Journal of neurosurgical sciences最新文献

{"title":"Hemorrhage in cerebral arteriovenous malformations: a dynamic equilibrium and hemodynamic degrees of freedom perspective.","authors":"Leonardo Fiori","doi":"10.23736/S0390-5616.26.06866-9","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06866-9","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of selective dorsal rhizotomy for spastic cerebral palsy: a systematic review and single-arm meta-analysis.","authors":"Maria Antônia Pereira, Victor G Soares, Hilária S Faria, Filipe V Ribeiro, João V Andrade Fernandes, Altair P de Melo Neto, Izabely Dos Reis DE Paula, Helvécio N Feitosa Filho, Vitor E Ribeiro, Matheus S Ferreira, João Paulo Teles, Gustavo S Noleto","doi":"10.23736/S0390-5616.26.06768-8","DOIUrl":"10.23736/S0390-5616.26.06768-8","url":null,"abstract":"<p><strong>Background: </strong>Selective dorsal rhizotomy (SDR) is used to treat spastic cerebral palsy (CP), but its effectiveness remains debated due to heterogeneous, predominantly non-randomized evidence.</p><p><strong>Methods: </strong>This systematic review and single-arm meta-analysis was prospectively registered in PROSPERO (CRD420251132796) and conducted in accordance with PRISMA 2020 and the Cochrane Handbook. PubMed, Embase, and Web of Science were searched for studies evaluating SDR in pediatric CP. Eligible designs included case series, retrospective or prospective cohorts, and randomized trials reporting motor or spasticity outcomes. The primary endpoints were Gross Motor Function Measure-66 (GMFM-66) and Modified Ashworth Scale (MAS). Risk of bias was assessed using the ROBINS-I tool. Mean change values with 95% confidence intervals (CI) were pooled using random-effects models (REML). Statistical heterogeneity was evaluated with the I² statistic, and sensitivity analyses (including leave-one-out and varying correlation coefficients for missing SDs) were performed.</p><p><strong>Results: </strong>Sixteen studies including 756 children were analyzed. SDR was associated with significant improvements in GMFM-66 at the shortest (mean change 3.29; 95% CI 1.54-5.03; I²=71%) and longest (mean change 3.71; 95% CI 2.00-5.42; I²=72%) available follow-up. Spasticity was significantly reduced, with a pooled mean change in MAS of -1.98 (95% CI -3.26 to -0.70; I²=99%). Sensitivity analyses confirmed the stability of results across assumptions, and leave-one-out analyses did not materially alter effect estimates. All included studies were judged to have a moderate risk of bias.</p><p><strong>Conclusions: </strong>SDR is associated with clinically meaningful and durable improvements in gross motor function and reductions in spasticity in children with spastic CP.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"312-317"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of gamma knife radiosurgery in the management of pediatric gliomas: a systematic review and meta-analysis.","authors":"Rudolfh B Arend, Marcelo P Sousa, Daniel M Kieling, Filipe V Ribeiro, Bruno Z Peroni, Natan L Lima, Lucca T Carretta, Stefeson G Cabral Junior, Gabriel Simoni, Raphael Camerotte, Marcio Y Ferreira, Letícia M Kieling, Kim Wouters, Lucca B Palavani, Alex Roman, Guilherme Gago, Cleiton Formentin, Herika N Brito","doi":"10.23736/S0390-5616.26.06777-9","DOIUrl":"10.23736/S0390-5616.26.06777-9","url":null,"abstract":"<p><strong>Background: </strong>Pediatric gliomas pose significant treatment challenges due to their location in eloquent areas and the vulnerability of the developing brain to toxicity. Gamma knife radiosurgery (GKRS) has emerged as a minimally invasive alternative aimed at maximizing local control while sparing healthy tissue. This systematic review and meta-analysis evaluated the efficacy and safety profile of GKRS in the management of pediatric gliomas.</p><p><strong>Methods: </strong>A comprehensive search was conducted across PubMed, Embase, and Web of Science databases for studies published between January 1994 and September 2024, adhering to PRISMA guidelines. Eligible studies included at least four patients and reported on tumor regression, control rates, or safety outcomes. Data were pooled using a random-effects model with single proportion analysis.</p><p><strong>Results: </strong>Eleven studies encompassing 203 patients were included in the quantitative synthesis. The pooled analysis demonstrated a complete tumor regression rate of 17% (95% CI 10-28%) and a partial regression rate of 47% (95% CI 34-60%). Favorable neurological outcomes were achieved in nearly all evaluated patients - 100% (95% CI 95-100%). Regarding safety, procedure-related mortality was 0%. The overall mortality rate was 9% (95% CI 4-18%), with significantly lower mortality observed in pilocytic astrocytomas (2%) compared to other tumor types (15%). Major and minor complications occurred in 3% and 6% of patients, respectively, while adverse radiation effects were noted in 11%.