021 and April 2022. In patients with intracranial tumors, demographic data were obtained through the hospital information system. Five of 139 cases were excluded from the study because their clinical and fundoscopic findings were not compatible with secondary intracranial hypertension. In the fundoscopic examination of the remaining 134 cases, bilateral varying degrees of papilledema were detected, and the cases were defined as increased intracranial tension secondary to an intracranial mass based on clinical and fundoscopic examination findings. Lumbar puncture was not performed in the cases due to invasive nature. Radiologic images were obtained retrospectively through the picture archiving and communication system (PACS, INFINITT Healthcare, Seoul, South Korea). In the postoperative period, the histopathological diagnosis of the tumors of the cases was accessed through the hospital system and noted. The study did not include pediatric patients under 18 or those without preoperative brain MRI examinations. A total of 29 patients with intracranial metastasis after histopathological diagnosis were excluded from the study, and 105 patients with primary intracranial tumors were included in the study. Our study was approved by the Clinical Research Ethics Committee of our hospital (Decision No: 2022/514/240/11).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eImage Analysis\u003c/h2\u003e \u003cp\u003eIn our study, intravenous (IV) contrast-enhanced brain MRI examinations of patients were evaluated with consensus by two neuroradiologists under the mentorship of a senior neuroradiologist. All images were acquired on a 1.5 T MRI with a slice thickness of 5 millimeters (mm) (Philips Medical Systems, Best, NL).Tumor position (intra-axial versus extra-axial) and location (supratentorial versus infratentorial) were determined and noted in the postcontrast axial series. Tumor areas were measured on consecutive postcontrast axial series, and tumor volume was calculated using the Cavalieri method (total area x [number of slices\u0026thinsp;+\u0026thinsp;gap]) \u003csup\u003e12\u003c/sup\u003e(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the postcontrast series, the distance of the tumor to the venous sinuses and possible invasion status were evaluated, and in cases with invasion, the invaded venous sinus and invaded tumor area were measured (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Findings related to intracranial hypertension were evaluated on T2-weighted axial slices. Accordingly, the development of tortuosity and the presence of optic nerve protrusion in the globe were noted. The optic nerve sheath diameter was measured 3 mm distal to the posterior part of the globe and recorded. Transverse diameters of bilateral Meckel's caves were measured. Pituitary gland height was measured on midsagittal T2-weighted sections and categorized into five groups according to Yuh \u003csup\u003e13\u003c/sup\u003e et al.\u0026rsquo;s classification of pituitary gland height (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The presence of arachnoid granulation was also evaluated and recorded in the axial T2-weighted series.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe Shapiro\u0026ndash;Wilk test and Kolmogorov\u0026ndash;Smirnov test were used to analyze compliance with normal distribution. Quantitative data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and median (minimum-maximum), and categorical data were presented as frequency (percentage). The comparisons of distributions of continuous variables among the groups were executed with the T-test or Mann\u0026ndash;Whitney U test. The cross tables of categorical variables were analyzed with chi-square or Fisher's exact tests. The significance level was taken as p\u0026thinsp;\u0026lt;\u0026thinsp;0.050. Data were analyzed with the IBM SPSS version 23 (IBM Corp, Armonk, NY, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 105 adult patients with histopathologically confirmed primary brain tumors. The age of the patients ranged from 19 to 85 years, with a mean of 50.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9 years. In the study, 54 (51.4%) of the patients were male and 51 (48.7%) were female. The most common primary brain tumor was glioblastoma (41.0%), and the tumor distribution is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Distribution of tumors according to histopathological diagnosis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"76%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eFrequency (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eGlioblastoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e41.