Journal of neurosurgical sciences最新文献

{"title":"Confocal endomicroscopy accuracy in identifying central nervous system tumors tissue at the infiltration margins: results from a prospective clinical trial.","authors":"Francesco Restelli, Bianca Pollo, Elio Mazzapicchi, Irene Tramacere, Morgan Broggi, Jacopo Falco, Marco Schiariti, Mario Stanziano, Francesco Dimeco, Paolo Ferroli, Gianluca Marucci, Ignazio G Vetrano, Francesco Acerbi","doi":"10.23736/S0390-5616.24.06302-1","DOIUrl":"10.23736/S0390-5616.24.06302-1","url":null,"abstract":"<p><strong>Background: </strong>We have previously shown the usefulness of a new confocal endomicroscopy system (CONVIVO^®) in providing a quick and reliable method for intraoperative diagnosis ex vivo in glioblastoma (GBM). In this study, we aimed to assess the intraoperative usefulness of CONVIVO^® in an in-vivo setting, focusing on its capability to explore the presence of residual tumor at the resection margins of Central Nervous System (CNS) tumors.</p><p><strong>Methods: </strong>We consecutively enrolled patients submitted to fluorescein-guided CNS-tumor removal (May 2020 to December 2022). CONVIVO^® was used in vivo to obtain images from virtual biopsies at the central tumor core and at its margin of resection, evaluating its ability to offer a histological diagnosis at the center and a tumor tissue identification at the periphery, with respect to corresponding standard histological sections. CONVIVO^® images were analyzed before interpretation of permanent or frozen sections, with the pathologist being totally blinded to histological results.</p><p><strong>Results: </strong>Seventy-five patients were studied. The most frequent diagnoses were GBM (50.6%) and metastasis (13.3%). At the tumor margins, on a total of 169 biopsies, we obtained an overall accuracy in tumor tissue identification of 82.2% (95% CI 75.0-89.5) in GBM/Grade 4 IDH-mutated astrocytomas, and 85.8% (95% CI 80.5-91.1) considering all tumors together. At the tumor center, a correct intraoperative diagnosis was obtained in 67.6% (95% CI 56.9-78.2) of all the cases, and in 80.9% (95% CI 69.1-92.8) of the GBM/Grade 4 IDH-mutated astrocytoma subgroup.</p><p><strong>Conclusions: </strong>CONVIVO^® allowed to accurately assess the presence of pathological marginal tissue remnants during resection of aggressive CNS tumors. More studies are needed to evaluate if this could possibly improve the extent of resection.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"225-235"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255810","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":"Clear neuroimaging margin at the brain-tumor interface is associated with gross total resection and longer survival in non-enhancing diffuse gliomas.","authors":"Anand A Dharia, Domenico A Gattozzi, Joseph S Domino, Adam G Rouse, Roukoz B Chamoun","doi":"10.23736/S0390-5616.24.06221-0","DOIUrl":"10.23736/S0390-5616.24.06221-0","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to determine whether the presence of distinct glioma margins on preoperative imaging is correlated with improved intraoperative identification of tumor-brain interfaces and overall improved surgical outcomes of non-enhancing gliomas.</p><p><strong>Methods: </strong>This is a retrospective study of all primary glioma resections at our institution between 2000-2020. Tumors with contrast enhancement or with final pathology other than diffuse infiltrative glial neoplasm (WHO II or WHO III) were excluded. Tumors were stratified into two groups: those with distinct radiographical borders between tumor and brain, and those with ill-defined radiographical margins. Multivariate analysis was performed to determine the impact of clear preoperative margins on the primary outcome of gross-total resection.</p><p><strong>Results: </strong>Within the study period, 59 patients met inclusion criteria, of which 31 (53%) had distinct margins. These patients were predominantly younger (37.6 vs. 48.1 years, P=0.007). Tumor and other patient characteristics were similar in both cohorts, including gender, laterality, size, location, tumor type, grade, and surgical adjuncts utilized (P>0.05). Multivariate regression identified that distinct preoperative margins correlated with increased rates of gross total resection (P=0.02). Distinct margins on preoperative neuroimaging also correlated positively with surgeon identification of intra-operative margins (P<0.0001), fewer deaths over the study period (P=0.01), and longer overall survival (P=0.03).</p><p><strong>Conclusions: </strong>Distinct glioma-parenchyma margins on preoperative imaging are associated with improved surgical resection for diffuse gliomas, as distinct margins may correlate with distinguishable glioma-brain interfaces intraoperatively. Further prospective studies may discover additional clinical uses for these findings.