[Intraoperative visual evoked potential recording in occipital tumor surgery]. / Udalenie opukholei zatylochnoi doli s primeneniem intraoperatsionnoi registratsii korkovykh zritel'nykh vyzvannykh potentsialov.

Currently, visual field defects are considered as an inevitable consequence of occipital lobe surgery. However, recent advances in neuroimaging techniques, such as diffusion tensor tractography allowing better visualization of optic radiation and its relationship with occipital lobe tumors, as well as intraoperative monitoring of cortical visual evoked potentials (cVEPs) can contribute to correct planning of surgery and minimizing the risk of visual field defects after surgery. OBJECTIVE: To evaluate the effectiveness of intraoperative monitoring of cVEP in patients with occipital lobe tumors. MATERIAL AND METHODS: Ten patients with occipital lobe tumors have undergone surgery with neurophysiological monitoring since 2020. Mean age of patients was 57 years. There were 6 women and 4 men. In 7 patients, neoplasms were located in the right hemisphere, in 3 patients - in the left hemisphere. According to preoperative automatic perimetry data, 7 patients had various visual field defects, and other ones had intact visual fields. All patients underwent pre- and postoperative MRI for visualization of optic radiation, its relationship with tumor and control of resection quality. Intraoperative monitoring of cVEPs was performed in all patients. RESULTS: Biopsy verified glioblastoma in 5 cases, metastasis of adenocarcinoma - 2 cases, diffuse glioma - 1 case, ganglioglioma - 1 case, CNS lymphoma - 1 case. Postoperative MRI confirmed total or subtotal resection of tumor in all cases. Enlargement of visual fields occurred in 3 patients after surgery. Two ones had deterioration and/or new homonymous defect. No changes of visual fields was observed in other cases. Analysis of visual field defects after surgery found no correlation with functional state of visual tract according to fractional anisotropy before and after surgery. CONCLUSION: MR tractography of optic radiation and intraoperative monitoring of cVEP allow choosing the safest approach for resection of occipital tumor and minimizing the risk of damage to visual cortex and optic radiation fibers. In most cases, postoperative visual functions do not worsen after intraoperative mapping of visual cortex and determining the safest trajectory for resection of occipital lobe tumors. Moreover, improvement is observed in some cases.

[Use of optical coherence tomography in diagnosis of retinal lymphomas]. / Vozmozhnosti opticheskoi kogerentnoi tomografii v diagnostike retinal'nykh limfom.

Primary intraocular lymphomas (PIOL) affecting the vitreoretinal complex is a rare nosology, and because of that PIOLs often cause diagnostic difficulties and/or lead to misdiagnosis. In the event of retinal lesions, in addition to routine ophthalmoscopy, optical coherence tomography (OCT) of the retina plays an important role in the diagnosis of the disease. PURPOSE: Evaluation of the characteristic features of retinal lymphomas using OCT. MATERIAL AND METHODS: The study included 6 patients (10 eyes) with retinal lymphomas associated with brain lesions of diffuse large B-cell lymphoma (DLBCL) who were treated at the N.N. Burdenko National Medical Research Center of Neurosurgery from 2017 to 2020; they were examined with OCT. RESULTS: All patients with retinal lymphomas showed typical OCT signs in the form of hyperreflective subretinal infiltrates. CONCLUSION: OCT is a modern non-invasive method that allows diagnosing retinal lymphomas based on clinical and instrumental signs with a high degree of reliability.

[Papilledema as a sign of intracranial hypertension]. / Zastoinyi disk zritel'nogo nerva kak priznak vnutricherepnoi gipertenzii.

Papilledema (choked disk) is a sign of intracranial hypertension (ICH) - condition that presents danger not only for patient's vision, but also for their life. Despite the fact that ICH is usually a neurosurgical pathology, sometimes an ophthalmologist is the first doctor such patients visit, most often in a primary healthcare clinic. At the same time, as practice shows, not all ophthalmologists are well aware about in this pathology; difficulties occur in differential diagnosis of papilledema against similar changes of the optic nerve head seen during ophthalmoscopic examination. This article reviews scientific literature on ICH, including benign ICH, diagnosis and differential diagnosis of papilledema. The authors also share their decades-long experience of working in a neurosurgical facility.

[Retrograde degeneration of visual pathway]. / Retrogradnaya degeneratsiya zritel'nogo puti.

