Surgical Approach For Treatment Research Articles

Research Progress of Immune Mechanisms Related to Persistent HPV Infection in CIN after Cervical Conization

Persistent human papillomavirus (HPV) infection is associated with the grading of cervicalintraepithelial neoplasia (CIN), high-risk HPV infection, multiple HPV infections, high HPV load,HPV infection of surgical margin, and age in CIN after conization. The immune mechanism iscomplex and is primarily related to vaginal microecology disorders, immune escape, immuneresponse impairment, and the release of regulatory cytokines. Currently, the treatment methods forpostoperative persistent HPV infection include surgical treatment, antiviral treatment, vaccination,and other approaches.

Preliminary Application of Bilateral Submandibular Horizontal Incision in the Treatment of Upper Cervical Tumors.

The upper cervical spine has a complex anatomical structure, making anterior surgical approaches challenging and prone to complications. This study aims to explore the use of bilateral submandibular incisions to provide safer and more convenient exposure of the upper cervical spine and to assess the feasibility of this approach for anterior surgical treatment of complex upper cervical diseases. From November 2019 to August 2021, three patients with malignant tumors of the upper cervical spine were subjected to an anterior-posterior combined approach for cervical tumor resection. The cohort consisted of one male and two females, aged between 41 and 51 years. The anterior approach began with a submandibular incision, followed by blunt dissection through the prevertebral muscles to expose the diseased vertebra. Subsequently, the diseased vertebra was excised, and either a titanium cage or a pre-customized 3D-printed artificial vertebral body was implanted anteriorly. Then, posterior fixation of the cervical spine was performed using pedicle screws to provide additional stability. Follow-up ranged from 8 to 34 months. All patients experienced varying degrees of pain relief within 24 hours post-operation. Frankel grading showed improvement by at least one grade in all three cases. Regular X-ray and magnetic resonance imaging examinations revealed no tumor recurrence or involvement of adjacent vertebrae in the surgical area. The anterior bilateral submandibular horizontal incision approach offers comprehensive exposure of the anatomical structures of the upper cervical spine. This approach introduces a new option for the anterior treatment of upper cervical spine diseases.

OXY-SCORE and Volatile Anesthetics: A New Perspective of Oxidative Stress in EndoVascular Aneurysm Repair-A Randomized Clinical Trial.

An aortic aneurysm (AA) is a life-threatening condition. Oxidative stress may be a common pathway linking multiple mechanisms of an AA, including vascular inflammation and metalloproteinase activity. Endovascular aneurysm repair (EVAR) is the preferred surgical approach for AA treatment. During surgery, inflammation and ischemia-reperfusion injury occur, and reactive oxygen species (ROS) play a key role in their modulation. Increased perioperative oxidative stress is associated with higher postoperative complications. The use of volatile anesthetics during surgery has been shown to reduce oxidative stress. Individual biomarkers only partially reflect the oxidative status of the patients. A global indicator of oxidative stress (OXY-SCORE) has been validated in various pathologies. This study aimed to compare the effects of the main volatile anesthetics, sevoflurane and desflurane, on oxidative status during EVAR. Eighty consecutive patients undergoing EVAR were randomized into two groups: sevoflurane and desflurane. Plasma biomarkers of oxidative damage (protein carbonylation and malondialdehyde) and antioxidant defense (total thiols, glutathione, nitrates, superoxide dismutase, and catalase activity) were measured before surgery and 24 h after EVAR. The analysis of individual biomarkers showed no significant differences between the groups. However, the OXY-SCORE was positive in the desflurane group (indicating a shift towards antioxidants) and negative in the sevoflurane group (favoring oxidants) (p < 0.044). Compared to sevoflurane, desflurane had a positive effect on oxidative stress during EVAR. The OXY-SCORE could provide a more comprehensive perspective on oxidative stress in this patient population.

Hybrid high and low molecular weight chains of hyaluronan for clitoral injection is an effective modality treatment for increasing female sexual satisfaction: an interventional, randomized-controlled parallel study.

