Study design: A series of 26 patients, submitted to decompressive craniectomy for su-pratentorial cerebral ischemia was retrospectively analyzed. Objectives: The aim of this study is to highlight the experience with this surgical tech-nique in our Institution and to analyze comparatively the preoperative and postoperative clinical and radiological data, as well as the prognostic factors verifying the agreement between our findings and the relevant literature data. Methods: From January 2018 to January 2023, we recruited 26 patients that underwent decompressive craniectomy for supratentorial cerebral ischemia. Demographic, medical history, clinical, laboratory, radiological and surgical data were collected. Statistical analysis was also performed to determine if any variable had a significant impact pre-viously and post-operatively or if they were predictive of favorable outcome. Results: The average age of the patients was 56.55 y, range between 26-80 y. Patients under 60 y were 51.8% and 59,25% of the whole sample were male. The outcome score calculated with the Modified Ranking Scale after about 1 year was < =4 in 11 patient; it distributed as follows: 2 pts with MRS 2, 5 pts with MRS 3 and 4 pts with MRS 4. The remaining were dead or in a vegetative state. Univariate statistical analysis was focused on neuroradiological parameters, studied both in pre- and post-operative CT scans. The variables that proved to be statistically significant were the presence or absence of visible cortical sulci, basal cisterns compression (cisterna ambiens in particular), quadrigeminal and sylvian cisterns. Of these parameters, the only one that maintained statistical sig-nificance even in the multivariate analysis was the presence of visible cisterna ambiens in post-operative radiological studies proving to be associated with a favorable outcome. Conclusions: Our study confirmed that decompressive craniectomy in cerebral ischemic stroke is an effective life-saving treatment in a subgroup of patients with intracranial hypertension. Standardization of the surgical indication remains a challenge and our analysis could suggest potentially useful work patterns in daily clinical practice, eventough our expe-rience had the important limitation of measuring only physical disability; further studies considering psychosocial, financial and caregiving aspects are needed. Moreover, sur-gical management remains in our opinion a tailored choice based on the experience of the surgeon and on the expectations of the patient and family.

Aim of the study: This paper focuses on the correlation of nicotine use with chronic lumbar back pain (CLBP). Methods: This is a cross-sectional observational study involving smoker and non-smoker patients with a diagnosis of chronic low back pain (CLBP), recruited during their initial neurosurgical consultation at the Neurosurgery Clinic over a period of 6 months. All patients were followed for a minimum of 3 months after the start of conservative therapy. Age, sex, smoking habits, and the presence of any comorbidities were noted. Pain severity and discomfort were evaluated using the Numeric Rating Scale (NRS), the DN4 questionnaire, and the Oswestry Disability Index (ODI). Based on imaging (MRI of the lumbosacral spine), diagnoses of disc herniation or vertebral lumbar stenosis were documented. Statistical analysis was performed using IBM SPSS Statistics software (Version 30). A p-value of less than 0.05 was considered statistically significant. Results: Improvement on the CLBP, NRS, and DN4 scales after the same conservative therapy was better in Patients with non-smoking habits improved more on the CLBP, NRS and DN4 scales when compared to smokers (NRS scale 0.001 and DN4 scale 0.027). Conclusions: Patients with smoking habitudes affected by lumbar disk her-niation and stenosis and undergoing conservative therapy had worse pain scores

Background: Spinal schwannomas and meningiomas represent common benign tumors of the spinal cord in adults, necessitating total excision. While total laminectomy has conventionally been employed, unilateral hemilaminectomy has emerged as a viable alternative. Methods: A retrospective analysis was conducted on patients undergoing spinal meningioma or schwannoma resection via laminectomy or unilateral hemilaminectomy from January 2013 to January 2023. Patient demographics, operative techniques, and postoperative outcomes were compared. Results: The study comprised 41 patients (mean age: 62.5 ±14.6 years), with 59% schwannomas and 41% meningiomas, predominantly in the thoracic spine. Total excision was achieved in all cases. Schwannoma resections had longer operative times (p=0.001) and greater intraoperative blood loss (p=0.000) compared to meningiomas. Unilateral hemilaminectomy (41%) exhibited ad-vantages over total laminectomy (59%), including reduced postoperative bed rest (p=0.003), shorter hospital stays (p=0.028), and diminished postoperative pain (p=0.02). Conclusions: Uni-lateral hemilaminectomy is a safe and effective approach for spinal schwannomas and menin-giomas of various sizes. It offers superior outcomes compared to total laminectomy, with benefits such as decreased postoperative bed rest, shorter hospitalization, and lower postoperative pain.