Study Design.: Heterogeneous data collection through a mix of prospective, retrospective, and ambispective methods. Objective.: To evaluate the effect of biological sex on patient-reported outcomes after spinal fusion surgery for lumbar degenerative disease. Summary of Background Data.: Current literature suggests sex differences regarding clinical outcome after spine surgery may exist. Substantial methodological heterogeneity and limited comparability of studies warrants further investigation of sex-related differences in treatment outcomes. Materials and Methods.: We analyzed patients who underwent spinal fusion with or without pedicle screw insertion for lumbar degenerative disease included within a multinational study, comprising patients from 11 centers in seven countries. Absolute values and change scores (change from preoperative baseline to postoperative follow-up) for 12-month functional impairment [Oswestry disability index (ODI)] and back and leg pain severity [numeric rating scale (NRS)] were compared between male and female patients. Minimum clinically important difference (MCID) was defined as >30% improvement. Results.: Six-hundred sixty (59%) of 1115 included patients were female. Female patients presented with significantly baseline ODI (51.5±17.2 vs. 47.8±17.9, P<0.001), back pain (6.96±2.32 vs. 6.60±2.30, P=0.010) and leg pain (6.49±2.76 vs. 6.01±2.76, P=0.005). At 12 months, female patients still reported significantly higher ODI (22.76±16.97 vs. 20.50±16.10, P=0.025), but not higher back (3.13±2.38 vs. 3.00±2.40, P=0.355) or leg pain (2.62±2.55 vs. 2.34±2.43, P=0.060). Change scores at 12 months did not differ significantly among male and female patients in ODI (∆1.31, 95% CI: -3.88 to 1.25, P=0.315), back (∆0.22, 95% CI: -0.57 to 0.12, P=0.197), and leg pain (∆0.16, 95% CI: -0.56 to 0.24, P=0.439). MCID at 12 months was achieved in 330 (77.5%) male patients and 481 (76.3%) female patients (P=0.729) for ODI. Conclusion.: Both sexes experienced a similar benefit from surgery in terms of relative improvement in scores for functional impairment and pain. Although female patients reported a higher degree of functional impairment and pain preoperatively, at 12 months only their average scores for functional impairment remained higher than those for their male counterparts, while absolute pain scores were similar for female and male patients.

Patients admitted to intensive care unit (ICU) after non-traumatic subarachnoid hemorrhage (SAH) represent a group with distinctive characteristics and few data are available on long-term outcome in this population. We conducted a single-center retrospective study in an Italian intensive care unit. All patients with non-traumatic SAH (ICD-9-CM Diagnosis Code 430) admitted to ICU were included. Disability and quality of life were evaluated via telephone interview after 12–15 months after initial bleeding using GOSE and EuroQoL, respectively. Baseline and clinical course characteristics were analyzed to evaluate relation with poor outcome defined as GOSE ≤ 3. Final population consisted of 38 patients. Twenty-four patients (63.2%) had favorable outcome (GOSE ≥ 4). Among 29 patients (76.3%) who survived at 1 year, median EQ-5D Index was 0.743 (IQR 0.287), while median EQ-VAS was 74.79 (IQR 18.5). Median EQ-5D Index and median EQ-VAS were higher among patients with favorable outcome (EQ-5D Index p = 0.037, EQ-VAS p = 0.003). Among baseline characteristics, only HH scale showed a significant relation with disability at one year (p = 0.033). Between complications occurred during ICU-stay only early HICP was related with unfavorable outcome (p = 0.028). Higher HH scale and early HICP were related with unfavorable outcome. Among patients with unfavorable outcome, quality of life has a broad range of variability, and this result should be taken into account when reporting patient-centered outcomes.

Background: Pilocytic astrocytoma (PCA) are commonly observed as slow-growing noncancerous brain tumors in pediatric populations, but they can also occur in adults, albeit rarely. When located in diencephalic regions, particularly in the hypothalamus, they present unique diagnostic and management challenges due to their rarity and overlapping clinical and radiological features with other intracranial pathologies. This systematic review aims to provide a comprehensive understanding of hypothalamic PCA in adults, focusing on their differential diagnosis, neurological presentation, diagnostic modalities, treatment strategies. A case illustration is also described in order to better underline all the difficulties related to the diagnostic process. Material and methods: A systematic literature search was conducted in the PubMed/MEDLINE, Embase, and Scopus databases up to November 2023 to identify studies. Results: The systematic literature search identified a total of 214 articles. Following screening by title and abstract and full-text review, 12 studies were deemed eligible and are included here. Conclusions: Adult-onset PCA in diencephalic regions pose diagnostic challenges due to their rarity and overlapping features with other intracranial lesions. Advanced imaging techniques play a crucial role in diagnosis, while surgery remains the cornerstone of treatment. Multidisciplinary collaboration is essential for the optimal management and long-term follow-up of these patients.

Background/Objectives: Spheno-orbital meningiomas (SOMs) are rare tumors described as benign despite their aggressive, osteodestructive behavior. Their invasive nature makes surgical management complex and often precludes complete excision. Reaching structures within the orbit remains challenging, particularly due to insufficient exposure or overly long surgical pathways. This study aimed to provide a qualitative anatomical description of two approaches—transcranial and endoscopic transorbital—and a preliminary quantitative analysis to assess the distances required to reach the anatomical areas most commonly involved in SOMs. Methods: Anatomical dissections were performed on five specimens (ten sides) at the Laboratory of Surgical Neuroanatomy (LSNA), University of Barcelona. Each specimen underwent pre- and post-dissection CT scans, and all data were organized using the BrainLab^® Workstation System. Results: Both approaches provided good exposure of structures deeply involved in SOMs. A description of the superior orbital fissure (SOF), inferior orbital fissure (IOF), and optic canal (OC) was achieved from both perspectives. The preliminary quantitative analysis showed significantly shorter distances to key anatomical targets using the endoscopic transorbital approach (ETOA) compared to the transcranial route. Conclusions: Currently, despite significant advances, the choice of the optimal surgical approach remains debated, reflecting the complexity of balancing tumor control with functional preservation. Both approaches allow for thorough evaluation of the orbital region, offering precise anatomical insights useful for SOM management.