Hormonal, behavioral, psychological, surgical, and pharmacopsychological treatment approaches contribute to female sexual dysfunction (FSD). Aim: The study is conducted to assess the effectiveness of hyaluronan high and low molecular weight hybrid cooperative complexes (hybrid H-HA/L-HA) in treating females with SD and to compare the female sexual function index (FSFI), dermatological life quality index (DLQI), and female genital self-image scale (FGSIS) before and after therapy. We divided the 60 female participants into two groups. Hybrid H-HA/L-HA was administered to form pili of 0.25cc around the clitoris in the direction of clock positions of 12, 3, 6, and 9. In Skene's gland; 0.25cc for each and 0.5cc into the corpus/body of the clitoris. Two treatments were held 30days apart.The same procedure was repeated on the control group, but with saline as a placebo. Women completed self-report questionnaires assessing sexual functioning using the FSFI, DLQI, and FGSIS before and after therapy. There was a significant (P= 634.152; P< .05) increase in the study group's weekly sexual interactions compared with the controls. The study group showed statistically significant amelioration in desire, arousal, lubrication, orgasm, satisfaction domains, overall score, and a decrease in pain following the first and second injection sessions (P= .014, .031, .003, .001, .011, .004, and .011, respectively). A comparison of the results between the two groups revealed significant improvement were found (P= .025).There were significant improvements in the domains of the FGSIS compared with the controls (P= .026). The study group showed a substantial improvement in satisfaction with the way their genital area looked, comfort level when allowing a sexual partner to view their genital area, belief that their genitals smell perfectly fine without being self-conscious about them, and overall score (P= .022, .031, .003, .001, and .004, respectively) (P< .05).The hybrid H-HA/L-HA sessions resulted in significantly greater positive perceptions and feelings, leisure activities, interpersonal interactions, and general assessments (P= .021, .021, and .020, respectively) (P< .05). Female individuals with SD experience sexual improvements after hybrid H-HA/L-HA injection. This is the first study focusing on female individuals with SD. We recommend conducting the study on a larger population and including their partners. Hybrid H-HA/L-HA injection for rejuvenating the clitoral injection appears to be a reliable and safe method for enhancing female genital self-image, sexuality, and quality of life.

Machine Learning for Treatment Management Prediction in Laryngeal Fractures

ObjectivesLaryngeal fractures are rare but potentially life-threatening traumas. Complications, such as airway obstruction and disrupted laryngeal anatomy, associate with significant morbidity. Early identification of at-risk patients and optimal management remain crucial for improved outcomes. Recently, machine learning (ML) has attained great attention as a unique and novel technique for evaluating complex non-linear relationships between multiple observations to create a predictive model with greater accuracy. This study aimed to demonstrate the potential of ML in predicting airway and surgical management of laryngeal fracture patients and identify key contributing parameters for the predictive performance of the ML models. MethodsThe ML models were developed using a patient series managed at the Helsinki University Hospital during 2005–2019. The developed models were further evaluated independently using a different cohort collected from the same institution between 1995–2004. ResultsThe ML showed a weighted area under curve (AUC) of 0.93 and accuracy of 0.86 following training for airway management. Likewise, for treatment approach, weighted AUC was 0.85 and accuracy 0.78. Injury type, Schaefer-Fuhrman grade (SF gr), age at incident, cause of injury, and fracture of the cricoid, in decreasing order of significance, were the most prominent features for the model's predictive performance for airway management. Similarly, our model identified SF gr, fracture of the cricoid, injury type, age at incident, and cause of injury as the most significant predictors for surgical treatment approach. ConclusionsThe proposed prediction of management approach by an ML technique can provide accurate predictions and thus aid clinicians in administering early and personalized interventions. The model may serve as a supporting tool in recognizing at-risk patients and in timely decision making. Further independent external validation is warranted for model generalizability.