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"245-252"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175505","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":"Assessing the predictive value of the Risk Analysis Index for short-term outcomes in acute spinal cord injury surgery.","authors":"Evan Courville, Kranti C Rumalla, Joshua Marquez, Joanna M Roy, Meic H Schmidt, Christian A Bowers","doi":"10.23736/S0390-5616.24.06189-7","DOIUrl":"10.23736/S0390-5616.24.06189-7","url":null,"abstract":"<p><strong>Background: </strong>Acute traumatic spinal cord injury (tSCI) requires rapid surgical intervention to maximize neurological function. Older patients comprise an increasingly larger proportion of SCI patients annually, necessitating accurate preoperative risk stratification tools. This study utilized a frailty-based preoperative risk stratification score to predict adverse events following non-elective neurosurgical intervention for acute tSCI patients.</p><p><strong>Methods: </strong>The National Inpatient Sample (NIS) was queried for acute tSCI patients aged ≥18 who underwent spine surgery in 2019-2020. The Risk Analysis Index (RAI) was implemented with crosstabulation, to analyze frailty scores with the following binary outcome measures: overall complications, non-home discharge (NHD), extended length of stay (eLOS) (>75^th percentile), and mortality. Area Under the Receiver Operating Characteristic (AUROC) analysis assessed the discriminative threshold of RAI compared to the modified 5-item Frailty Index (mFI-5) for NHD and 30-day mortality.</p><p><strong>Results: </strong>A total of 9995 SCI patients underwent non-elective spine surgery. There were 1525 perioperative complications (15.3%) and 510 (5.1%) mortalities. An increasing RAI score was significantly associated with increasing postoperative mortality rates: RAI 0-20 (1.5%, N.=45), RAI 21-30 (3.4%, N.=110), RAI 31-40 (6.8%, N.=115), and RAI>41 (11.8%, N.=240) (P<0.001). RAI demonstrated superior discrimination compared to the mFI-5 for mortality and NHD with a C-statistic >0.72.</p><p><strong>Conclusions: </strong>Increasing frailty, as measured by RAI, was a reliable predictor of non-home discharge and 30-day mortality for SCI patients who underwent non-elective spinal surgery and RAI demonstrated superior discrimination compared to the mFI-5 for NHD and mortality.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"276-283"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446319","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":"Limits and usefulness of intraoperative evoked potentials during laminoplasty.","authors":"Rossella Rispoli, Christian Lettieri, Giada Pauletto, Gabriele Valiante, Yan Tereshko, Barbara Cappelletto","doi":"10.23736/S0390-5616.23.06077-0","DOIUrl":"10.23736/S0390-5616.23.06077-0","url":null,"abstract":"<p><strong>Background: </strong>Over the past 10 years, intraoperative neurophysiological monitoring (IONM) has been widely performed during surgery for treating spondylotic cervical myelopathy. Our study considers the predictive value of IONM during laminoplasty, regarding, first, the adequacy of spinal cord decompression and, second, the long-term neuro-functional outcome.</p><p><strong>Methods: </strong>We considered 38 patients with the diagnosis of degenerative cervical myelopathy who underwent an open-door laminoplasty. All patients were evaluated preoperatively, and at three and 12 months postoperatively, with the Japanese Orthopedic Association (JOA) point scale. Upper and lower limb somatosensory and motor evoked potentials (SSEPs and MEPs) were recorded preoperatively and intraoperatively.</p><p><strong>Results: </strong>During surgery, three of 38 patients showed a deterioration of SSEPs and MEPs compared to baseline values. Surgery was then converted from laminoplasty to laminectomy, resulting in the gradual restoration of the evoked potentials. The neurophysiological parameter significantly associated with a better clinical outcome was the latency of lower limbs MEPs. The 12 patients who had a more prominent reduction of the MEPs latency at the end of surgery showed a higher post-surgical JOA score, increasing ≥30% compared to baseline values at the 3- and 12-month follow-up.</p><p><strong>Conclusions: </strong>Though not a predictor of clinical outcome, the IONM was essential to evaluate the effectiveness of spinal cord decompression. Reduced latency of lower limbs MEPs may predict a better clinical outcome. We suggest that IONM in patients with degenerative cervical myelopathy should be routine. It is necessary to conduct larger studies to clarify the predictive value of IONM.