</p><p><strong>Conclusions: </strong>GKRS is a safe and effective treatment modality for pediatric gliomas, offering high rates of tumor regression and excellent neurological preservation. The procedure is associated with minimal morbidity and zero procedure-related mortality, supporting its utility as a reliable therapeutic option for selected pediatric patients.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"332-342"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing benefits and risks: bevacizumab's role in postoperative recovery after spinal oncologic neurosurgery.","authors":"Lucas Pari Mitre, Marya E Jassé DE Souza Dias, Rebeca Oliveira DA Silva, Mariana L DE Bastos Maximiano, Aladine A Elsamadicy","doi":"10.23736/S0390-5616.26.06721-4","DOIUrl":"10.23736/S0390-5616.26.06721-4","url":null,"abstract":"<p><strong>Background: </strong>Spinal oncologic neurosurgery presents considerable therapeutic challenges. Bevacizumab, a monoclonal antibody targeting VEGF, has shown potential to reduce tumor vascularity and postoperative fibrosis. However, its perioperative use raises safety concerns, particularly regarding wound healing.</p><p><strong>Methods: </strong>A systematic search of PubMed, Web of Science, and ClinicalTrials.gov was performed through January 2025. Studies including patients who received Bevacizumab perioperatively for spinal tumors were reviewed. Outcomes included clinical and radiographic response, overall survival, and adverse events. Pooled analyses used random-effects models, and subgroup comparisons were performed. Risk of bias was assessed via the ROBINS-I tool.</p><p><strong>Results: </strong>Ten studies with 85 patients were included. Clinical improvement occurred in 48% (95% CI: 0.22-0.75), and radiographic improvement in 61% (95% CI: 0.37-0.81). Overall survival across all patients averaged 20.8 months (95% CI: 13.6-31.9). A statistically significant survival benefit was observed in non-glioblastoma (non-GBM) tumors (39.1 months [95% CI: 33.0-46.3]) compared to GBM (16.2 months [95% CI: 9.7-27.0], P=0.0013). Adverse events included fatigue (35%), constipation (31%), hypertension (23%), anemia (22%), and wound infections (22%). No wound dehiscence was reported. Clinical and radiographic responses did not significantly differ between GBM and non-GBM groups, despite histologic differences. Heterogeneity varied across analyses, and risk of bias was generally high due to retrospective designs.</p><p><strong>Conclusions: </strong>Bevacizumab may offer clinical and radiologic benefit in select spinal tumor patients, particularly in non-GBM histologies, where a significant survival advantage was demonstrated. Though overall response was promising, complication rates, especially fatigue and hypertension, warrant diligence. The absence of reported wound dehiscence is encouraging but must be interpreted in the context of small, heterogeneous cohorts. Further prospective trials are needed to define optimal perioperative use strategies and establish clearer safety margins.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"343-352"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic versus non-robotic sacroiliac joint fusion: a meta-analysis.","authors":"Zeyad Kamar, Emre Koyuncu, Michael J Albdewi, Ceyhan Ceran Serdar, Hussien Abouzeid, Paul Carne, Natalie Slosar, Noojan J Kazemi, Yamaan S Saadeh","doi":"10.23736/S0390-5616.26.06691-9","DOIUrl":"10.23736/S0390-5616.26.06691-9","url":null,"abstract":"<p><strong>Background: </strong>This meta-analysis aimed to compare intraoperative metrics and postoperative outcomes of sacroiliac joint fusions (SIJF) performed under robotic versus non-robotic navigation.</p><p><strong>Methods: </strong>Studies of adults undergoing SIJF with intraoperative navigation that reported ≥1 relevant outcome were included. PubMed, Scopus, and Web of Science were searched for studies published between September 14^th, 2015, and September 14^th, 2025. Before data analysis, patients were split into robotic and non-robotic fusion groups, and the non-robotic group was further split into fluoroscopic (F), virtual surgical planning (2D), and stereotactic (3D) navigation subgroups. Risk of bias was assessed using the revised Graphical Appraisal Tool for Epidemiological Studies (GATE). Datasets were analyzed using MedCalc and Stata.