Innovative surgical treatment approaches for endothelial dysfunction : Descemet stripping only (DSO) and endothelial cell injection

Currently, due to arising number of patients Germany and many other countries experience alarge deficit of donor eyes for posterior lamellar keratoplasty procedures in the treatment of corneal endothelial diseases. To address this unmet need there is an ongoing investigation of treatment modalities which do not rely on donor tissue or enable clinicians to treat more patient eyes per donor eye. The authors introduce apromising approach for both treatment principles. First, the technique of Descemet stripping only (DSO) is detailed, in which acentral part of the Descemet's membrane including the endothelium is surgically removed without replacement with donor tissue. This then allows endothelial cells from the periphery of the cornea to migrate into the central area and can reduce corneal opacification and swelling. As arepresentative technique of the second group, the authors introduce endothelial cell injection, in which human corneal endothelial cells are cultivated in vitro and then, after removal of the diseased endothelium, injected into the anterior chamber of the recipient's eye to form anew and healthy endothelium. This is supported by injection of Rho kinase inhibitors and aface-down positioning of the patient after surgery. It is postulated that endothelial cell injection could possibly enable clinicians to treat up to 300 patient eyes with the tissue generated from 1 donor eye. Whether and how these novel approaches will become established in Europe remains to be seen.

Choice of surgical treatment approach in patients with metastatic colorectal cancer complicated by intestinal obstruction

BACKGROUND: Every year more than 1 million new cases of colorectal cancer are diagnosed worldwide, with approximately 30% patients already having distant metastases. Colorectal cancer is often complicated, which makes chemotherapy challenging or, in some cases, impossible, therefore worsening the prognosis. As the first step, such patients need to undergo surgical treatment, in order to eliminate existing complications. However, what volume of surgery remains a discussion point among ongologists: a colostomy or a cytoreductive r2 resection to remove the primary tumor. AIM: To analyze the results of complex treatment in patients with metastatic colorectal cancer and to optimize surgical treatment approaches. MATERIALS AND METHODS: We conducted a study in Samara regional clinical Oncology dispensary (Samara, Russia), which included patients with metastatic colorectal cancer complicated by intestinal obstruction. Before treatment, all patients were examined according with current clinical standards. Subsequently, the patients were divided into two groups: the first group included patients who underwent cytoreductive surgery (r2 resection to remove the primary lesion due to the presence of colonic obstruction), and the second group included patients who underwent palliative surgery (colostomy or a bypass anastomosis in order to eliminate intestinal obstruction without removing the primary tumor). RESULTS: We found that postoperative complications in patients who had undergone primary tumor removal were significantly more prevalent. At the same time, however, the number of complications at the stage of chemotherapy, combined with angiogenesis inhibitor therapy, was significantly greater than in the group of patients in whom primary lesion was not removed. Complications that arose during chemotherapy affected the number of chemotherapy cycles performed. Discontinuation of chemotherapy affected event-free and overall survival. CONCLUSION: Timely identification and elimination of existing complications by removing the primary tumor focus before chemotherapy is an important component of an individual approach in order to develop treatment optimal tactics for patients with metastatic colorectal cancer.

Patient and hospital factors influence surgical approach in treatment of acute cholecystitis.

Minimally invasive (MIS) cholecystectomies have become standard due to patient and hospital advantages; however, this approach is not always achievable. Acute and gangrenous cholecystitis increase the likelihood of conversion from MIS to open cholecystectomy. This study aims to examine patient and hospital factors underlying differential utilization of MIS vs open cholecystectomies indicated for acute cholecystitis. This is a retrospective, observational cohort study of patients with acute cholecystitis who underwent a cholecystectomy between 2016 and 2018 identified from the California Office of Statewide Health Planning and Development database. Univariate analysis and multivariable logistic regression models were used to analyze patient, geographic, and hospital variables as well as surgical approach. Our total cohort included 53,503 patients of which 98.4% (n = 52,673) underwent an initial minimally invasive approach and with a conversion rate of 3.3% (n = 1,759). On multivariable analysis advancing age increased the likelihood of either primary open (age 40 to < 65 aOR 2.17; ≥ 65 aOR 3.00) or conversion to open cholecystectomy (age 40 to < 65 aOR 2.20; ≥ 65 aOR 3.15). Similarly, male sex had higher odds of either primary open (aOR 1.70) or conversion to open cholecystectomy (aOR 1.84). Hospital characteristics increasing the likelihood of either primary open or conversion to open cholecystectomy included teaching hospitals (aOR 1.37 and 1.28, respectively) and safety-net hospitals (aOR 1.46 and 1.33, respectively). With respect to cholecystectomy, it is well-established that a minimally invasive surgical approach is associated with superior patient outcomes. Our study focused on the diagnosis of acute cholecystitis and identified increasing age as well as male sex as significant factors associated with open surgery. Teaching and safety-net hospital status were also associated with differential utilization of open, conversion-to-open, and MIS. These findings suggest the potential to create and apply strategies to further minimize open surgery in the setting of acute cholecystitis.

