Journal of neurological surgery. Part A, Central European neurosurgery最新文献

{"title":"A Screening Protocol for Idiopathic Normal Pressure Hydrocephalus: Reducing Underdiagnosis, Relieving the Economic Burden for the Health Systems, while Improving the Quality of Life of our Patients.","authors":"Gianpaolo Petrella, Silvia Ciarlo, Giuseppe Demichele, Edvige Iaboni, Daniele Armocida, Maurizio Salvati, Angelo Pompucci, Alessandro Pesce","doi":"10.1055/a-2649-7805","DOIUrl":"https://doi.org/10.1055/a-2649-7805","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic Normal Pressure Hydrocephalus (iNPH) is a common condition affecting the elderly. Numerous investigations highlight that its period-prevalence could be underestimated, as well as the economic burden of the missed treatments. The objective of the present investigation is to determine if a cohort of radiolocally suspected iNPH patients presents the clinical landmarks of this condition, and to estimate the economic burden of these potentially missed diagnoses.</p><p><strong>Methods: </strong>We recorded age, sex, reason to access emergency rooms (ER) of our community hospitals, values of Evans' Index, Callosal Angle, presence of DESH and obvious ventricular enlargement. We telephoned the patients who presented at least two radiological signs of iNPH and administered the iNPHGs, to assess the severity of signs and symptoms linked to iNPH, to understand if a strong radiologic suspect had a clinical correlation.</p><p><strong>Results: </strong>Among the 308 brain CT scans of a week, a total of 21 agreed to be enrolled in the present investigation. When administering iNPHGs questionnaire to radiological suspected iNPH, 17/21 patients (80.1%) scored ≥1 in at least two of the three iNPHGS subscale. The scores of the three subscales were strongly associated to each other. The estimated monthly and yearly health-related costs may be EUR 4'799'440 and 57.59 million of Euros respectively.</p><p><strong>Conclusions: </strong>There is an association between the radiologic features of iNPH and the scores of iNPHGs. The period-prevalence could be 5.51%, implying high healthcare costs, with significant societal impact, and reduced quality of life in patients suffering from undiagnosed iNPH.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584197","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":"A Novel Pedicle Screw Placement Surgery Based on Integration of Surgical Guides and Augmented Reality.","authors":"Huiyang Kong, Shuyi Wang, Can Zhang, Zan Chen, Zhanglei Wu, Jiayu Wang","doi":"10.1055/a-2200-3585","DOIUrl":"10.1055/a-2200-3585","url":null,"abstract":"<p><strong>Background: </strong> Augmented reality is a new technology that, when applied to spinal surgery, offers the potential for efficient, safe, and accurate placement of pedicle screws. This study investigated whether augmented reality combined with a guide board improved the safety and accuracy of pedicle screw placement compared to traditional freehand screw placement.</p><p><strong>Methods: </strong> Four trainers were divided into augmented reality navigation and freehand groups. Each group consisted of a novice and an experienced spine surgeon. A total of 80 pedicle screws were implanted. First, the AR group reconstructed the three-dimensional (3D) model and planned the screw insertion route according to the computed tomography (CT) data of L2 lumbar vertebrae. Next, the Microsoft HoloLens 2 was used to identify the vertebral model, and the planned virtual path was superimposed on the real cone model. Then, the screw was placed according to the projected trajectory. Finally, Micron Tracker was used to measure the deviation of screws from the preoperatively planned trajectory, and pedicle screws were evaluated using the Gertzbein-Robbins scale.</p><p><strong>Results: </strong> In the augmented reality group, the linear deviation of the experienced doctors and novices was 1.59 ± 0.39 and 1.73 ± 0.52 mm, respectively, and the deviation angle was 2.72 ± 0.61 and 2.87 ± 0.63 degrees, respectively. In the freehand group, the linear deviation of the experienced doctors and novices was 2.88 ± 0.58 and 5.25 ± 0.62 mm, respectively, and the deviation angle was 4.41 ± 1.18 and 7.15 ± 1.45 degrees, respectively. The screw placement accuracy rate was 97.5% in the augmented reality navigation group and 77.5% in the freehand group.</p><p><strong>Conclusions: </strong> Augmented reality navigation improves the accuracy and safety of pedicle screw implantation compared with the traditional freehand method and can assist inexperienced doctors in successfully completing the surgery.