BACKGROUND: Optical coherence tomography (OCT) gives the opportunity to examine retrograde degeneration of visual pathway damaged at various levels. OBJECTIVE: To estimate OCT data on retrograde degeneration of visual pathway damaged at various levels. MATERIAL AND METHODS: Ganglion cell layer (GCL) thickness was measured by OCT in 79 patients with visual pathway damaged at various levels and known duration of visual disturbances. Twenty-One patients were diagnosed with traumatic lesions of the optic nerves and/or chiasma. Fifty-eight patients had retro-genicular visual pathway damage. Thirty-three patients were examined for postoperative homonymous hemianopia after surgery for drug-resistant temporal lobe epilepsy. Twenty-five patients were diagnosed with occipital lobe damage following stroke (12 patients), surgery for arteriovenous malformation (11 patients) and traumatic brain injury (2 patients). All patients underwent assessment of visual acuity, automatic static perimetry, MRI/CT of the brain. Retinal ganglion cell complex was analyzed during OCT. RESULTS: GCL thinning following anterior visual pathway damage was detected in 20 out of 21 patients after ≥22 days. In case of post-genicular visual pathway damage, GCL thinning was found in 25 out of 58 patients (9 out of 33 ones after surgery for temporal lobe epilepsy and 16 out of 25 patients with occipital lobe lesion). After surgery for temporal lobe epilepsy, minimum period until GCL thinning detection after previous visual pathway damage was 3 months, in case of occipital lobe lesion - 5 months. CONCLUSION: Retrograde visual pathway degeneration is followed by GCL thinning and depends on the level of visual pathway lesion.

[Study of the functional significance of polymorphic loci of the LOXL1 gene associated with glaucoma according to genome-wide studies (in silico analysis)]. / Izuchenie funktsional'nogo znacheniya polimorfnykh lokusov gena LOXL1, assotsiirovannykh s glaukomoi po dannym polnogenomnykh issledovanii (analiz in silico).

Glaucoma is one of the most common eye diseases leading to blindness, and whole-genome studies have shown that genetic factors are important in its formation.Purpose - to perform an in silico analysis of the functional significance of polymorphic loci of the LOXL1 gene associated with glaucoma, using data from wholegenome studies. MATERIAL AND METHODS: Using the catalog of genome-wide studies (GWAS) of the National Human Genome Research Institute (https://www.genome.gov/gwastudies/), three polymorphic loci of the LOXL1 gene (rs2165241, rs4886776, rs893818) associated with glaucoma (pseudoexfoliation glaucoma/syndrome) were chosen for the study. Using modern databases on functional genomics (SIFT, PolyPhen-2, HaploReg, GTExportal), the functional significance of these polymorphic loci was assessed (nonsynonymous substitutions, epigenetic effects, association with gene expression, associations with alternative splicing of gene transcripts). RESULTS: The work establishes the important functional significance of the rs2165241, rs4886776 and rs893818 polymorphic loci of the LOXL1 gene. They demonstrate significant epigenetic effects (affect the affinity to five transcription factors, are located in the region of promoters and enhancers, in the region of hypersensitivity to DNase-1), are associated with the expression and alternative splicing of three genes (LOXL1, LOXL1-AS1, RP11-24D15.1) in cell cultures, organs and tissues pathogenetically significant for development of glaucoma, are strongly linked to the rs1048661 polymorphism, which causes the replacement of the Arg141Leu amino acid in the LOXL1 polypeptide. CONCLUSION: Polymorphic loci of the LOXL1 gene (rs2165241, rs4886776, and rs893818) are of great functional importance (epigenetic, eQTL, and sQTL), which may be the biomedical basis of their associations with glaucoma.

[Surgical treatment of drug-resistant epilepsy following hippocampal sclerosis]. / Khirurgicheskoe lechenie farmakorezistentnoi epilepsii pri skleroze gippokampa.