Primary cubital tunnel syndrome – surgical treatment methods and their effectiveness

Cubital tunnel syndrome (CuTS) is one of the most common neuropathies of the upper extremity. This condition, if left untreated, can significantly impact patients' everyday functioning and quality of life. Diagnosis of CuTS is mostly based on clinical evaluation but can be supplemented by electrodiagnostic studies, and various imaging techniques. Conservative treatments such as physical therapy, splinting, and anti-inflammatory medications are often first-line interventions. However, surgical approach may become necessary when conservative measures fail to provide relief or in cases of severe compression. There are numerous surgical approaches to treating CuTS and there is no clear consensus on one best method. Simple decompression of the ulnar nerve and its subcutaneous transposition are the most popular surgical techniques employed. Each method has its advantages and drawbacks, with varying implications for nerve recovery and postoperative complications. This review aims to provide a comprehensive overview of CuTS, while focusing on available surgical treatment approaches, their popularity and outcomes. Further research is warranted to refine surgical techniques and develop more effective interventions for this debilitating condition.

Substitute or coexistence? Mediastinoscopy-assisted versus thoracoscope-assisted esophagectomy in esophageal cancer: a meta-analysis of perioperative outcomes and long-term survival.

Currently, mediastinoscopy-assisted esophagectomy (MAE) and thoracoscope-assisted esophagectomy (TAE) represent two prevalent forms of minimally invasive esophagectomy extensively employed in the management of esophageal cancer (EC). The aim of this meta-analysis is to assess and compare these two surgical approaches concerning perioperative outcomes and long-term survival, offering valuable insights for refining surgical strategies and enhancing patient outcomes in this field. Adhering to PRISMA guidelines, the authors systematically searched PubMed, Web of Science, Cochrane Library, Embase, and CNKI databases until 1 March 2024, for studies comparing MAE and TAE. Outcomes of interest included perioperative outcomes (intraoperative outcomes, postoperative recovery, postoperative complications) and survival rates. Statistical analyses were performed using RevMan 5.4, with heterogeneity dictating the use of fixed or random-effects models. A total of 21 relevant studies were finally included. MAE was associated with significantly shorter operation times [mean difference (MD)=-59.58min, 95% CI: -82.90 to -36.26] and less intraoperative blood loss (MD=-68.34ml, 95% CI: -130.45 to -6.23). However, MAE resulted in fewer lymph nodes being dissected (MD=-3.50, 95% CI: -6.23 to -0.78). Postoperative recovery was enhanced following MAE, as evidenced by reduced hospital stays and tube times. MAE significantly reduced pulmonary complications [odds ratio (OR)=0.59, 95% CI: 0.44, 0.81] but increased the incidence of recurrent laryngeal nerve injury (OR=1.84, 95% CI: 1.30, 2.60). No significant differences were observed in anastomotic leakage, chylothorax, cardiac complications, wound infections, and gastric retention between MAE and TAE. The long-term survival outcomes showed no statistical difference [hazard ratio (HR)=1.05, 95% CI: 0.71, 1.54]. MAE offers advantages in reducing operation time, blood loss, and specific postoperative complications, particularly pulmonary complications, with a shorter recovery period compared to TAE. However, it poses a higher risk of recurrent laryngeal nerve injury and results in fewer lymph nodes being dissected. No difference in long-term survival was observed, indicating that both techniques have distinct benefits and limitations. These findings underscore the need for personalized surgical approaches in EC treatment, considering individual patient characteristics and tumor specifics.

