The effect of modified head-of-bed elevation on postoperative headache and CSF leakage after meningioma resection

Postoperative headache and cerebrospinal fluid (CSF) leakage are common complications after meningioma resection, which may prolong hospitalization, increase infection risk, and negatively affect patient recovery. Although maintaining a 30° head-of-bed (HOB) elevation is standard postoperative nursing care to reduce intracranial pressure, the optimal elevation angle remains uncertain. This study aimed to evaluate the efficacy of an improved HOB elevation of 30° to 35° in reducing postoperative headache severity and CSF leakage in patients undergoing meningioma resection. This retrospective cohort study included 128 patients who underwent meningioma resection between January 2021 and December 2023 at our hospital. Patients were allocated to the control group (n = 64, HOB = 30°) or the improved group (n = 64, HOB = 30°-35°). Postoperative headache severity, CSF leakage incidence, wound healing, and patient satisfaction were compared between groups. Statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk), and a P value <0.05 was considered statistically significant. An early postoperative HOB elevation of 30° to 35° after meningioma resection significantly reduces postoperative headache severity, reduces CSF leakage, and improves patient satisfaction compared with the conventional 30° position. These findings suggest that slightly increasing the HOB angle could be considered as part of optimized postoperative nursing protocols. Compared with the control group, the improved group exhibited significantly lower headache scores on postoperative day 3 (3.12 ± 1.21 vs 4.58 ± 1.44, t = 5.487, P < .001) and day 7 (2.11 ± 0.93 vs 3.72 ± 1.26, t = 7.023, P < .001). The incidence of CSF leakage was markedly reduced in the improved group (3.13% vs 14.06%, χ2 = 4.398, P = .036), while patient satisfaction was significantly higher (93.75% vs 79.69%, χ2 = 5.184, P = .023).