{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T19:50:55Z","timestamp":1793994655375,"version":"4.8.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Spontaneous intracranial hypotension (SIH) due to a spinal cerebrospinal fluid (CSF) leak is a debilitating but curable condition, often affecting individuals of working age, making a considerably socioeconomic impact likely.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This monocentric retrospective study in Germany analyzed work capacity in patients \u226465\u202fyears before and after surgical closure of a spinal CSF leak between April 2018 and September 2024. The economic burden was evaluated via direct hospital costs and indirect costs from productivity losses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two hundred and ten patients (median age 45.5\u202fyears, 62% female), all physically capable of working, were included. After symptom onset, 96% could not perform their professional work as before: 61% were completely unable, 18% reduced working time, and 17% adapted conditions. Three months postoperatively, 55% had completely returned to work, 19% were working part-time. At the last follow-up these numbers further improved to 65 and 17%, respectively, only 9% were still unable to work, 9% had retired. A shorter symptom duration was significantly associated with complete return to work. Median direct costs per patient for diagnosis and treatment was \u20ac11,407, indirect costs for 160\u202fdays (the median symptom duration before surgery) averaged \u20ac21,169. Extrapolated to the incidence rate, the additional annual economic burden in Germany is estimated at \u20ac85.75 million for 160 sick days, largely from preventable productivity losses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SIH significantly impairs working ability. Early treatment can restore work capacity and substantially reduces preventable productivity losses, strongly advocating timely intervention not only from a medical but also from an economic perspective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1738826","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T05:22:53Z","timestamp":1769664173000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Return to work \u2013 estimated socioeconomic impact of spontaneous intracranial hypotension and effects of neurosurgical treatment"],"prefix":"10.3389","volume":"17","author":[{"given":"Mazin","family":"Omer","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Wolf","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manou","family":"Overstijns","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"El Rahal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]},{"name":"Faculty of Medicine, University of Geneva","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"L\u00fctzen","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Urbach","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Zander","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Krismer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Helge","family":"Klingler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Hohenhaus","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukesch","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Beck","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Volz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center University of Freiburg","place":["Freiburg im Breisgau, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1177\/03331024211048510","article-title":"Incidence of spontaneous intracranial hypotension in a community: Beverly Hills, California, 2006\u20132020","volume":"42","author":"Schievink","year":"2022","journal-title":"Cephalalgia"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1001\/jamaneurol.2020.4799","article-title":"Clinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension syndrome: a systematic review and meta-analysis","volume":"78","author":"D\u2019Antona","year":"2021","journal-title":"JAMA Neurol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1056\/NEJMra2101561","article-title":"Spontaneous intracranial hypotension","volume":"385","author":"Schievink","year":"2021","journal-title":"N Engl J Med"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"e16579","DOI":"10.1111\/ene.16579","article-title":"Spontaneous intracranial hypotension - neurological symptoms, diagnosis, and outcome","volume":"32","author":"Dalby","year":"2025","journal-title":"Eur J Neurol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1212\/WNL.0000000000002986","article-title":"A classification system of spontaneous spinal CSF leaks","volume":"87","author":"Schievink","year":"2016","journal-title":"Neurology"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"2776","DOI":"10.1007\/s00415-024-12242-2","article-title":"Don\u2019t delay, but don\u2019t despair: symptom duration, comorbidity and outcome after closure of spinal cerebrospinal fluid leaks","volume":"271","author":"Volz","year":"2024","journal-title":"J Neurol"},{"key":"ref7","first-page":"159101992311654","article-title":"Incidence of spontaneous intracranial hypotension in Olmsted County, Minnesota: 2019\u20132021","author":"Pradeep","year":"2023","journal-title":"Interv Neuroradiol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1001\/jamaneurol.2019.0006","article-title":"Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis","volume":"76","author":"Etminan","year":"2019","journal-title":"JAMA Neurol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1161\/STROKEAHA.120.029538","article-title":"Incidence and outcome of aneurysmal subarachnoid hemorrhage: the Swiss study on subarachnoid hemorrhage (Swiss SOS)","volume":"52","author":"Schatlo","year":"2021","journal-title":"Stroke"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1212\/WNL.0000000000003122","article-title":"Diskogenic microspurs as a major cause of intractable spontaneous intracranial