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"383-389"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61563218","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":"Isolated Sixth Cranial Nerve Palsy in Patients with Pituitary Apoplexy.","authors":"Oday Atallah, Amr Badary, Vivek Sanker, Wireko Andrew Awuah, Anil Ergen, Regunath Kandasamy, Bipin Chaurasia","doi":"10.1055/s-0044-1791973","DOIUrl":"10.1055/s-0044-1791973","url":null,"abstract":"<p><strong>Background: </strong> Pituitary apoplexy is an acute clinical syndrome constituted by headache, visual impairment, ophthalmoplegia, and altered mental status. Abducens nerve palsy due to pituitary apoplexy is a significant clinical manifestation in pituitary apoplexy cases.This study aims to investigate the rare occurrence of isolated sixth cranial nerve palsy in patients with pituitary apoplexy, a condition characterized by sudden hemorrhagic or ischemic infarction of the pituitary gland.</p><p><strong>Methods: </strong> A search was conducted on major databases, including PubMed, Web of Science, and ScienceDirect, to identify cases of isolated sixth cranial nerve palsy in patients with pituitary apoplexy. Only six cases were found in the available literature. Descriptive statistics were used to summarize the data, and relevant clinical features were compared between the cases.</p><p><strong>Results: </strong> Among the six identified cases, isolated sixth cranial nerve palsy in patients with pituitary apoplexy predominantly affected middle-aged adults, with a prominent male preponderance. Clinical manifestations included acute-onset diplopia and headache, with the most common radiologic finding being pituitary gland enlargement or hemorrhage. Laboratory investigations revealed hormonal dysregulation in some cases. Treatment approaches varied and included conservative management and surgical intervention. Outcomes were generally favorable, with most patients experiencing partial or complete resolution of their cranial nerve palsy.</p><p><strong>Conclusion: </strong> Isolated sixth cranial nerve palsy in patients in the context of pituitary apoplexy is an exceptionally rare occurrence, with only six documented cases in the available literature. Further research and case reporting are essential to better understand this rare clinical entity and guide optimal management strategies.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"408-414"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604807","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 Use of Shape Memory Alloys in Cages for Cervical Spinal Surgery.","authors":"F Arlt, D Winkler, N Knoop, M Weidling, F Frank, J Meixensberger, R Grunert","doi":"10.1055/s-0044-1795156","DOIUrl":"10.1055/s-0044-1795156","url":null,"abstract":"<p><strong>Background: </strong> Degenerative changes in the cervical spine can include the gradual loss of functionality of the intervertebral disks, development of osteophytes and ligament hypertrophy. Removal of the intervertebral disk and replacement with a cage (anterior discectomy and fusion [ACDF]) is a standardized operative procedure in these patients. The implant should provide structural support, should restore the physiologic lordosis, and enable a solid fusion. In this context, shape memory materials have great potential in the development of implants in spinal surgery.</p><p><strong>Methods: </strong> We designed and developed a cage that automatically adapts to the cross-section of the intervertebral disk space and simultaneously ensures mechanical support for load transfer between the adjacent vertebral bodies. A special mechanism (shape memory alloy [SMA]) should allow the implant to adapt to the geometric configuration of the intervertebral disk space. The cage developed was tested in an artificial cervical spine.</p><p><strong>Results: </strong> The base body of the cage consists of polyether ether ketone (PEEK) with a width of 14 mm, length of 16 mm, and height of 4 mm. A shape memory actuator, made of nickel-titanium alloy, is used to realize the geometry adaptation. Utilizing this, the transformation from martensite to austenite is completed at 35°C. Biomechanical testing with lateral bending and compression was performed. Subsequent cyclic loading results in a constant hysteresis curve, indicating stable implant positioning.</p><p><strong>Conclusions: </strong> We feel confident about having developed an alternative cage for ACDF that can potentially reduce peri- and postoperative morbidity and provide long-term stability by reducing bone removal during cage implantation. Therefore, we are encouraged to proceed with further biomechanical testing in cadaver specimens to eventually reach the goal of in vivo application.