Tracz Jovanna A, Farmer Matthew L, Hughes Mark, Mukherjee Debraj, Brennan Paul M
Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, 48202, USA.
World Neurosurg X. 2024 Sep 29;25:100409. doi: 10.1016/j.wnsx.2024.100409. eCollection 2025 Jan.
Return to play (RTP) decisions after cranial surgery are important to patients. Most published data relate to RTP following sports-related brain injury. This study investigated factors that influence neurosurgical RTP decision-making following craniotomy for non-traumatic brain lesions.
A patient scenario-based survey was distributed to U.S. and Europe-based neurosurgeons via the American Association of Neurological Surgeons/Congress of Neurological Surgeons Tumor Section and the European Association of Neuro-Oncology. From one core patient scenario, 5 further scenarios were developed involving patients of varying age, sport preference, tumor pathology, and craniotomy approach. Respondents provided RTP recommendations and factors important in forming these recommendations.
Forty-one responses were received; Europe (48%), U.S. (37%). The most commonly cited factors influencing RTP decision-making across scenarios were symptomatic recovery (85.4%), resolution of blood and/or air on imaging (43.4%), and patient demand (31.7%). The sports with the longest average RTP timeline were boxing (10.3 months), rugby (8.7 months), and American football (8.5 months) in the core patient scenario. Twenty-nine percent of neurosurgeons requested neuroimaging before determining RTP recommendations in this scenario, more commonly in America than Europe (46.7% and 5.0% respectively, = .006).
Although limited by sample size, the data provides a foundation to support development of a systematic approach to RTP decision-making following craniotomy for brain lesions of non-traumatic etiology. Future work to develop consensus guidelines will benefit from objective data about outcomes, particularly in relation to repeat imaging prior to RTP.
颅骨手术后的重返运动（RTP）决策对患者很重要。大多数已发表的数据与运动相关脑损伤后的RTP有关。本研究调查了非创伤性脑病变开颅术后影响神经外科RTP决策的因素。
通过美国神经外科医师协会/神经外科医师大会肿瘤学分会和欧洲神经肿瘤学协会，向美国和欧洲的神经外科医师发放了基于患者病例的调查问卷。从一个核心患者病例出发，又设计了另外5个病例，涉及不同年龄、运动偏好、肿瘤病理和开颅方法的患者。受访者提供了RTP建议以及形成这些建议的重要因素。
共收到41份回复；欧洲（48%），美国（37%）。在所有病例中，最常被提及的影响RTP决策的因素是症状恢复（85.4%）、影像学上血液和/或空气的消散（43.4%）以及患者需求（31.7%）。在核心患者病例中，平均RTP时间线最长的运动项目是拳击（10.3个月）、橄榄球（8.7个月）和美式足球（8.5个月）。在该病例中，29%的神经外科医师在确定RTP建议前要求进行神经影像学检查，在美国比在欧洲更常见（分别为46.7%和5.0%，P = 0.006）。
尽管受样本量限制，但这些数据为支持制定非创伤性病因脑病变开颅术后RTP决策的系统方法提供了基础。未来制定共识指南的工作将受益于关于结果的客观数据，特别是与RTP前重复影像学检查相关的数据。