Surgery is an effective approach for drug-resistant temporal lobe epilepsy following hippocampal sclerosis. There is still no clear and unanimous opinion about advantages and disadvantages of certain surgical technique. MATERIAL AND METHODS: There were 103 surgical interventions in 101 patients. Females prevailed (1.45:1). Age of patients ranged from 16 to 56 years (median 28). Anteromedial temporal lobectomy and selective amygdaloghippocampectomy were performed in 49 (47.6%) and 54 (52.4%) patients, respectively. In the latter group, 30 patients were operated via a 14-mm burr hole-subtemporal approach. Postoperative outcomes were assessed using the Engel grading system. The follow-up period ranged from 2 to 8 years (median 4 years). RESULTS: By the 2nd year, Engel class I was observed in 74 (72%) patients, Engel II, III and IV - in 20 (19.4%), 6 (5.8%) and 3 (2.9%) patients, respectively. Engel class I was achieved after anteromedial temporal lobectomy in 68% of cases, selective amygdaloghippocampectomy via standard approaches in 75% of cases, amygdaloghippocampectomy via subtemporal burr hole approach - in 80% of cases. Neurocognitive impairments after anteromedial lobectomy and selective amygdaloghippocampectomy were similar. At the same time, mental disorders de novo prevailed in the group of anteromedial lobectomy (p<0.05). There were no severe visual field disorders after subtemporal burr-hole access. In other cases, these disorders occurred in 36.2% of patients (p<0.05). There were 8 (7.8%) postoperative complications: 5 (10.2%) - after anterior temporal lobectomy, 3 (5.5%) - after selective surgeries via standard approaches. There were no complications after burr-hole surgery. CONCLUSION: Selective amygdaloghippocampectomy is not inferior to anteromedial lobectomy. Moreover, this procedure is associated with a lower risk of complications and adverse events.

[Analysis of the functional role of polymorphism in the CDKN2B-AS1 gene GWAS-significant for primary open-angle glaucoma (an in-silico study)]. / Analiz funktsional'nogo znacheniya GWAS-znachimogo dlya pervichnoi otkrytougol'noi glaukomy polimorfizma gena CDKN2B-AS1 (in silico issledovanie).

Primary open-angle glaucoma (POAG) is the most common form of glaucoma in which genetic factors play a significant role. According to genome-wide studies (GWAS), the CDKN2B-AS1 gene is associated with POAG. PURPOSE: To study in silico the functional significance of the CDKN2B-AS1 gene polymorphism GWAS-significant for primary open-angle glaucoma. MATERIAL AND METHODS: The in-silico analysis was based on data from the GWAS catalog, five polymorphic loci of the CDKN2B-AS1 gene (rs1063192, rs7865618, rs2157719, rs944800, rs4977756) associated with POAG were selected. The study evaluated the regulatory potential, the relationship with the expression and alternative splicing of genes of the CDKN2B-AS1 gene polymorphism using modern databases for functional genomics - HaploReg and GTExportal. RESULTS: An important functional significance of the polymorphic loci rs1063192, rs7865618, rs2157719, rs944800, rs4977756 of the CDKN2B-AS1 gene was revealed. These loci are located in the region of histones marking enhancers and in the region of hypersensitivity to DNAse-1, can be found in more than ten different organs and tissues, in the regions of regulatory DNA motifs to five transcription factors (AIRE, GATA, Tgif1, Pou2f2, and Zfp187), and are associated with expression of three genes (CDKN2B-AS1, CDKN2B, CDKN2A) and alternative splicing of transcripts of two genes (CDKN2B-AS1 and RP11-149I2.4) in cell cultures, organs and tissues with pathogenic significance for glaucoma development. CONCLUSION: Polymorphism of the CDKN2B-AS1 gene (rs1063192, rs7865618, rs2157719, rs944800, rs4977756) has significant regulatory potential and is associated with the expression and alternative splicing of genes, which possibly underlies its association with primary open-angle glaucoma.

[Occipital gliomas. Case report and literature review]. / Intraoperatsionnaya registratsiya korkovykh zritel'nykh vyzvannykh potentsialov pri udalenii gliomy zatylochnoi doli. Klinicheskoe nablyudenie i obzor literatury.

The authors report intraoperative mapping with cortical visual evoked potentials during occipital tumor resection. This approach was valuable to reduce the risk of visual cortex and visual pathways damage and, accordingly, the likelihood of postoperative visual impairment. The peculiarity of this case is registration of clear cortical visual evoked potentials in various positions before and after tumor resection. Intraoperative monitoring was valuable to avoid damage to visual cortex and visual pathways during tumor resection. There was no postoperative visual deterioration. Moreover, we observed partial recovery of visual fields after resection of occipital malignant tumor.