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"260-267"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136397766","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":"O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) PET as a potential selection tool for second surgery in glioblastoma patients.","authors":"Orazio S Santonocito, Gianluca Grimod, Anna L DI Stefano, Francesco Pieri, Mariagrazia Nizzola, Nicola Mazzuca, Francesco Pasqualetti, Riccardo Morganti, Vanna Zucchi, Carlo Gambacciani","doi":"10.23736/S0390-5616.23.06019-8","DOIUrl":"10.23736/S0390-5616.23.06019-8","url":null,"abstract":"<p><strong>Background: </strong>Treatment-related changes still represent a diagnostic challenge in the management of patients with suspect of recurrent glioblastoma. The specificity of conventional MRI in detecting recurrence remains limited. Brain PET imaging provides information on tumor metabolism and can contribute to improving the diagnostic accuracy of cerebral neoplasms. We performed a retrospective analysis to evaluate the clinical value of O-(2-¹⁸F-fluoroethyl)-L-tyrosine (¹⁸F-FET) PET in the diagnosis of glioblastoma recurrence.</p><p><strong>Methods: </strong>A retrospective analysis on patients considered suitable for salvage surgery for recurrence glioblastoma was performed. ¹⁸F-FET-PET was performed to investigate gadolinium enhancement suspected for recurrence. Static and kinetic ¹⁸F-FET parameters were analyzed and related to O-6-methylguanine-DNA methyltransferase (MGMT) status.</p><p><strong>Results: </strong>Forty-two of the 51 patients who underwent ¹⁸F-FET-PET were re-operated. In each case, neuropathological diagnosis of tumor recurrence was confirmed. pMGMT hypermethylation was detected in 21 patients. Mean tumor-to-brain ratios (TBR) max was 3.87 (range 2.6-6.0). Static and kinetic ¹⁸F-FET parameters were similar according to MGMT status.</p><p><strong>Conclusions: </strong>¹⁸FET-PET can be a reliable tool to improve the selection of patients suitable for salvage surgery for glioblastoma recurrence.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"253-259"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138830111","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":"Frailty predicts non-home discharge in anterior lumbar interbody fusion patients.","authors":"Derek B Asserson, Danielle A Alaouieh, Joanna M Roy, Meic H Schmidt, Christian A Bowers","doi":"10.23736/S0390-5616.24.06179-4","DOIUrl":"10.23736/S0390-5616.24.06179-4","url":null,"abstract":"<p><strong>Background: </strong>Anterior lumbar interbody fusion (ALIF) is a well-established surgical approach in the treatment of degenerative pathology, trauma, infection, and neoplasia of the spine. This study sought to assess the usefulness of frailty as a predictor of non-home discharge (NHD) for patients who undergo the procedure.</p><p><strong>Methods: </strong>Patient cases were extracted from the American College of Surgeons's National Surgical Quality Improvement Program database from 2012 to 2020. Univariable and receiver operating characteristic curve analyses were used to compare the 5-item Modified Frailty Index (mFI-5) to the Revised Risk Analysis Index (RAI-rev) in relation to NHD.</p><p><strong>Results: </strong>Simple linear regression demonstrated that increasing frailty was associated with an increased likelihood of NHD among 25,317 patients (mFI-5 odds ratio: 2.13, 3.23, 8.4; RAI-rev odds ratio: 3.22, 9.6, 23.6 [P<0.001 for all]). In each instance, a Cochran-Armitage trend test was significant (P<0.001), indicating a linear association of increasing odds. The RAI-rev resulted in a C-statistic of 0.722, compared to 0.628 for the mFI-5, and was shown to have superior discriminative ability with a DeLong Test (P<0.001).</p><p><strong>Conclusions: </strong>Frailty, as measured by mFI-5 and RAI-rev, was associated with an increased likelihood of NHD in patients who underwent ALIF. This finding supports recent literature on the promising utility of these indices, especially the RAI-rev, in preoperative decision-making across multiple facets of neurosurgery.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"284-289"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049690","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":"Pre-surgical planning with extended reality in neurosurgery: a survey-based study describing a preliminary experience in Italy.","authors":"Alessio Iacoangeli, Sergio Capelli, Andrea Held, Matteo Barba, Alessandra Marasi, Alessandro DE Benedictis, Maurizio Iacoangeli, Davide Locatelli, Marco M Fontanella, Carlo G Giussani, Davide Luglietto, Maria C Rossi Espagnet, Carlo E Marras","doi":"10.23736/S0390-5616.24.06355-0","DOIUrl":"10.23736/S0390-5616.24.06355-0","url":null,"abstract":"<p><strong>Background: </strong>Extended reality (XR) systems play an increasingly role in preoperative planning in different surgical fields including neurosurgery. Considering educational purposes, not all residents have the same opportunities to learn and deal with XR. Thus, the authors sought to evaluate the perspectives of an Italian sample of neurosurgical trainees on XR, and to size the impact of these developing technologies on the learning curve of a small group of residents coming from different Italian Institutions.