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eMeningioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eAstrocytoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eLymphoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eEpendymoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eSchwannoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eMedulloblastoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eOligodendroglioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eGliosarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eHemangioblastoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eGanglioglioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eNonneoplastic tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.41414141414141%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e \u003cp\u003eOf the tumors, 63(60.0%) were intra-axial and 42(40.0%) were extra-axial. Intra-axial tumors were significantly (p\u0026thinsp;=\u0026thinsp;0.016) more common in males (39/54) than in females (24/51). In 91 (86.7%) cases, the tumor was located supratentorial, whereas in 14 (13.3%) cases, it was located infratentorial, and the MRI findings of the cases are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The MRI findings of intra-axial and extra-axial tumors are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There were statistically significant differences between intra-axial tumors and extra-axial tumors in terms of pituitary gland height (p\u0026thinsp;=\u0026thinsp;0.016) and tumor sinus invasion area (p\u0026thinsp;=\u0026thinsp;0.010). In the analysis comparing meningioma (73.8%), the most common extra-axial tumor, with other tumors, there was a significant difference between meningioma and non-meningioma tumors in terms of pituitary gland height and dural sinus invasion area (p\u0026thinsp;=\u0026thinsp;0.008 and p\u0026thinsp;=\u0026thinsp;0.029, respectively).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePosition, location and intracranial hypertension findings of intracranial tumors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient (N\u0026thinsp;=\u0026thinsp;105)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraaxial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEkstraaxial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupratentorial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfratentorial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOptic nerve tortuosity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOptic disc protrusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePitutiary gland height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0-Normal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-Mild height loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-Partial empty sella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3-Empty sella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDural sinus invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of intracranial hypertension findings according to position of intracranial tumors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntraaxial\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEkstraaxial\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft optic nerve sheath diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight optic nerve sheath diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft Meckel cave diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.652\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight Meckelcave diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDural sinus invasion (+/-)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10/53 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13/29 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDural sinus invasion area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePitutiary gland height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the radiological findings of secondary intracranial hypertension in patients with primary intracranial tumors and the relationship between these findings and tumor type. Our study found that decreased pituitary gland height, one of the secondary intracranial hypertension findings, was more common in extraaxial tumors than intraaxial tumors, regardless of tumor volume. Morphologic changes related to pituitary gland height have been previously discussed in the literature with different results\u003csup\u003e14,15\u003c/sup\u003e and there are few studies on intracranial hypertension secondary to intracranial tumors. Our study found no statistically significant volume difference between intraaxial and extraaxial tumors; therefore, no significant relationship was found between tumor volume and pituitary gland height.\u003c/p\u003e \u003cp\u003eIn our study, a statistically significant difference was found in pituitary gland height between the groups in comparing meningioma, the most common extraaxial tumor, and other tumors, which is consistent with the literature. Kim et al.\u003csup\u003e15\u003c/sup\u003e reported that slow-growing extraaxially located meningiomas cause empty sella appearance more frequently than other tumors, even though they do not have direct sella invasion. This may be explained by the involvement of dural surfaces in meningiomas, which may affect CSF circulation. Chronic hypertension due to impaired CSF absorption causes weakening of the diaphragm sella and collapse over time, reducing the height of the pituitary gland. On the other hand, it is difficult to make comparisons in aggressive, rapidly progressing intraparenchymal tumors since survival may be relatively shorter.