The increasing number of neurosurgical procedures has led to a corresponding rise in complications such as cerebrospinal fluid (CSF) leakage. CSF leakage can manifest with various issues, including headache, dizziness, and meningitis, often resulting in prolonged hospital stays, increased treatment costs, and, in severe cases, even mortality. Therefore, effective dural closure to prevent CSF leakage is critical. While traditional suturing remains a primary method, it is not always feasible. An alternative approach involves the use of surgical sealants.

The authors previously demonstrated the efficacy of photocrosslinkable hyaluronic acid (HA) as a surgical sealant and elaborated on its advantages [2]. In this study, they investigated the in vivo degradation of photocrosslinkable HA over time and its efficacy in preventing CSF leakage during dural regeneration using an animal model with magnetic resonance imaging (MRI) imaging.

A cranial defect was created in rats, and the dura was incised to induce CSF leakage. The experimental group was treated with the HA photosealant, which was then photocrosslinked by light exposure. The control group received no treatment.

MRI scans performed at 1, 2, and 4-weeks post-procedure in the experimental group revealed no CSF leakage and demonstrated progressive biodegradation of the sealant. Histological examinations confirmed that the HA photosealant maintained its structural integrity until dural regeneration was complete, with no observed adverse tissue reactions. On average, approximately 66% of the sealant remained at 2 weeks, and about 40% remained at 4 weeks.

HA is highly biocompatible, does not induce foreign body reactions, and effectively prevents adhesion by reducing scar tissue formation. Furthermore, it promotes dural healing by preventing astrocytic scarring, which can hinder dural regeneration. However, traditional HA has limitations, including rapid degradation and poor mechanical properties. The HA photosealant developed by the authors overcomes these drawbacks through an enhanced multi-length network, thereby improving its mechanical properties and extending its degradation profile.

This is the first paper to analyze the biodegradability of HA photosealant in a rat craniectomy model using MRI. As an anticipated outcome of this result, perspectives may be given on elucidating in vivo efficacy and biodegradation patterns of applied HA photosealant.

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional spinal deformity of unknown etiology, characterized by lateral curvature in the coronal plane, thoracic hypokyphosis in the sagittal plane, and axial rotation. Surgical intervention aims to correct the deformity, achieve trunk balance, and preserve motion segments through strategic spinal fusion. The introduction of pedicle screws led to the establishment of a new standard in scoliosis corrective surgery.

Recently, the multiplanar deformity reducer (MDR) system was developed to facilitate scoliosis correction by facilitating gradual rod derotation. However, the safety and efficacy of the MDR system in terms of surgical outcomes have yet to be thoroughly investigated. They presented the experiences using the MDR system for AIS corrective surgery and evaluated its impact on radiographic and surgical outcomes in comparison to the established direct vertebral rotation (DVR) technique.

A retrospective cohort study was done for AIS patients who underwent corrective surgeries. Radiological parameters were assessed by computed tomography (CT) and EOS imaging systems with EOS 3D analysis. The study included 22 patients, divided into two groups: nine in the MDR group and 13 in the DVR group. There were no significant differences between the MDR and DVR group concerning preoperative and postoperative values and the degree/percentage of correction. Although apical vertebral rotation showed no significant difference between MDR and DVR groups measured by CT, it exhibited greater inter-rater variability, compared to other radiological measurements investigated in this study.

It was demonstrated that the MDR system is comparably effective in various aspects of AIS corrective surgery, including operative blood loss, operation time, complications, reoperation rates, radiographic correction, and clinical outcome. Although this study did not demonstrate the superiority of MDR over DVR, it is significant in that it provides evidence to consider MDR in AIS surgery. It also highlights the advantages of using EOS 3D analysis for rotational parameters. Unlike CT scans which primarily focus on the radiographic plane, EOS 3D analysis takes into account the patient plane by considering the position of the pelvis. Despite being a retrospective study with the limitation that some variables requiring consideration were excluded from the analysis, the research is meaningful for having demonstrated the usefulness of the MDR system.