hypotension","volume":"87","author":"Beck","year":"2016","journal-title":"Neurology"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"e241653","DOI":"10.1148\/radiol.241653","article-title":"MRI and surgical findings refine concepts of type 2 cerebrospinal fluid leaks in spontaneous intracranial hypotension","volume":"314","author":"L\u00fctzen","year":"2025","journal-title":"Radiology"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1212\/WNL.0000000000000639","article-title":"CSF-venous fistula in spontaneous intracranial hypotension","volume":"83","author":"Schievink","year":"2014","journal-title":"Neurology"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1093\/ons\/opz134","article-title":"Clinical outcomes following surgical ligation of cerebrospinal fluid-venous fistula in patients with spontaneous intracranial hypotension: a prospective case series","volume":"18","author":"Wang","year":"2020","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"3331024231196808","DOI":"10.1177\/03331024231195830","article-title":"Recovery and long-term outcome after neurosurgical closure of spinal CSF leaks in patients with spontaneous intracranial hypotension","volume":"43","author":"Volz","year":"2023","journal-title":"Cephalalgia"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"e200272","DOI":"10.1212\/CPJ.0000000000200272","article-title":"Impact of spinal CSF leaks on quality of life and mental health and long-term reversal by surgical closure","volume":"14","author":"Volz","year":"2024","journal-title":"Neur Clin Pract"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"5466","DOI":"10.1007\/s00415-022-11207-7","article-title":"The impact of spontaneous intracranial hypotension on social life and health-related quality of life","volume":"269","author":"Jesse","year":"2022","journal-title":"J Neurol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1421579","DOI":"10.3389\/fneur.2024.1421579","article-title":"More than a headache-somatic and mental symptom burden in spontaneous intracranial hypotension before and after surgical treatment","volume":"15","author":"Volz","year":"2024","journal-title":"Front Neurol"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"e296","DOI":"10.1371\/journal.pmed.0040296","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"von Elm","year":"2007","journal-title":"PLoS Med"},{"key":"ref19","first-page":"1","article-title":"The international classification of headache disorders, 3rd edition","volume":"38","year":"2018","journal-title":"Cephalalgia"},{"key":"ref20","article-title":"Average gross monthly earnings","year":""},{"key":"ref21","volume-title":"German Social Code Book V (SGB V) \u00a744 \u2013 Statutory sick pay provisions","year":""},{"key":"ref22","first-page":"1","article-title":"Germany: health system review","volume":"22","author":"Bl\u00fcmel","year":"2020","journal-title":"Health Syst Transit"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1007\/s00415-021-10710-7","article-title":"Outcome after surgical treatment of cerebrospinal fluid leaks in spontaneous intracranial hypotension-a matter of time","volume":"269","author":"H\u00e4ni","year":"2022","journal-title":"J Neurol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1227\/ons.0000000000001042","article-title":"Keyhole fenestration for cerebrospinal fluid leaks in the thoracic spine: quantification of bone removal and microsurgical anatomy","volume":"27","author":"Volz","year":"2024","journal-title":"Oper Neurosurg"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"147","DOI":"10.3171\/2022.7.SPINE2252","article-title":"Minimally invasive surgery for spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension","volume":"38","author":"Beck","year":"2023","journal-title":"J Neurosurg Spine"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1227\/ons.0000000000001401","article-title":"Safety, sequelae, and efficacy of nerve root clipping in patients with spontaneous spinal cerebrospinal fluid leaks","volume":"28","author":"El Rahal","year":"2025","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2581","DOI":"10.1517\/14656560903304063","article-title":"The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review","volume":"10","author":"Juniper","year":"2009","journal-title":"Expert Opin Pharmacother"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.ejpain.2008.04.005","article-title":"Costs of back pain in Germany","volume":"13","author":"Wenig","year":"2009","journal-title":"Eur J Pain"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1177\/0333102411425866","article-title":"Treatment costs and indirect costs of cluster headache: a health economics analysis","volume":"31","author":"Gaul","year":"2011","journal-title":"Cephalalgia"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"113","DOI":"10.2147\/CEOR.S81396","article-title":"A burden of illness study for neuropathic pain in Europe","volume":"8","author":"Liedgens","year":"2016","journal-title":"Clinicoecon Outcomes Res"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s10194-025-02069-1","article-title":"Prevalence, disability, and economic impact of migraine in Spain: a nationwide population-based study","volume":"26","author":"Sanchez-del-Rio","year":"2025","journal-title":"J Headache Pain"},{"key":"ref32","article-title":"Cost of Illness in Neurology in Europe (COIN-EU) Project","year":""},{"key":"ref33","doi-asserted-by":"crossref","first-page":"e037564","DOI":"10.1136\/bmjopen-2020-037564","article-title":"Occurrence, mortality and cost of brain disorders in Denmark: a population-based cohort study","volume":"10","author":"Vestergaard","year":"2020","journal-title":"BMJ Open"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1738826\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T05:22:56Z","timestamp":1769664176000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1738826\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":33,"alternative-id":["10.3389\/fneur.2026.1738826"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1738826","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"article-number":"1738826"}}