[Genome-wide studies of primary open-angle glaucoma]. / Polnogenomnye issledovaniya pervichnoi otkrytougol'noi glaukomy.

The article reviews literature on developmental stages of genome-wide association studies (GWAS) of primary open-angle glaucoma (POAG). This problem is currently developing and one of the most complex in ophthalmology. The article considers main GWAS of POAG and established GWAS-significant polymorphisms associated with the disease. The topic of genome-wide studies of primary open-angle glaucoma will be of certain interest to ophthalmologists, materials on GWAS-significant loci can be used both in the selection of polymorphisms in replicative studies of POAG in various populations of Russia, and to expand ideas about the molecular genetic mechanisms of the development of the disease.

[Etiopathogenesis of primary open-angle glaucoma]. / Etiopatogenez pervichnoi otkrytougol'noi glaukomy.

The article reviews literature covering the etiopathogenesis and risk factors for the development of primary open-angle glaucoma (POAG). Currently, this problem is one of the most complex and controversial in ophthalmology. The review considers the main theories: vascular, mechanical (retentional, hydromechanical), dystrophic (theory of primary scleropathy), metabolic, concept of liquor hypertension, concept of the individual norm of intraocular pressure, as well as POAG risk factors.

[Visual field disorder after surgery of temporal lobe epilepsy associated to hippocampus sclerosis]. / Narushenie polia zreniia posle operatsii po povodu visochnoi épilepsii, obuslovlennoi sklerozom gippokampa.

OBJECTIVE: Assessment of frequency and severity of visual field disorders after neurosurgical operations at patients with pharmacoresistant form of epilepsy in hippocampus sclerosis. MATERIAL AND METHODS: The study included 48 patients having surgical operations for a pharmacoresistant form of temporal lobe epilepsy due to hippocampus sclerosis. Anterior lobectomy with amygdalohippocampectomy (LE + AHE) was performed in 25 patients; Selective amygdalohippocampectomy (SAHE) was performed in 23 patients. We evaluated both the frequency of cases of homonymous visual field disorders and their severity. RESULTS: After surgery the normal visual field was preserved at 7 (14.6%) patients. The appearance of visual field disorder by the type of homonymous hemianopsia was observed at 41 (85.4%) patients. When assessing the severity of visual field disorder, the smallest disorder was at patients who underwent sub-temporal access of SAHE: a statistically significant difference in the frequency of severe visual field disorder was revealed when comparing this group with patients having LE + AHE (p<0.02), as well as with patients having SAHE with access through sylvian gap (p<0.02). CONCLUSION: SAHE with sub-temporal access allows maintaining or minimally injuring the central optic neuron fibers, including the Meyer loop at patients operated for symptomatic temporal lobe epilepsy.

[Neurosarcoidosis of the anterior visual pathway (a case report and literature review)]. / Neirosarkoidoz perednego zritel'nogo puti (klinicheskie nabliudeniia i obzor literatury).

Sarcoidosis is a multisystem granulomatous disorder of unknown nature. Patients often present with pulmonary, skin, eye, and orbital lesions. Involvement of the central nervous system (CNS) is accompanied by granulomatous leptomeningitis and damage to the basal brain structures with formation of granulomas near the cranial nerves, hypothalamus, pituitary gland, cavernous sinuses, optic chiasm, and intracranial optic nerves. The optic nerves can be affected independently of the other CNS regions, which may be the first manifestation of the disease. The article presents two clinical cases of sarcoidosis affecting the anterior visual pathway. Diagnosis of the disease was associated with certain difficulties. A biopsy revealed a sarcoidosis lesion.

[Structural retinal and optic nerve changes in patients with post-geniculate visual pathway damage]. / Strukturnye izmeneniia setchatki i zritel'nogo nerva pri porazhenii tsentral'nogo nevrona zritel'nogo puti.

AIM: To establish the possibility of retrograde trans-synaptic neural degeneration following acquired post-geniculate visual pathway damage. MATERIAL AND METHODS: Twenty-two patients with homonymous hemianopia caused by acquired post-geniculate visual pathway damage were examined. Peripapillary retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) measurements were assessed with RTVue-100 Fourier-domain optical coherence tomography (OCT). RESULTS: In 12 out of 22 patients we detected binocular GCC thinning that was ipsilateral to post-geniculate involvement. Nine patients showed a decrease in the RNFL thickness. However, topographic correspondence between the post-geniculate lesion and RNFL thickness was established for 2 of them only. GCC thinning was more common in patients with hemianopsia acquired more than 6 months ago (p<0.0009). CONCLUSION: Having assessed the ganglion cell complex and retinal nerve fiber layer with OCT, we have proved possible that trans-synaptic retrograde degeneration develops in patients with post-geniculate visual pathway damage.