\u003c/p\u003e \u003cp\u003eIn the comparison of intraaxial and extraaxial tumors in terms of sinus invasion, extraaxial tumors caused dural sinus invasion more frequently, and the superior sagittal sinus invasion was the most common. In the analysis comparing meningioma, the most common extraaxial tumor, with other tumors, there was a significant difference in the area of dural sinus invasion between meningioma and other tumors. Although there is no volume difference between intraaxial and extraaxial tumors, the fact that secondary hypertension findings are more common in extraaxial tumors may be explained by impaired CSF absorption secondary to dural sinus invasion\u003csup\u003e15\u003c/sup\u003e. Currently, the most commonly accepted theory in the pathogenesis of idiopathic intracranial hypertension (IIH) is decreased CSF absorption\u003csup\u003e16\u003c/sup\u003e. In the literature, it has been reported that CSF absorption decreased in 4 of 5 cases (80%) as a result of intrathecal contrast administration in IIH patients\u003csup\u003e17\u003c/sup\u003e. In our study, we think the decrease in pituitary gland height observed most frequently in meningioma cases is related to the dural sinus invasion area.\u003c/p\u003e \u003cp\u003eBased on the results of our study, we postulate that intracranial hypertension may be detected more frequently in the chronic period in unoperated extra-axial tumors, especially meningiomas. In this respect, knowing the clinical and radiological findings of intracranial hypertension in cases followed up for intracranial mass will play an important role in early and accurate diagnosis. In addition, endocrine dysfunction has been reported in empty sella cases secondary to intracranial hypertension in the literature, and periodic follow-up of the cases is recommended in terms of endocrine dysfunction\u003csup\u003e18\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study, there was no statistically significant difference between intraaxial and extraaxial tumors in findings related to optic nerve secondary to intracranial hypertension and an increase in Meckel's cave dimensions, which is one of the findings related to the enlargement of CSF distances. Hingwala et al.\u003csup\u003e19\u003c/sup\u003e compared idiopathic intracranial hypertension (IIH) and secondary intracranial hypertension case groups and found a statistically significant difference in the development of posterior globe flattening and optic nerve protrusion in the IIH cases compared to secondary intracranial hypertension group. The same study emphasized that posterior globe flattening alone was more effective regarding the diagnosis of IIH. In our study, no significant difference was found between the groups in optic nerve sheath diameter, and it is known that the results may vary according to the measurement technique and position\u003csup\u003e14\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe study is limited by its retrospective nature and the small number of cases reported. Another limitation is that the CSF opening pressure of the cases could not be measured with lumbar puncture, which is an invasive procedure, and intracranial hypertension could not be quantified. Comprehensive studies in large case groups are needed to understand the radiological findings and pathological relationship of secondary intracranial hypertension.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, for the identification and follow-up of secondary intracranial hypertension, radiological imaging methods should be used and it should be kept in mind that the findings may be related to tumor pathology.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBNK: Conception, design of work, image interpretation, data analysis and manuscript writing. YŞ: data collection, data analysis and manuscript writing. T\u0026Ccedil;: data collection, data analysis and manuscript writing. HPG: design of work, image interpretation, data analysis, image interpretation and manuscript writing. All authors have approved the submitted version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAllen CH, Ward JD. An evidence-based approach to management of increased intracranial pressure. \u003cem\u003eCrit Care Clin\u003c/em\u003e. 1998;14(3):485-495. doi:10.1016/S0749-0704(05)70012-9\u003c/li\u003e\n\u003cli\u003eNag DS, Sahu S, Swain A, Kant S. 