</p><p><strong>Methods: </strong>A 23-question cross-sectional survey was administered to 32 neurosurgery residents nationwide to evaluate their perspectives and experience on XR in a neurosurgical setting. A specific 20-question survey was administered to a pilot group of 5 trainees, working at the Bambino Gesù Children's Hospital, to evaluate their experience with daily-use of XR and to probe its impact on their learning curve a period of 3 months.</p><p><strong>Results: </strong>The majority of the interviewed perceived XR as effective in simulating the real surgical scenario both in terms of anatomy and surgical trajectory. These results also reflect the subjective perception of the five trainee-pilot group which report a progressive confidence on the surgical case management.</p><p><strong>Conclusions: </strong>This preliminary study suggests XR as an effective tool which can positively influence trainees' education. There is a broad perception of its beneficial impact even in contexts where XR is not frequently available. Further and larger studies are necessary in our country to better understand and standardize these results.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"236-244"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408734","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":"Proposal of a new score system (Cervical Surgical Score) for management of degenerative cervical myelopathy.","authors":"Francesco Costa, Francesco Restelli, Elio Mazzapicchi, Emanuele Rubiu, Giulio Bonomo, Marco Schiariti, Niccolò Innocenti, Carla D Anania, Andrea Cardia, Maurizio Fornari","doi":"10.23736/S0390-5616.23.06165-9","DOIUrl":"10.23736/S0390-5616.23.06165-9","url":null,"abstract":"<p><strong>Background: </strong>To date, no shared algorithms with the aim of guiding surgical strategy in complex cases of degenerative cervical myelopathy (DCM) exist. Our purpose is to present the Cervical Surgical Score (CSS) which could help in identifying complex DCM cases, suggesting a surgical strategy.</p><p><strong>Methods: </strong>We created the CSS based on multidisciplinary and literature-focused discussions, based on eight parameters including number of levels of cervical pathology and myelopathy, type and predominance of compression and grade of clinical myelopathy. We prospectively enrolled surgical DCM patients in a 15-months period, collecting clinical and radiological data. During outpatient clinic a specific surgical indication was offered to DCM patients. To validate the score, each outpatient clinic surgical indication was compared a posteriori to the one that resulted from multidisciplinary CSS scoring, focusing on patients for which both an anterior and posterior approach were considered suitable.</p><p><strong>Results: </strong>A total of 100 patients operated on for DCM at our Institution between December 2021 and February 2023 were prospectively enrolled. In 53% of patients the pathology was present at more than two levels. According to CSS calculation, 14% of patients resulted in the \"grey zone\", where both an anterior and posterior approach were deemed feasible. Among them, in 42.8% of cases the CSS allowed a modification of the originally planned surgery. Looking at outcome, an improvement of m-JOA score in 62% of patients was disclosed.</p><p><strong>Conclusions: </strong>This preliminary study showed the reliability and usefulness of CSS in detecting complex DCM cases, requiring further analysis by expert spine surgeons, suggesting a surgical strategy.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"158-166"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175138","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":"Clinical epidemiology, management and outcomes of traumatic cervical spinal-cord and spine injuries: a systematic review of 1645 pooled cases.","authors":"Promise T Jaja, Linda Iroegbu-Emeruem, Iqra Kulsoom, Amechi Odeku","doi":"10.23736/S0390-5616.25.06404-5","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06404-5","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical spine (mostly atlanto-axial) accounts for over half of the acute traumatic disruptions of the spinal cord and its coverings; alongside its persisting neurological deficits. Two-thirds of the etiology were fairly evenly distributed between traffic crashes, falls, assault and other occupation-related injuries. We described the etiological mechanisms, neuro-anatomical level, severity, treatment and outcomes of traumatic cervical spinal-cord and spine injuries (C-SCI+SI).