[The trans-eyebrow supraorbital approach for removal of anterior cranial fossa and suprasellar meningiomas]. / Supraorbital'nyi chrezbrovnyi dostup dlia udaleniia meningiom perednei cherepnoi iamki i supraselliarnoi oblasti.

Over the past two decades, improvements in surgical tools, navigation systems, and endoscopic techniques have resulted in the widespread use of keyhole surgery for a wide range of skull base tumors. Currently, the trans-eyebrow supraorbital approach is being increasingly used in surgery for anterior cranial fossa and parasellar tumors. MATERIAL AND METHODS: The study included 7 patients who underwent surgery for meningioma using the trans-eyebrow supraorbital approach at the Burdenko Neurosurgical Institute in the period between 2013 and 2017. The age of patients ranged from 51 to 75 years (median, 60 years); there were 5 females and 2 males. The maximum diameter of resected tumors ranged from 20 to 60 mm (median 40 mm). RESULTS: Total resection of the tumor was achieved in all 7 cases, which was confirmed by postoperative MRI control. All 7 patients had a good cosmetic result. In 1 case, there was postoperative cerebrospinal fluid rhinorrhea due to incomplete closure of the frontal sinus, which required the patient to be re-operated. None of 7 cases was associated with injury to the main vessels or cavernous sinus. CONCLUSION: Supraorbital trans-eyebrow craniotomy provides a minimally invasive approach for removing most anterior cranial fossa base and suprasellar tumors. The advantages of keyhole surgery, in comparison with traditional craniotomies, are minimal complications associated with the approach.

[Chiasm and optic nerve glioma manifested as hemorrhage (two clinical cases and a literature review)]. / Glioma khiazmy i zritel'nykh nervov, proiavivshaiasia krovoizliianiem (dva klinicheskikh nabliudeniia i obzor literatury).

The article presents two rare clinical cases of low-grade (WHO grade I-II) glioma of the anterior visual pathway structures, the chiasm and optic nerves, in adults. The feature of these cases was the benign nature of a chiasm and optic nerve glioma in adults as well as its presentation in the form of hemorrhage to the tumor and parenchymal and subarachnoid space, which to some extent complicated making the correct diagnosis. Removal of an intracerebral hematoma and open tumor biopsy were performed in one case, and removal of a hematoma and partial tumor resection followed by radiotherapy were performed in the other case.

[Supracerebellar transtentorial approach to tumors of the posterior portions of the medial temporal region].

OBJECTIVE: Despite the advances in microsurgery, the choice of the most adequate approach to the posterior part of the medial temporal region (MTR) remains a very controversial issue. The supracerebellar transtentorial approach (STA) is considered as the most preferable one, since it provides the optimal balance between retraction, incision, and resection of the brain tissue. Here, we present our consecutive series of 20 patients who underwent STA surgery. MATERIAL AND METHODS: Twenty patients with glial tumors affecting the posterior MTR underwent STA surgery between 2006 and 2014. The mean age of the patients was 20 years. Benign tumors were predominant (18 out of 20 cases). RESULTS: Resection of the posterior and middle MTRs was conducted in 16 cases. The anterior MTR was accessed through STA in 1 patient only; in 2 patients, STA was combined with the infraoccipital approach. Cerebellar edema occurred in 4 patients, with hemiparesis persisting in one of the cases for 1 year after surgery. Of 8 patients with drug resistant epilepsy, the Engel class 1 or 2 outcome was achieved in 6 cases within 1 year after surgery. CONCLUSION: STA provides an excellent surgical route to the posterior and middle MTR portions; however, the anterior MTR portions cannot be reached safely. The operative risks of STA increase as the surgeon proceeds with resection of the anterior MTR portions. Anterior MTR structures can be removed using a combination of the supracerebellar and infraoccipital transtentorial approaches or two-stage resection.

[The influence of psychological factors on the integral health characteristic (data from a prospective population study)].