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A stereological study of MRI and the Cavalieri principle combined for diagnosis and monitoring of brain tumor volume. \u003cem\u003eJournal of Clinical Neuroscience\u003c/em\u003e. 2010;17(12ş\u0026uuml;,):1499-1502. doi:10.1016/j.jocn.2010.03.044\u003c/li\u003e\n\u003cli\u003eYuh WTC, Zhu M, Taoka T, et al. MR imaging of pituitary morphology in idiopathic intracranial hypertension. \u003cem\u003eJournal of Magnetic Resonance Imaging\u003c/em\u003e. 2000;12(6):808-813. doi:10.1002/1522-2586(200012)12:6\u0026lt;808::AID-JMRI3\u0026gt;3.0.CO;2-N\u003c/li\u003e\n\u003cli\u003eRohr AC, Riedel C, Fruehauf MC, et al. MR imaging findings in patients with secondary intracranial hypertension. \u003cem\u003eAmerican Journal of Neuroradiology\u003c/em\u003e. 2011;32(6):1021-1029. doi:10.3174/ajnr.A2463\u003c/li\u003e\n\u003cli\u003eJi HK, Jung HK, Hyun WK, Ho GH, Chul KJ. Analysis of empty sella secondary to the brain tumors. \u003cem\u003eJ Korean Neurosurg Soc\u003c/em\u003e. 2009;46(4):355-359. doi:10.3340/jkns.2009.46.4.355\u003c/li\u003e\n\u003cli\u003eWeisberg LA. Computed tomography in benign intracranial hypertension. \u003cem\u003eNeurology\u003c/em\u003e. 1985;35(7):1075-1078. doi:10.1212/wnl.35.7.1075\u003c/li\u003e\n\u003cli\u003eMartins AN. Resistance to drainage of cerebrospinal fluid: clinical measurement and significance. \u003cem\u003eJ Neurol Neurosurg Psychiatry\u003c/em\u003e. 1973;36(2):313-318. doi:10.1136/jnnp.36.2.313\u003c/li\u003e\n\u003cli\u003eMaira G, Anile C, Mangiola A. Primary empty sella syndrome in a series of 142 patients. \u003cem\u003eJ Neurosurg\u003c/em\u003e. 2005;103(5):831-836. doi:10.3171/jns.2005.103.5.0831\u003c/li\u003e\n\u003cli\u003eHingwala DR, Kesavadas C, Thomas B, Kapilamoorthy TR, Sarma PS. Imaging signs in idiopathic intracranial hypertension: Are these signs seen in secondary intracranial hypertension too? \u003cem\u003eAnn Indian Acad Neurol\u003c/em\u003e. 2013;16(2):229-233. doi:10.4103/0972-2327.112476\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"neurosurgical-review","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nrev","sideBox":"Learn more about [Neurosurgical Review](https://www.springer.com/journal/10143)","snPcode":"10143","submissionUrl":"https://submission.nature.com/new-submission/10143/3","title":"Neurosurgical Review","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Intracranial hypertension, magnetic resonance imaging, brain tumor, extraaxial tumors","lastPublishedDoi":"10.21203/rs.3.rs-4205569/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4205569/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIntracranial hypertension is a potentially fatal entity that can occur due to idiopathic or secondary causes and can be detected by radiological methods. To determine radiological findings of intracranial hypertension secondary to primary intracranial tumors and to reveal the relationship between tumor pathology and radiological findings.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study included 105 adult patients with a histopathologically confirmed primary intracranial tumor. Tumor characteristics and MRI findings associated with intracranial hypertension were noted. The relationship between tumor type and radiological findings was evaluated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eGlioblastoma (41.0%) followed by meningioma (29.5%) was the most common primary brain tumor. There was a statistically significant difference between intraaxial tumors and extraaxial tumors in terms of pituitary gland height (p\u0026thinsp;=\u0026thinsp;0.016) and sinus invasion area of the tumor (p\u0026thinsp;=\u0026thinsp;0.010). In the subgroup analysis, there was a significant difference between meningioma, the most common extraaxial tumor, and other tumors in terms of pituitary gland height and dural sinus invasion area (p\u0026thinsp;=\u0026thinsp;0.008 and p\u0026thinsp;=\u0026thinsp;0.029, respectively).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIt is important to know the radiological findings of secondary intracranial hypertension caused by intracranial masses and to keep in mind that it may be associated with tumor pathology and some secondary intracranial hypertension findings may be detected more frequently in extraaxial tumors.\u003c/p\u003e","manuscriptTitle":"Analysis of Radiological Findings and Pathological Correlation in Secondary Intracranial Hypertension","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-09 12:57:25","doi":"10.21203/rs.3.rs-4205569/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-04-09T13:06:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-04T04:34:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"Neurosurgical Review","date":"2024-04-02T09:36:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"neurosurgical-review","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nrev","sideBox":"Learn more about [Neurosurgical Review](https://www.springer.com/journal/10143)","snPcode":"10143","submissionUrl":"https://submission.nature.com/new-submission/10143/3","title":"Neurosurgical Review","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a00b2769-41dc-4e61-a243-1e8169a66c4d","owner":[],"postedDate":"April 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-10T12:10:04+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-09 12:57:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4205569","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4205569","identity":"rs-4205569","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}