This narrative review provides a comprehensive analysis of the several methods and technologies employed to measure handgrip strength (HGS), a significant indicator of neuromuscular strength and overall health. The document evaluates a range of devices, from traditional dynamometers to innovative sensor-based systems, and assesses their effectiveness and application in different demographic groups. Special attention is given to the methodological aspects of HGS estimation, including the influence of device design and measurement protocols. Endogenous factors such as hand dominance and size, body mass, age and gender, as well as exogenous factors including circadian influences and psychological factors, are examined. The review identifies significant variations in the implementation of HGS measurements and interpretation of the resultant data, emphasizing the need for careful consideration of these factors when using HGS as a diagnostic or research tool. It highlights the necessity of standardizing measurement protocols to establish universal guidelines that enhance the comparability and consistency of HGS assessments across various settings and populations.

• Gross total removal has a pivotal role in surgical treatment of intradural spinal tumors. • Sodium fluorescein prevents vascular injuries also preserving pial vessels in posterior myelotomy. • Fluorescence before the durotomy helps to distinguishing tumor from healthy tissue in intradural lesions. • Intraoperative fluorescence is safe and effective, also preserving functional anatomy in tumor removal.

DTI is a useful tool in presurgical planning, helping in differentiating not infiltrating neoplasms, such as spinal ependymomas, from other infiltrative and more aggressive neoplasms, which are considered not resectable.

Background: Glioma surgery has been remarkably enhanced in the past 2 decades, with improved safety and limited but improved life expectations. The fluorescence-guided resection of high-grade gliomas (HGGs) plays a central role in this sense, allowing a greater extent of resection (EOR). The introduction of exoscopic-guided surgery may be considered in implementing fluorescence techniques over traditional microscopes. We present the application and the advantages of exoscopic-guided surgery compared to microscopic surgery in tumor resection guided by 5-ALA fluorescence in patients with HGGs. Methods: Ten consecutive patients underwent surgery for HGG resection. The surgery was performed via an exoscopic-guided procedure (Olympus ORBEYE) and after the oral administration of Gliolan 5 h before the procedure. During surgery, the procedure shifted to using a microscopic (Kinevo 900, Zeiss) view. The intensity of the fluorescence under the two different procedures was subjectively measured in different picture samples during the surgery on a 1 to 5 (from minimum to maximum) scale. The brightness of the surgical field and the detailing of the anatomy were also analyzed comparatively. Results: Among the ten patients, the histopathological diagnosis was an high-grade glioma in all cases. In nine cases, it was possible to achieve gross total resection. There was no perioperative mortality. The median fluorescence intensity, on a scale of 1–5, was 4.5 in the exoscope group and 3.5 in the microscope group (p < 0.01). Conclusions: The exoscopic-guided surgery adds advantages to traditional fluorescence-guided surgery with 5-aminolevulinic acid. Beyond the important advantage of low cost and the possibility to perform collaborative surgeries, it adds a plain and continuous visualization of the tumor and offers advantages in the surgical field of fluorescence-guided glioma surgery compared to the microscopic-guided one.