AIM: To develop integral assessment of the health status based on the examination of representative samples from different regions of Russia (Veliky Novgorod, Nizhni-Novgorod, Vologda, Omsk and Nalchik) with the use of special questionnaires and simple anthropometric and functional methods in the framework of a prospective 3-year population study of organized groups. METHODS: The above questionnaires allowed to elucidate the socio-economic status of the patients, their somatic and psychological conditions (lifestyle index or psychological protection mechanisms (PPM), social adaptation, sanogenic reflexia; also used were Eysenck's psychotism scale, hospital anxiety and depression scale, the perceived stress scale (PSS), and moral potential of personality development scale. RESULTS: It was shown that the profile of psychological protection mechanisms is dominated by primitive reactions, such as projection, protection, and negation. Most subjects from the sample formed the pathogenic type of reflexia (inability to resolve a problem situation based on the cognitive components of the patient's mental state). Mathematical treatment of the so-called "simple cross-tabulation" with unification of all negative PPM revealed the highly significant relationship of LSI (not norm) with most previous somatic diseases (p<0.001), i.e. the history of myocardial infarction, angina of effort, cardiovascular syndromes, diabetes, hypertension, chronic broncho-pulmonary, hepatic, gastrointestinal, urogynecological, oncological, and psychic diseases. (p<0.007). CONCLUSION: Pyschological changes have greater influence than somatic ones on physiological parameters determining the population health status which suggests the necessity of taking them into account when planning health promotion measures.

[MORPHOFUNCTIONAL MYOCARDIAL CHARACTERISTICS IN PATIENTS WITH MASKED ARTERIAL HYPERTENSION AND WHITE COAT HYPERTENSION].

The aim of this work was to study morpho-functional myocardial characteristics in patients with masked arterial hypertension (AH) and white coat hypertension (WCH) given antihypertensive therapy (AHT) and without it. This cross-sectional cohort study included employees of a large industrial enterprise who annually underwent routine medical examination supplemented by 24 hr AP monitoring and echocardiography carried out at specified time of the working day. The participants of the study were divided into 6 groups based on the relationship between clinical AP and mean AP during work. Group I comprised 20 (7%) subjects with normal AP, group 2--20 (7%) with masked AH, group 3--40 (14%) with WCH, group 4--81 (28.3%) with optimal A HT effect, group 5--64 (22.4%) with unmanifest inefficiency of AHT, group 6--40 (14%) with WCH during AHT. Criteria for masked AH and unmanifest AHT inefficiency were clinical AP below 140 and 90 mm Hg in combination with mean AP during work 135 and/or 85 mm Hg and higher. Echocardiography was performed in a standard positions in M- and B-modes as well as in three Doppler regimes. One-factor ANOVA was used to analyze differences between the groups and Pearson's Chi-square test to determine the relationship between categorical variables. 206 (72%) of the 286 employees of the large industrial enterprise had a diagnosis of AH. It was shown that ambulatory AP values obtained by 24 hr monitoring better characterized the patient's condition than clinical AP since they correlated with the frequency of disorders in the target organs and the risk of cardiovascular complications in patients with AH. Patients with masked AH more frequently developed left ventricular hypertrophy and diastolic dysfunction than those having normal clinical and ambulatory AP. The mean width of the left ventricle wall and left ventricular isovolumic relaxation time (therefore, the degree of LV hypertrophy and diastolic dysfunction) in the patients with unmanifest inefficiency of AHT were greater than in those with optimal AHT effect. The occurrence of WCH was comparable in the two groups. These data were used to determine intensity of preventive AHT at the workplace with a view to improving medical and occupational prognosis.

Neuro-ophthalmological Features of Cerebral Venous Sinus Thrombosis.

Neuro-ophtalmological symptoms of 49 patients with cerebral venous sinus thrombosis and different onset of the disease were evaluated. Papilloedema was revealed in 84.6% of patients with acute and subacute onset of the disease and in all patients with chronic onset. Visual disturbances due to papilloedema and post-papilloedema optic atrophy were found in 65.2% of patients with chronic onset. Patients with acute onset of cerebral venous sinus thrombosis were successfully treated with local endovascular thrombolysis. Patients with chronic onset of cerebral venous sinus thrombosis in cases with visual disturbances needed lumboperitoneal shunting to prevent further visual loss.