Intraoperative Findings Research Articles

A new hernia blocking system to prevent recurrent lumbar disc herniation: surgical technique, intraoperative findings and six-months post-operative outcomes.

The aim of this study was to evaluate the performance and safety of a new hernia blocking system (HBS), implanted after a limited discectomy, to prevent recurrence of lumbar disc herniation. Prospective, multicenter (6 sites), cohort clinical investigation. Thirty patients with a postero-lateral disc herniation between L4-S1 and large annular defects (> 6mm wide), who underwent a limited discectomy and were treated with a new HBS (DISC care, NEOS Surgery S.L.), were included. This article presents details about the investigational device, its surgical technique, intraoperative parameters, and up to 6months follow-up outcomes. The primary endpoint of the study was to assess the incidence of early symptomatic reherniation. In addition, disc height, leg and back pain (NRS 0-10), Oswestry Disability Index (ODI), quality of life (EQ-5D-5L) and device safety, were evaluated. gov: NCT04188236; date: 27th November 2019. Thirty patients (43.3% female, 41.7 ± 10.9years) were implanted with the device under evaluation in a mean of 16 ± 9.6min. Six months after surgery, no symptomatic reherniation was detected and disc height was maintained in all patients included. All patients had a significant reduction in leg pain (> 2 points in the NRS), 92.9% improved > 15 points in the ODI and 82.6% significantly improved their quality of life (≥ 12 points in EQ VAS score). No product-related serious adverse events nor reoperations occurred. The implantation of an HBS is a feasible and safe procedure that prevents early disc herniation recurrence in patients at high risk of reherniation.

Different scanning protocol to assess left atrial appendage thrombus in patients with atrial fibrillation by cardiovascular computed tomography

To investigate whether we can rule out the left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) using different scanning protocol by Cardiovascular Computed Tomography (CCT). We retrospectively reviewed the CCT images of 138 patients with AF to assess LAA thrombus. Patients with no thrombosis diagnosed by preoperative CCT should be confirmed using intraoperative findings as the reference standard. Patients diagnosed with thrombosis were then compared with TEE examination. Different CT scanning protocol were used to assess LAA thrombus according to individual differences. In 126 cases, there was no thrombus in the LAA evaluated by preoperative CCT, and it was confirmed in the subsequent radiofrequency operation. CCT has the accuracy of 100% in confirming the absence of thrombus in the LAA. Twelve thrombi were detected by CCT, eleven thrombi were detected by TEE. Only one patient had different results between CCT and TEE. We could use different CT scanning protocol to rule out LAA thrombus according to individual differences. In some special patients, LAA thrombus can be evaluated by CCT instead of TEE.

Comparative analysis of clinical characteristics of symptomatic pituitary adenomas in elderly patients: a consecutive series of 114 patients

BackgroundPituitary adenomas (PAs) present with clinical features such as neuroendocrine abnormalities and mass effects, common in the general morbidity population. However, in elderly patients, the disease progression renders some clinical features difficult to detect and identify in time. Consequently, elderly patients with PAs are often not identified and receive sufficient intervention on time to achieve a satisfactory outcome.MethodsClinical data were collected from 114 consecutive patients older than 70 years with PAs who had undergone surgery. Based on the average age, the patients were categorized into a younger group and an elder group, and were statistically analyzed and compared.ResultsSixty-five males (57.0%) and 49 females (43.0%) were included in the study, with an average age of 73.2 years. Their common preoperative symptoms included vision impairment, followed by headache and vomiting, and visual field defect. The milder the preoperative visual impairment, the greater the possibility of post-operative visual improvement (P=0.001). The tumors were primarily non-functional pituitary adenomas (NFPAs, 73.7%), with a high degree of suprasellar invasion but a low degree of parasellar invasion (P<0.0001). For further analysis, based on the average age, we categorized the patients into younger (age< 73 years, 59 cases) and elder (age≥ 73 years, 55 cases) groups. The elder group was more likely to have preoperative vision impairment problems (P=0.044), whilst post-operative visual improvement was worse (P=0.001). The elder group also had a more severe suprasellar invasion (P=0.009), with a higher proportion of NFPA than the younger group (P=0.006). Compared to the younger group, the tumors in the elder group were larger (P=0.039), and had a higher rate of apoplexy (P=0.039), and were more likely to have comorbid postoperative complications (P=0.031), such as fever and cerebrospinal fluid (CSF) leakage, compared to the younger group.ConclusionsElderly patients with PA had specific clinical characteristics. Their relatively worse pre- and post-operative conditions and intraoperative findings illustrated the need for early surgery.