</p><p><strong>Results: </strong>Twenty papers describing 1581 SIJFs were analyzed for visual analogue scale (VAS) pain, Oswestry Disability Index (ODI), and postoperative complications. ODI and VAS showed postoperative improvement across all groups, with a steeper VAS reduction in the robotic group. Postoperative complication rates were lowest in the non-robotic (2D) subgroup, and lower in the robotic group than in the non-robotic (3D) subgroup. The non-robotic (F) subgroup had the lowest rate of new pain, whereas the robotic group had the highest. The robotic group showed the lowest rate of hematomas. Qualitative analysis of reported data suggests that robotic navigation demonstrates the highest accuracy rate, whereas fluoroscopy demonstrates the lowest. The results, although consistent, were not statistically significant, likely due to substantial heterogeneity among studies.</p><p><strong>Conclusions: </strong>Findings indicate a reduction in postoperative pain and favorable outcomes across both navigation modalities. Additionally, robotic approaches provide an added benefit of reducing intraoperative radiation exposure. Further prospective comparative studies with larger sample sizes are needed to obtain statistically significant comparative data between the groups and to reach definitive conclusions.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"299-311"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training of Italian residents: lights and shadows of the Calabria Decree.","authors":"Francesca Vitulli, Teresa Somma, Ilaria Bove, Domenico Solari, Tamara Ius, Felice Esposito, Luigi M Cavallo","doi":"10.23736/S0390-5616.25.06601-9","DOIUrl":"10.23736/S0390-5616.25.06601-9","url":null,"abstract":"<p><strong>Background: </strong>The Calabria Decree (Law No. 145 of 2018) and its subsequent amendments introduced reforms aimed at improving the employment and training conditions of medical residents in Italy. Notably, the decree allowed for the early hiring of residents, starting from their second year of specialization, with permanent contracts upon completion of their training. This study explores the impact of these reforms on neurosurgery residents, specifically examining the effects on their professional development, education, and well-being.</p><p><strong>Methods: </strong>A survey was conducted by the Italian Society of Neurosurgery (SINCH) and distributed to neurosurgery residents, as well as heads of university and non-university hospital departments. The survey gathered data on residents' demographic information, satisfaction with their employment contracts, preparedness for clinical responsibilities, and perceived effects on their training, particularly in terms of surgical and academic activities. Hospital and university leaders were asked to share their perspectives on the impact of early employment on resident training, research activities, and the overall functioning of healthcare institutions.</p><p><strong>Results: </strong>A total of 32 neurosurgery residents participated in the survey. Half of the respondents were employed under fixed-term contracts, while the other half had permanent contracts. Residents expressed high satisfaction with surgical activities, with 71.9% feeling well-prepared for managing surgical emergencies. However, 28.1% reported concerns over a perceived loss of essential training, particularly in research. From the university perspective, 86% of institutions viewed early employment as detrimental to resident education, particularly in academic and research activities. In contrast, hospitals reported positive effects, especially regarding human resource management, patient care, and resident enthusiasm.</p><p><strong>Conclusions: </strong>Early employment under the Calabria Decree has several advantages, particularly in terms of clinical exposure and operational efficiency in hospitals, however, it raises concerns about the potential impact on academic training and scientific research. To ensure comprehensive training, it is essential to foster collaboration between universities and hospitals, emphasizing the importance of maintaining a strong academic foundation alongside clinical practice. The study highlights the need for ongoing adjustments to the training structure to achieve a balance between practical and theoretical education for neurosurgery residents.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"259-264"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurosurgeons in Italy: results of a national census (2022-2024).","authors":"Francesca Vitulli, Maria A Cinalli, Maria R Scala, Maurizio Fornari, Vincenzo Esposito, Giuseppe Cinalli","doi":"10.23736/S0390-5616.26.06753-6","DOIUrl":"10.23736/S0390-5616.26.06753-6","url":null,"abstract":"<p><strong>Background: </strong>A precise understanding of the national neurosurgical workforce is essential for effective healthcare planning and ensuring the long-term sustainability of the specialty. In Italy, the number of newly trained neurosurgeons is strictly limited by a competitive national residency entrance system, making accurate forecasting of workforce needs critical. Recent evidence suggests an aging neurosurgical population, highlighting the urgency of estimating retirements and training requirements to maintain adequate staffing levels. However, updated and comprehensive data on the national neurosurgical workforce have long been lacking. The Società Italiana di Neurochirurgia (SINCH) therefore promoted a national census to provide an accurate overview of all active neurosurgeons during the biennium 2022-2023.