</p><p><strong>Evidence acquisition: </strong>We systematically reviewed PubMed and Cochrane CENTRAL on 16th May 2023, using a prospectively registered protocol (CRD42023417530). The search strategy combined search words (from the keywords; \"cervical spinal cord injury,\" \"conservative\" and \"operative\" \"treatment\") using Boolean operators. These yielded 787 and 55 records from PubMed (then 223 after delimiting to 10 years) and CENTRAL respectively; after records screening, 106 and 1 record were relevant respectively. Seventy-six reports were recruited for the quasi-quantitative synthesis following full-text review and methodological quality/bias assessment (using Joanna Briggs Institute critical appraisal tools).</p><p><strong>Evidence synthesis: </strong>Seventy-six reports yielded 1645 pooled cases. Weighted-mean age (N.=1512) was 46.3 years, with male (70.2%; gender N.=1525) preponderance. C-SCI+SI were mostly caused (N.=1079) by falls (42.1%) and road traffic crashes (42.2%); presenting(N.=178) with neck pain (71.4%) mostly and under one-fifth had neurological deficits (-plegias or -paresis, 11.8%; radiculopathy, 6.2%). The commonest vertebral levels (N.=1525) were 23.9% for the second cervical vertebra (c2), c5(20.4%) and c6(20.0%). Treatment (N.=1297) was combined pre-operative non-operative [skull traction (72.0%/842), cervical collar (13.9%/163)] in 90.2%, with solely non-operative (33.9%/439) options also used. Operative implant-based arthrodeses (66.2%/858) were done, using anterior (68.5%), posterior (20.2%/173) and combined (10.4%/89) approaches. Good bony fusion (89.0%) and clinical improvements (43.2%) were reported.</p><p><strong>Conclusions: </strong>Mostly low-level evidence showed C-SCI+SI occurring more amongst the middle-aged and men; following falls or road traffic crashes. The second, fifth and sixth cervical levels are mostly affected; with excellent post-intervention bony-union, with neurological improvements in two-fifths. Better international reporting standards are advocated.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"69 2","pages":"187-199"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997555","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":"Bed rest duration and development of cerebrospinal fluid leaks after intradural spinal surgery: a meta-analysis of comparative studies.","authors":"Alberto Benato, Fabio Zeoli, Flavia Beccia, Marco Battistelli, Alessandro Rapisarda, Alessandro Olivi, Filippo M Polli","doi":"10.23736/S0390-5616.25.06470-7","DOIUrl":"10.23736/S0390-5616.25.06470-7","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative cerebrospinal fluid (CSF) leaks and related complications are a major concern after intradural spinal surgeries. The role of prolonged bed rest in reducing the incidence of these complications has been debated. This meta-analysis aimed to evaluate whether early versus late mobilization affects the incidence of CSF leak-related complications (CLRC) after intradural spinal surgery.</p><p><strong>Evidence acquisition: </strong>Following PRISMA guidelines, we conducted a systematic review and meta-analysis of comparative studies on early ambulation (EA) versus prolonged bed rest (PBR) in patients undergoing intradural spinal surgery. Studied considered for inclusion defined EA as mobilization on postoperative day 1, while PBR as mobilization on postoperative day 3. The primary outcome was the incidence of CLRC, defined as pseudomeningocele, durocutaneous fistula, or wound dehiscence. Secondary outcome was the incidence of medical complications.</p><p><strong>Evidence synthesis: </strong>Three retrospective comparative studies with a total of 949 patients were included in the analysis. No significant difference was found in the incidence of CLRC between the EA and PBR groups. Length of hospital stay (LOS) and postoperative medical complications incidence were significantly lower in the EA group.</p><p><strong>Conclusions: </strong>This meta-analysis found that EA does not increase the risk of CLRC compared to PBR, while shortening LOS and reducing medical complications occurrence. These findings suggest that early mobilization could be a safe and effective postoperative strategy, reducing hospital stay and complication rates.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"69 2","pages":"210-217"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970431","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}