Predictive factors for postoperative ileus after elective right hemicolectomy performed on over 80% Enhanced Recovery After Surgery-adherent patients: a retrospective cohort study.

Laparoscopic right hemicolectomy is the standard surgical approach for treatment of right-sided colonic neoplasms. Although performed within a strict Enhanced Recovery After Surgery (ERAS) program, patients still develop postoperative ileus. The aim of this study was to describe the factors responsible for postoperative ileus after right hemicolectomy in a patient population with over 80% ERAS adherence. In this retrospective study, we analyzed 499 consecutive patients undergoing elective right-sided colectomy for neoplastic disease in a single high-volume center. All patients followed an updated ERAS program. The overall median ERAS adherence was 80%. Patients with ≥ 80% adherence (n = 271) were included in further analysis. Their median ERAS adherence was 88.9% (interquartile range, 80-90; range, 80-100). Twenty-four of 271 patients (8.9%) developed postoperative ileus. A univariate regression analysis revealed carcinoma situated in the transverse colon, duration of operation over 200 minutes, and opiate consumption over 10 mg on the second postoperative day (POD) to be associated with a significantly higher risk of postoperative ileus. Multivariate regression analysis revealed that duration of surgery over 200 minutes (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.0-5.8; P = 0.045) and opiate consumption over 10 mg on POD 2 (OR, 4.8; 95% CI, 1.6-14.3; P = 0.005) independently predict a higher risk for postoperative ileus. The median length of hospital stay was significantly longer in patients with postoperative ileus (8 days vs. 3 days, P < 0.001). None of the 271 patients died during a 30-day follow-up. Long duration of surgery, even minor postoperative opiate use, predict a higher risk for postoperative ileus in strictly ERAS-adherent patients undergoing laparoscopic right hemicolectomy.

Two-Step Conservative Surgery for Complicated Forms of Diabetes-Related Foot Osteomyelitis.

Diabetes-related foot osteomyelitis (DFO) is a common yet complex condition, often complicated by concurrent soft tissue infections (STIs). This study evaluates the efficacy of a two-step conservative surgical approach, hypothesizing that it offers comparable outcomes to a one-step procedure. Conducted on a cohort of 93 patients with DFO, the study categorized cases into two types: OM1 (osteomyelitis without STI) and OM2 (osteomyelitis with STI). OM2 was further subdivided into OM2a (early diagnosis) and OM2b (late diagnosis), with OM2 patients undergoing initial soft tissue debridement followed by elective bone surgery. The results indicated no significant differences in infection recurrence or amputation rates between the two surgical approaches, with recurrence observed in 20.7% of cases and amputations in 10.8%. The two-step procedure was associated with higher inflammatory responses and greater need for antibiotics and hospital admissions. However, these factors did not translate into increased recurrence or amputation compared to the one-step procedure. The study supports the two-step approach as a safe and effective method for managing complicated DFO cases, providing a viable alternative to immediate amputation or single-stage surgery. Despite some limitations, including regional specificity and potential underdiagnosis in late-diagnosed cases, the findings offer valuable insights for clinical management and suggest further research to refine treatment protocols. The study's strengths include confirmed histopathological diagnoses and consistent follow-up, reinforcing the validity of the two-step surgical approach for complex DFO treatment.

Epidemiology and Management Paradigm of Head and Neck Infections, Including COVID-19 Pandemic Period: A 10-Year Retrospective Study in a Maxillofacial Center of Cluj-Napoca.

Background. The management of odontogenic infections varies across the globe. To shed light on the subject, this study delves into the practices of the Oral and Maxillofacial Department at Cluj-Napoca County Hospital. Material and Methods. This comprehensive retrospective analysis of 10 years of clinical experience covered a range of factors, including demographics, clinical and investigations factors, medical and surgical treatment approaches, and follow-up. Additionally, the study examined the change in trends over the course of the COVID-19 pandemic. Results. While head and neck infection occurrence had a decreasing trend before the COVID-19 pandemic, during the pandemic era the number of patients almost doubled. The infections were prevalent in the submandibular space, teeth being the prevalent cause. Young adults are prone to suffer from odontogenic infections. High levels of C reactive protein, ASA II-IV risk, and hepatic dysfunction indicated a longer time of hospitalization. The majority of antibiograms were negative, and the positive ones indicated Streptococcus and Staphylococcus species as prevalent pathogens. Extra- or intraoral surgical drainage and wide-spectrum antibiotics proved to be the workhorse for odontogenic infections. Conclusion. This study advances our understanding of oral and maxillofacial surgery and offers actionable strategies for improving patient outcomes in similar healthcare institutions worldwide.

Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient

Background: Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries. Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies. Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique. Case presentation: A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and who was a heavy smoker, was admitted to our hospital with symptoms of long time with bilateral claudication and became leg rest pain. He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access. Aortoiliac occlusive disease (TASC II Type D Class) diagnosis was made by lower extremity duplex ultrasound and CT angiography. The patient underwent urgent percutaneous transluminal angioplasty with kissing stent technique. The patient was discharged 4 days after the procedure without any significant complaints, received optimal medical treatment, and was educated about smoking cessation. Conclusion: Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.

Clinical characteristics and multimodal imaging can help diagnosing and treating mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy.

Mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE) is a recently described, histopathologically and molecularly defined (SLC35A2-mutated) type of cortical malformation. Although increasingly recognized, the diagnosis of MOGHE remains a challenge. We present the characteristics of the first six patients diagnosed in Bulgaria, with the aim to facilitate identification, proper presurgical evaluation, and surgical treatment approach in this disease. Revision of histopathological specimens of 202 patients operated on for drug-resistant focal epilepsy identified four cases with MOGHE. Another two were suggested, based on clinical characteristics and subsequently, were histologically confirmed. Sanger SLC35A2 sequencing on paraffin-embedded or fresh-frozen brain tissue was performed. Analysis of seizure types, neuropsychological profiles, electroencephalographic (EEG), imaging features and epilepsy surgery outcomes was done. Three out of the six cases (50%) harbored pathogenic SLC35A2 mutations. One patient had a heterozygous somatic variant with uncertain significance. Clinical characteristics included epilepsy onset in infancy (in 100% under 3 years of age), multiple seizure types, and moderate or severe intellectual/developmental delay. Epileptic spasms with hypsarrhythmia on EEG were the initial seizure type in five patients. The subsequent seizure types resembled those in Lennox-Gastaut syndrome. The majority of the patients (n = 4) presented prominent and persisting autistic features. Magnetic resonance imaging (MRI) showed multilobar (n = 6) and bilateral (n = 3) lesions, affecting the frontal lobes (n = 5; bilaterally in three) and characterized by increased signal on T2/fluid-attenuated inversion recovery (FLAIR). Voxel-based morphometric MRI post-processing and positron emission tomography helped determining the localization and extent of the lesions and presumed epileptogenic zones. After surgery, four patients (66.7%) were seizure-free ≥2 years. Interestingly, all seizure-free patients carried somatic SLC35A2-alterations. Epileptic spasms, early prominent neuropsychological disturbances, MRI-T2/FLAIR hyperintense lesions with cortico-subcortical blurring, frequently multilobar and especially frontal, can preoperatively help to suspect MOGHE. Epilepsy surgery is still the only successful treatment option in MOGHE.

Recent Advances in Understanding and Management of Arteriovenous Malformations of the Temporal Skin Area

Context: Arteriovenous malformations (AVMs) of the temporal skin area, though less common than cerebral AVMs, pose significant challenges in terms of cosmetic and functional outcomes. Over the past decade, substantial advancements have been made in the understanding and management of these lesions. This paper aims to review the latest developments in the pathophysiology, diagnosis, and treatment of temporal skin AVMs, and to explore ongoing challenges and emerging research directions. Evidence Acquisition: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar. The focus was on research published in the past ten years related to temporal skin AVMs, including reviews, clinical studies, and advancements in treatment techniques. Results: The review discusses the evolution in understanding the pathophysiology of temporal skin AVMs, improvements in diagnostic imaging techniques, and the refinement of surgical and non-surgical treatment approaches. The outcomes, including cosmetic and functional results, and complications associated with various treatments, are also presented. Conclusions: The management of temporal skin AVMs has benefited from multidisciplinary approaches, combining surgery, interventional radiology, and dermatology. However, challenges remain in achieving optimal cosmetic and functional outcomes, necessitating ongoing research and innovation.