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"348-352"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605195","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":"Cerebral Hemorrhage Volume Threshold and Shunt-Dependent Acute Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage: A Semiautomated Measurement Study.","authors":"Gema Bravo-Garrido, Antonio José Vargas-Lopez, Miriam Fernández-Gómez, Mario Gomar-Alba, Gaizka Urreta-Juárez, Patricia Martínez-Sánchez","doi":"10.1055/a-2568-4732","DOIUrl":"10.1055/a-2568-4732","url":null,"abstract":"<p><p>Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) that can adversely affect prognosis. This study investigates the association between semiautomatic measurement of cerebral hemorrhage volumes in aSAH patients and the onset of shunt-dependent acute hydrocephalus (SDAHC) within the first 72 hours. Furthermore, the study seeks to establish a bleeding volume threshold indicative of SDAHC.A retrospective observational analysis was conducted on a cohort of aSAH patients admitted to a specialized referral hospital between 2016 and 2021. Volumes of SAH, intraventricular hemorrhage (IVH), intraparenchymal hemorrhage (IPH), and total hemorrhage (TH) were computed from brain computed tomography scans utilizing Advantage Workstation Server analytical software. Receiver operating characteristic (ROC) curves and multivariate analyses were employed to determine the association between hemorrhage volumes and SDAHC.The study included 170 patients, of whom 111 (65.3%) were women, with a mean age of 58.5 years (standard deviation: 14.6). Fifty-five patients (32.4%) presented SDAHC. IVH volumes had an area under the ROC curve of 0.757 (95% confidence interval [CI]: 0.674-0.839; <i>p</i> < 0.001). An IVH volume > 2.7 cm³ showed a sensitivity of 70.9% and a specificity of 77.2% for predicting SDAHC, whereas TH volumes > 29.5 cm³ demonstrated a sensitivity of 69.1% and a specificity of 61.4%. Multivariate analysis revealed that IVH volumes > 2.7 cm³ (odds ratio [OR]: 5.373; 95% CI: 2.477-11.657), TH volumes > 29.5 cm³ (OR: 2.232; 95% CI: 1.008-4.942), and a bicaudate index ≥ 0.2 were significantly associated with SDAHC, adjusting for confounders.In aSAH patients, semiautomatic measurement of hemorrhage volumes using specialized software is independently associated with SDAHC. This method could facilitate early prediction and timely intervention.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742990","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":"Comparison of Sitting versus Nonsitting Position for the Resection of Brain Metastases in the Posterior Fossa in a Contemporary Cohort.","authors":"Philipp Krauss, Stefan Motov, Tamara Vernik, Maximilian Niklas Bonk, Sergey Shmygalev, Katharina Kramer, Jens Lehmberg, Ehab Shiban","doi":"10.1055/s-0044-1788620","DOIUrl":"10.1055/s-0044-1788620","url":null,"abstract":"<p><strong>Background: </strong> For surgery of brain metastases, good immediate postoperative functional outcome is of utmost importance. Improved functional status can enable further oncologic therapies and adverse events might delay them. Pros and cons of either sitting or prone positioning for resective surgery of the posterior fossa are debated, but contemporary data on direct postoperative outcome are rare. The aim of our study was to compare the functional outcome and adverse events of surgery for brain metastases in the sitting versus the nonsitting position in the direct postoperative setting.</p><p><strong>Methods: </strong> We retrospectively compared surgery of metastases located in the posterior fossa over a 3-year period in two level-A neurosurgical centers. Center 1 performed surgery exclusively in the sitting, while center 2 performed surgery only in the nonsitting position.</p><p><strong>Results: </strong> Worse functional outcome (Karnofsky performance scale) and functional deterioration were seen in the \"sitting\" group. We found significantly more \"sitting\" patients to deteriorate to a KPS score of ≤60%. In this study, treating patients with brain metastases in the sitting position resulted in a number needed to harm (NNH) of 2.3 and was associated with worse outcome and more adverse events.</p><p><strong>Conclusion: </strong> Therefore, we recommend the nonsitting position for surgery of brain metastases of the posterior fossa.