Performance of Warmblood horses following tenoscopic desmotomy of the main part of the accessory ligament of the superficial digital flexor tendon for treatment of tendinopathy: 62 cases.

Desmotomy of the accessory ligament of the superficial digital flexor tendon (AL-SDFT) has been described for the treatment of superficial digital flexor tendon (SDFT) tendinopathy in Thoroughbred and Standardbred racehorses, and in event horses. To our knowledge, the outcome of this procedure has not been described in a population of warmblood horses. To report on the outcome of treatment of SDFT tendinopathy in warmblood horses using tenoscopic desmotomy of the main part of the AL-SDFT. Prospective observational case series. All 62 horses included in the case series had uni- or bilateral SDFT tendinopathy within the metacarpal/carpal region. The following data were collected and analysed using crosstabulations: breed, age, sex, use, affected limb(s), duration of tendinopathy, lameness grade, type and size of the SDFT lesion, bi- or unilateral desmotomy, duration of surgery, intraoperative findings, intraoperative/post-operative complications, duration of hospitalisation and outcome 24 months after surgery. Forty-six horses (75%) were sound with 31 (51%) of these horses performing at the same level as prior to injury. Recurrent SDFT injuries or persistent lameness was observed in 15 (25%) horses. Two horses (3%) developed septic tenosynovitis post-operatively, one required euthanasia. Horses with lesions in the proximal third of the SDFT had a better outcome than those with lesions in the two distal thirds (OR = 4.71, 95% CI = 1.33-16.70). There were no control groups of horses with SDFT tendinopathy treated by conservative therapy, tenoscopic complete or conventional open desmotomy. Tenoscopic desmotomy of the main part of the AL-SDFT is a successful treatment for SDFT tendinopathy in warmblood horses, especially in proximal SDFT lesions.

Correlation Between CT Renal Angiography of Live Kidney Donors and Intraoperative Findings: A Cross-sectional Study.

Introduction A comprehensive understanding of the renal vascular anatomy variations is paramount to a successful kidney transplant. This reduces vascular injury risks and minimizes ischemia duration, optimizing surgical outcomes. The current study aims to assess the accuracy of renal computed tomography angiography (CTA) findings of live renal donors by comparing them with intraoperative findings. Methods This prospective cross-sectional study was conducted between October 2018 and February 2020. It included all healthy donors with two kidneys of normal size, shape, and position who were deemed suitable for nephrectomy. The CTA examinations were performed with the same protocol, which combined the vascular-excretory phase. A specialized radiologist confirmed anatomical findings. The CTA results were compared with intraoperative findings, which were documented by the transplantation team. Results The study included 220 patients. The preoperative CTA was highly sensitive and accurate, reaching 99.5% and 98.6%, respectively, for single vessels and 100% sensitivity and accuracy for triple vessels, pelvicalyceal system, and ureter duplication. The sensitivity of CTA for double vessels (vein and artery) was 90% and 92.6%, respectively, while accuracy was 98.6% for both. Conclusion CTA can be used to assess renal arteries and veins for potential renal donors with high accuracy. Although the CTA's minor, statistically non-significant discordance with the surgical findings regarding double arteries and veins, no artery or vein was missed on the CTA. Therefore, the sensitivity of CTA can reach 100%.

Endoscopic transsphenoidal surgery for infradiaphragmatic craniopharyngiomas and impact of diaphragm sellae competence on hypothalamic injury