</p><p><strong>Methods: </strong>A national cross-sectional descriptive study was conducted between 2022 and 2023 to characterize the demographics and distribution of neurosurgeons within the Italian Public Health System and affiliated facilities. Three principal investigators and one supervisor coordinated the project under SINCH supervision. Data were collected through: 1) consolidation of the SINCH-PROGETKA database; 2) direct verification via personalized e-mails to all 113 neurosurgical unit directors (112 complete replies); 3) systematic web-based searches across 17 medical directory platforms; and 4) cross-matching with official medical organizations (FNOMCEO). Data were analyzed by institution type, geographic area, gender, age, and leadership role.</p><p><strong>Results: </strong>A total of 1489 active neurosurgeons were identified, with 1055 (74.1%) confirmed as SINCH members. Most professionals worked in public institutions (AOSSN 51.1%, AOU 17.2%, IRCCS 9.7%, AOU-IRCCS 5.4%), while 235 (15.9%) operated primarily in the private sector. Workforce distribution showed marked regional disparities: Northern and Central Italy accounted for 71% of neurosurgeons, whereas the South and Islands hosted only 29%. The national average was 1 neurosurgeon per 39,523 inhabitants, one of the highest ratios in Europe. Women represented 24.1% of active neurosurgeons but only <4% of unit directors. The mean age of directors was 59 years, reflecting an aging leadership cohort.</p><p><strong>Conclusions: </strong>This updated census provides the most comprehensive profile to date of Italian neurosurgeons. Despite adequate overall numbers, regional and gender imbalances persist, and leadership renewal remains limited. When compared with the previous ICoNe2 study, these data confirm Italy's exceptionally high neurosurgical density and underscore the need for coordinated workforce planning, optimization of training programs, and rational redistribution of resources to ensure sustainable and equitable neurosurgical care nationwide.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"289-298"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the value of elective lumbar fusion: a systematic review of existing methodologies and framework for the Operative Value Index.","authors":"Advith Sarikonda, Anthony Y Chen, Theo S Biddle, Danyal A Quraishi, Preston Carey, Arbaz Momin, Matthews Lan, D Mitchell Self, Ashmal S Kabani, Ahilan Sivaganesan","doi":"10.23736/S0390-5616.26.06769-X","DOIUrl":"10.23736/S0390-5616.26.06769-X","url":null,"abstract":"<p><strong>Background: </strong>Despite wide variation in the outcomes and costs of lumbar fusion, few studies have integrated these domains together within a single metric to assess \"value\" (outcomes achieved per dollar spent). In this review, we sought to 1) characterize existing metrics of cost-effectiveness for lumbar fusion, 2) evaluate all applications of time-driven activity-based costing (TDABC) in spine surgery, and 3) outline the conceptual foundation for a standardized Operative Value Index (OVI).</p><p><strong>Methods: </strong>Two PRISMA-concordant systematic reviews were performed on PubMed and Scopus databases. The first review examined all studies which reported a cost-effectiveness metric for lumbar fusion. The second review examined all applications of TDBAC in spine surgery.</p><p><strong>Results: </strong>Among 366 screened studies, 40 (21 for cost-effectiveness in lumbar fusion, 19 for TDABC in spine surgery) fulfilled inclusion criteria. The incremental cost-effectiveness ratio (ICER) was the most common metric, followed by OVI. Costs were frequently defined as reimbursement or charges; few studies assessed actual costs or TDABC. TDABC studies consistently demonstrated that costs were driven primarily by surgeon-level and procedure-specific factors, not patient characteristics. OVI studies uniformly used TDABC costs combined with disease-specific outcomes, but were limited to short-term follow-up and primarily intraoperative costs.