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"342-347"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008924","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 of Subperiosteal Drains in Chronic Subdural Hematoma: A Prospective Randomized Single-Center Study.","authors":"Yavor Bozhkov, Julian Feulner, Michael Buchfelder, Max Kleiss, Sebastian Brandner, Thomas M Kinfe","doi":"10.1055/a-2418-3682","DOIUrl":"10.1055/a-2418-3682","url":null,"abstract":"<p><strong>Background: </strong> Chronic subdural hematomas (cSDHs) are most frequently treated by evacuation via a burr-hole craniostomy procedure. Subperiosteal drains have been introduced as alternatives to subdural ones, but only a few prospective studies have explored their efficacy. Thus, a prospective randomized trial was designed to assess their use.</p><p><strong>Methods: </strong> The study enrolled patients with newly diagnosed surgically amenable cSDH. These patients were randomized into two groups. The first group underwent cSDH evacuation via a single burr hole craniostomy procedure, followed by placement of a subperiosteal drain; the second group underwent the identical procedure without drain placement. Patient demographics, drain volumes, duration of drainage, cSDH recurrence, and postoperative outcomes were recorded.</p><p><strong>Results: </strong> Eighty-eight patients presenting with cSDH (12 with bilateral cSDHs) from a total of 100 surgical cases were enrolled. Nine patients (1 bilateral) were lost to follow-up. Of all remaining 90 procedures, 37 were carried out with drain placement and the remaining 53 without drain placement. There were five recurrent cases (13.5%) in the drain placement group and 17 (32.1%) in the group without drain placement. This resulted in a statistical significance (odds ratio [OR]: 0.33; <i>p</i> < 0.05) favoring the use of a drain.</p><p><strong>Conclusion: </strong> Subperiosteal drain placement can be used safely and effectively to treat cSDH in conjunction with a burr-hole craniostomy procedure, significantly reducing the rate of recurrence without any additional disadvantages.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"390-396"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289481","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":"Opioid Use after Transforaminal Lumbar Interbody Fusion: A Comparison between Open and Minimally Invasive Surgery.","authors":"Juan Felipe Abaunza-Camacho, Sara Gomez-Niebles, Humberto Madrinan-Navia, Rafael Aponte-Caballero, William Mauricio Riveros, Leonardo Laverde-Frade","doi":"10.1055/s-0044-1792141","DOIUrl":"10.1055/s-0044-1792141","url":null,"abstract":"<p><strong>Background: </strong> Opioids are medications frequently used in patients with moderate and severe chronic pain. Their pharmacologic profile allows their use in acute severe postoperative pain. However, due to their highly addictive profile, opioid misuse is considered a public health issue. Vertebral spine fusion, decompression, and instrumentation are often associated with acute, severe postoperative pain. The present study aims to compare postoperative opioid consumption in a group of patients who underwent open transforaminal lumbar interbody fusion (OTLIF) against a similar group of patients who underwent minimally invasive transforaminal lumbar interbody fusion (MTLIF).</p><p><strong>Methods: </strong> We present a quantitative, observational, analytical, and historical cohort study. After convenience sampling, we identified 45 patients, 34 of whom underwent OTLIF and 11 underwent MTLIF. The analysis was made after measuring the following variables: demographics, type of surgery, length of stay, pain control, opioid type, and opioid dose. Statistical methods were implemented according to the origin and behavior of the variable.</p><p><strong>Results: </strong> We found a difference between significant and nonsignificant pain among the groups with less opioid consumption in the MTILF group. This difference was seen in the frequency and dosage during all observation periods. However, in the postoperative observation, the frequencies and dosages were equal between groups. According to linear regression, the type of surgery, radiculopathy, and radiculitis explain the significant postoperative pain in up to 50% of cases.</p><p><strong>Conclusion: </strong> Our study reveals a significant difference in opioid consumption between patients undergoing different surgical techniques. While these findings are valid for the studied population, the limitation in sample size highlights the need for further research. The implications of our findings on postoperative pain management and opioid use in spinal surgeries are significant and warrant continued investigation.