ОЦЕНКА РЕЗУЛЬТАТОВ ПРИМЕНЕНИЯ АЛГОРИТМА ВЫБОРА ОПТИМАЛЬНОГО ХИРУРГИЧЕСКОГО ДОСТУПА К ЗАБРЮШИННОМУ ПРОСТРАНСТВУ У ПАЦИЕНТОВ С РАЗЛИЧНЫМИ ПАРАМЕТРАМИ КОНСТИТУЦИИ.

Relevance. Despite the rapid development and predominance of endovideosurgical techniques in the treatment of pathologies of organs and structures of the retroperitoneal space, the implementation of transperitoneal or retroperitoneal approaches for open surgical interventions remains a routine activity. Surgical treatment of various pathologies of retroperitoneal localization leads to the development of nonspecific life-threatening complications in 23.8% - 30% of clinical observations, and associated mortality - 7.2% - 11% of cases. Previously, our works presented the results of comparing the number of this type of complications when using laparotomy or retroperitoneal access, depending on the constitutional parameters of the patient. An assessment was made of the significance of the influence of constitutional parameters on the development of nonspecific life-threatening complications, on the basis of which an algorithm for choosing the optimal surgical access to the structures of the retroperitoneal space was developed [patent application No. 2024113445 dated May 17, 2024]. Purpose of the study. To evaluate the effectiveness of using an algorithm for selecting the optimal surgical approach in the surgical treatment of pathologies of organs and structures of retroperitoneal localization. Materials and methods. Comparative analysis of the results of surgical treatment of patients with various surgical pathologies of the retroperitoneal space. Group I (n = 167), where the choice of surgical approach was determined using the “optimal surgical approach selection algorithm.” Group II (n = 284), in which the choice of access to the structures of the retroperitoneal space was not unified and was chosen without taking into account the constitutional parameters of the patient. In the perioperative period, the duration of surgical intervention, the volume of intraoperative blood loss, the number of days of stay in the intensive care unit, the time of postoperative respiratory support, the duration of postoperative intestinal paresis and the number of postoperative bed days were assessed. Criteria assessed in the postoperative period: development of myocardial infarction, acute cardiovascular failure, ARDS with the development of respiratory failure, acute kidney injury; cases of development of ischemic colitis and small intestinal obstruction, requiring repeated interventions, as well as the phenomenon of multiple organ failure. Wound complications included failure of retroperitoneal and laparotomy wounds, including eventration. To calculate quantitative characteristics, the median (Me) and percentiles (Q0.25 - Q0.75) were determined. Calculation of statistical significance between groups was performed using the Mann-Whitney U test**, for comparison of qualitative indicators - the Chi-square test* in IBM SPSS Statistics 25 software. Results. In group I, compared with group II, there was a shorter surgical intervention time [140.8 vs 179.5] min, p = 0.031**, a smaller volume of intraoperative blood loss [280.4 vs 413.3] ml, p = 0.024* *; postoperative respiratory support [4.5 vs 8.5] hours, p = 0.041**; length of stay in the intensive care unit [1.8 vs 3.4] days, p = 0.021**; postoperative intestinal paresis [1.2 vs 4.8] days p = 0.024**; and duration of total postoperative hospital stay [9.1 vs 16.4] days p = 0.003**. The number of postoperative nonspecific life-threatening and wound complications in group I was 24 (14.4%), and in group II - 64 (22.5%) cases (p = 0.023*). The number of complications-related deaths in group I was 9 (5.4%); in group II - 32 (11.26%) cases (p = 0.037*). Conclusion. The use of an algorithm for selecting the optimal surgical approach for surgical treatment of pathologies of organs and structures of the retroperitoneal localization of the access leads to a reduction in the number of nonspecific life-threatening complications to 14.4%, and associated deaths to 5.4%.