</p><p><strong>Conclusions: </strong>Current value assessments in lumbar fusion are limited by heterogeneous outcomes and imprecise costing. A standardized framework integrating pathology-specific outcomes with episode-level costing (not charges or reimbursement) may enable more generalizable and accurate comparisons of operative value.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"318-331"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-market safety patterns of hydrogel dural sealants: a comparative manufacturer and user facility device experience analysis.","authors":"Mokshal Porwal, Alan Mach, Stephen Jaffee, Alexander Yu","doi":"10.23736/S0390-5616.26.06744-5","DOIUrl":"10.23736/S0390-5616.26.06744-5","url":null,"abstract":"<p><strong>Background: </strong>Polyethylene glycol (PEG) hydrogel dural sealants (DuraSeal, Adherus) reinforce dural closure, but case reports describe cerebrospinal fluid (CSF) leak, infection, and swelling-related neurologic injury. We characterized post-market safety in the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database, comparing structured problem codes with negation-aware narrative review.</p><p><strong>Methods: </strong>MAUDE reports from January 1, 2015, to June 30, 2024, mentioning either device were extracted and deduplicated by unique identifiers (MDR_REPORT_KEY, REPORT_NUMBER). Structured FDA patient and device problem codes were mapped to clinical categories (CSF leak, infection, wound dehiscence, neurologic deficit, swelling/mass effect, polymerization/application issue, adhesion, reoperation/hospitalization). Narratives underwent deterministic, negation-aware screening for the same categories, and for each device we calculated event proportions.</p><p><strong>Results: </strong>After deduplication, 279 reports were analyzed (256 DuraSeal, 23 Adherus). Most were coded as injury or malfunction; deaths were rare. CSF leak was the most frequent signal (DuraSeal 26.2% structured vs. 27.0% narrative; Adherus 52.2% vs. 47.8%). For DuraSeal, narrative review nearly doubled infection reports (8.2% vs. 19.9%) and identified swelling/mass effect (9.4%), neurologic deficit (4.3%), and reoperation/hospitalization (7.8%) largely absent from structured codes. For Adherus, narrative review identified isolated reports of infection, swelling/mass effect, and reoperation.</p><p><strong>Conclusions: </strong>PEG hydrogel dural sealants show post-market safety patterns dominated by CSF leak, suspected infection, and swelling-related neurologic events. Exclusive reliance on structured MAUDE codes underestimates key complications. Integrating structured fields with negation-aware narrative review yields a more complete safety profile and supports cautious use in constrained intracranial spaces.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"271-278"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"O-Ring\" technique is effective in reducing cerebrospinal fluid leak in posterior fossa surgery.","authors":"Francesco Guerrini, Gianluca Grimod, Elena Roca, Federico Nicolosi, Virginia Ferretti, Valeria Musella, Giannantonio Spena","doi":"10.23736/S0390-5616.25.06682-2","DOIUrl":"10.23736/S0390-5616.25.06682-2","url":null,"abstract":"<p><strong>Background: </strong>Posterior fossa approaches are commonly used during routine neurosurgery. Cerebrospinal fluid (CSF) leakage is one of the most important posterior fossa surgery-related complications. CSF leakage can manifest as both pseudomeningocele and external leakage. If craniotomy or craniectomy is performed, the skull defect can be repaired using heterologous polymethylmethacrylate (PMMA) cranioplasty. The aim of this study was to evaluate the clinical results of the O-ring technique in terms of postoperative complications.</p><p><strong>Methods: </strong>Patients treated using the retrosigmoid (RS), key-hole RS, or cerebellar hemispheric approach with O-ring PMMA cranioplasty were selected. Data analysis considered age, sex, pathology, surgical approach, presence of preoperative hydrocephalus, wound closure problems, and CSF-related complications postoperatively and at one- and three-month follow-ups.</p><p><strong>Results: </strong>Thirty-three patients were selected, and meningioma was the most common disease. The majority of patients (60.6%) were treated with the standard RS approach. No patient presented with surgical complications in terms of pseudomeningocele or external CSF leakage, neither postoperatively nor at the one-month follow-up. On three-month follow-up MRI, subcutaneous fluid collection was observed in two patients (6.1%).</p><p><strong>Conclusions: </strong>Our study shows promising results that the O-ring technique could represent a valid option to reduce postoperative CSF leakage in posterior fossa surgery.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"265-270"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}