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"361-368"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676045","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":"Intimal Hemorrhage of Basilar Artery Induced by Severe Vasospasm Following Subarachnoid Hemorrhage: The Experimental Analysis.","authors":"Ahmet Gökyar, Mehmet Hakan Şahin, Mehmet Kürşat Karadağ, Sinan Bahadır, Mete Zeynal, Sare Altas Sipal, Mehmet D Aydin","doi":"10.1055/a-2273-5418","DOIUrl":"10.1055/a-2273-5418","url":null,"abstract":"<p><strong>Background: </strong> Cerebral vasospasm, a serious complication of subarachnoid hemorrhage (SAH), has been extensively studied for its neurochemical and pathophysiologic mechanisms. However, the contribution of inner elastic membrane dissection and subintimal hemorrhage to basilar artery occlusion remains underexplored. This study investigates inner elastic membrane-related changes in the basilar artery after SAH.</p><p><strong>Methods: </strong> Twenty-four hybrid rabbits were divided into control, sham, and SAH groups, with SAH induced by autologous blood injection. After 2 weeks, basilar artery changes, vasospasm indexes (VSIs), and dissections were evaluated.</p><p><strong>Results: </strong> The SAH group showed significantly higher VSI, with vascular wall thickening, luminal narrowing, convoluted smooth muscle cells, intimal elastic membrane disruption, endothelial cell desquamation, and apoptosis. Some SAH animals exhibited subintimal hemorrhage, inner elastic membrane dissection, and ruptures. Basilar arteries with subintimal hemorrhage had notably higher VSI.</p><p><strong>Conclusions: </strong> These findings highlight the role of subintimal hemorrhage and inner elastic membrane dissection in basilar artery occlusion post-SAH, offering valuable insights into vasospasm pathophysiology.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"369-376"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139931549","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":"Preoperative and Postoperative Midline Index Ratio and Pre- and Postoperative Variation of the Hematoma Thickness Accurately Predict Surgical Recurrence of Chronic Subdural Hematomas.","authors":"Federica Novegno, Giulia Fiorucci, Andrea Iaquinandi, Maurizio Salvati, Alessandro Pesce","doi":"10.1055/s-0044-1792142","DOIUrl":"10.1055/s-0044-1792142","url":null,"abstract":"<p><strong>Background: </strong> Chronic subdural hematoma (cSDH) is a common pathology in daily practice of neurosurgery. Surgical management usually offers a significant clinical recovery. However, the recurrence rate is still high. Several studies have suggested various factors associated with hematoma recurrence with no univocal results. The aim of this study was to determine the prognostic value of early postoperative computed tomography (CT) examination to predict the need for reoperation.</p><p><strong>Methods: </strong> A retrospective review of 115 cSDH patients was performed. Clinical findings and pre- and early postoperative CT scan data were recorded. Univariable and bivariable analyses were performed to determine which of the studied factors were associated with an increased risk of reoperation. Their prognostic abilities were assessed using receiver operating characteristic curves.</p><p><strong>Results: </strong> Overall, 21 of 115 patients required a surgical revision. Among the comorbidities, diabetes mellitus represented the only factor related with hematoma recurrence (66.76 vs. 23.40%, <i>p</i> = 0.001). Preoperative hematoma density and postoperative residual hyperdensity on early CT scan emerged as significant predictors of cSDH recurrence (recurrence: 18/21, 85.7% vs. nonrecurrence: 17/94, 18.1%, <i>p</i> = 0.001). The ratios of post- and preoperative hematoma thickness (<i>P</i>) and post- and preoperative midline shift (<i>Q</i>) and their sum (<i>K</i>) were statistically higher in the recurrence group with cutoff values of 0.745, 0.555, and 1.135, respectively.</p><p><strong>Conclusions: </strong> Systematic early postoperative CT scan after cSDH evacuation may predict hematoma recurrence. In the present study, we found postoperative hyperdensity on CT scan and degree of hematoma variation after surgical evacuation to be the strongest predictors of the need for reoperation.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"353-360"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909710","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}