Pre- and Post-Operative Quality of Life in Patients with Osteoradionecrosis of the Jaw.

Osteoradionecrosis of the jaw (ORNJ) is a feared complication following radiation therapy performed for oncological treatment of head and neck cancers (HNC). To date, there is no clear evidence regarding the impact of surgical treatment of ORNJ on the quality of life (QoL) of affected patients. However, understanding the significance of the surgical treatment approach and its effects on QoL is an essential factor in the decision-making process for optimal, individualized therapy. In this prospective clinical study, QoL was assessed in relation to health related QoL (HRQoL) and oral health related QoL (OHQoL) before and after surgical treatment of ORNJ using standardized questionnaires (EORTC QLQ-C30, QLQ-HN35, OHIP-14). The overall QoL scores as well as individual domains of the collected scales regarding functional and symptom-related complaints were statistically analyzed. Subgroups concerning age, gender, different risk factors and type of ORNJ therapy were compared using Kruskal Wallis test. In addition, clinical and demographic patient data were collected and analyzed. QoL improvement correlated with the type of surgical ORNJ and the length of hospitalization. Better QoL scores were achieved post-operatively regarding different symptoms like pain, swallowing and mouth opening. Long-term effects of radiation therapy remained visibly restrictive to QoL and worsen over time.

A hybrid approach in surgical treatment of kidney stone disease

Nephrolithiasis is a disease that occurs with the formation of stones in the urinary tract. The occurrence of such stones depends on geographical, climatic, ethnic, dietary, and genetic factors. Most often, they are seen in countries with warm and dry climates. The Balkans are an endemic area, and 2% of the population is estimated to have the condition annually. The frequency is the same in both sexes. It is relatively rarer in childhood. This study aimed to show the modern possibilities for surgical treatment of kidney stone disease and combinations of different surgical approaches to achieve mini-invasiveness, short-term hospital stay, and reduction of postoperative complications. We present a clinical case of a patient with kidney stone disease with multiple lithiasis with multiple localization found in the left kidney. A combined (hybrid) operative approach was used &amp;ndash; combining the laparoscopic technique and flexible renoscopy. We combined the possibilities of the two operative procedures and achieved a one-act cure for the patient. The method was minimally invasive. The hospital stay was shorter, and no postoperative complications occurred.

“Mail-slot” Technique for Minimally Invasive Placement of Subdural Grid Electrodes: A Single-institution Experience

BackgroundIn the management of multi-drug-resistant focal epilepsies, intracranial electrode implantation is employed for precise localization of the ictal onset zone. In select patients, subdural grid electrode implantation is utilized. Subdural grid placement traditionally requires large craniotomies to visualize the cortex prior to mapping. However, smaller craniotomies may enable shorter operations and reduced risks. We aimed to compare surgical outcomes between patients undergoing traditional large craniotomies with those undergoing tailored 'mini' craniotomies (the “Mail-Slot” technique) for subdural grid placement. MethodsThis retrospective cohort study included 23 patients who underwent subdural electrode implantation for epilepsy monitoring between 2014 and 2020. Patients were categorized into mini craniotomies (N=9) and traditional large craniotomies (N=14) groups. Demographics, operative details, and outcomes were reviewed. Craniotomy size and number of electrodes were determined via post-hoc radiographs. ResultsOf the 23 patients studied, the mini group had smaller craniotomy sizes (mean=22.71 cm2 vs. 65.17 cm2, p<0.001) and higher electrode-to-size ratios (mean=4.25 vs. 1.71, p<0.0001). The mini group had slightly fewer total electrodes (mean=88.67 vs. 107.43, p=0.047). No significant differences were found in operative duration, blood loss, invasive EEG duration, complications, or Engel scores between the groups. One patient per group required further invasive epilepsy monitoring for localization; all patients underwent therapeutic surgery. ConclusionOur findings suggest that mini craniotomies for subdural grid placement in epilepsy monitoring offer significant advantages, including smaller craniotomy sizes and shorter operation durations, without compromising safety or efficacy. These results support the trend towards minimally invasive, patient-tailored surgical approaches in epilepsy treatment.