Investigate the impact of diaphragm sellae competence on surgical outcomes and risk factors for postoperative hypothalamic injury (HI) in patients undergoing endoscopic transsphenoidal surgery (ETS) for infradiaphragmatic craniopharyngiomas (ICs). A retrospective analysis of 54 consecutive patients (2016–2023) with ICs treated by ETS was conducted. All tumors originated from the sellar region inferior to the diaphragm sellae and were classified into two subtypes in terms of diaphragm sellae competence: IC with competent diaphragm sellae (IC-CDS) and IC with incompetent diaphragm sellae (IC-IDS). Clinical features, intraoperative findings, and follow-up data were compared between subtypes. Postoperative HI was assessed using an magnetic resonance imaging-based scoring system. Fifty-four patients (29 males, 25 females) were included in this study, with 12 (22.2%) under 18 years old. Overall, 35 cases were IC-CDS, while 19 were IC-IDS. Compared with IC-CDS, patients with IC-IDS tended to have hormone hypofunction before surgery (p = 0.03). Tumor volume in IC-IDS group (9.0 ± 8.6 cm3) was also higher than that in IC-CDS group (3.3 ± 3.4 cm3, p = 0.011). Thirty-seven patients underwent standard endoscopic transsphenoidal approach (SEA) and 17 underwent an extended endoscopic transsphenoidal approach (EEA). Gross total resection (GTR) was achieved in 50 cases (92.6%). Postoperative CSF leak was observed in four patients (7.4%). Permanent diabetes insipidus (DI) occurred in 13 patients (27.7%), six in IC-CDS and seven in IC-IDS. Postoperative HI occurred in 38.9% of patients. Univariate analysis revealed that large tumor size (p = 0.014), prior hypopituitarism(p = 0.048) and IC-IDS (p < 0.001) were significantly associated with postoperative HI. Multivariate analysis revealed that IC- IDS was the sole predictor of postoperative HI. To our knowledge, this is the largest case series in the literature to describe IC resected by endoscopic surgery in a single institution. Classification based on diaphragm sellae competence highlights distinct clinical features and surgical outcomes between IC-CDS and IC-IDS subtypes. Notably, IC-IDS is an independent risk factor for postoperative HI. Preoperative identification of subtype can guide surgical strategy and potentially minimize complications.

Sentinel lymph node mapping with Indocyanine green fluorescence (ICG) for pediatric and adolescent tumors: a prospective observational study

Sentinel lymph node biopsy (SLNB) is an important technique in the staging of pediatric melanomas, sarcomas, and potentially useful for other solid tumors. Precise visual localization of the sentinel lymph node (SLN) during the operation is a key challenge of this procedure. Presently, the gold standard method employing Technetium 99 (99mTc) for localization carries a notable false-negative rate. In this context, we propose evaluating the use of Indocyanine Green near-infrared (ICG-NIR) as a supplementary tool to enhance the identification of SLN. A prospective observational study focused on pediatric and adolescent patients undergoing SLNB using ICG-NIR at a single institution from 2019 to 2022. Lymphoscintigraphy with 99mTc was performed before surgery and 99mTc was detected intraoperatively using a handheld gamma probe. ICG was administered intraoperatively and assessed using transcutaneous NIR. The study collected demographic data, intra-operative findings (Technetium 99 m, ICG fluorescence), and histopathological data. Eight patients with a median age of 16 years (range: 8–19 years) underwent fluorescence-guided sentinel lymph node harvesting with 100% sensitivity. Sentinel lymph node fluorescence was verified with a positive radiosignal in all patients. No adverse events were recorded. Fluorescence-guided assessment of the lymphatic system is both feasible and effective for sentinel lymph node identification. Nevertheless, larger-scale studies are essential to establish indocyanine green as a viable alternative rather than a complementary technique alongside the gold-standard radioisotope-guided method for sentinel lymph node assessment in children.

Endoscopic Carpal Tunnel Release after Prior Distal Radius Fixation: Clinical Outcomes and Intraoperative Findings

Endoscopic Carpal Tunnel Release after Prior Distal Radius Fixation: Clinical Outcomes and Intraoperative Findings

Factors Influencing the Amount of ACL Remnant Available for Preservation at the Time of ACL Surgery

Background: The preservation of the anterior cruciate ligament (ACL) remnant during reconstruction or repair could offer advantages such as enhanced vascularity, proprioception, and biomechanical properties. However, research on the clinical factors influencing ACL remnant preservation at the time of surgery is limited. Purpose/Hypothesis: The purpose was to identify clinical factors influencing the amount of ACL remnant during surgery. It was hypothesized that not solely the delay from injury to surgery influences the amount of ACL remnant present at the time of surgery, but also other patient characteristics such as sex and age, as well as intraoperative findings. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed on patients who underwent arthroscopic ACL reconstruction between January 2013 and December 2022. ACL remnants were categorized based on their location into tibial attachment, midsubstance, and femoral attachment, accounting for 20%, 60%, and 20% of the total ACL length, respectively. A multivariate logistic regression was performed to identify factors predictive of the amount of ACL remnant. Results: In a cohort of 5725 patients, different variables were associated with an ACL remnant &lt;20% at the time of surgery. Patients aged ≤20 years had an odds ratio of 1.748 (95% CI, 1.473-2.075; P &lt; .0001), and those aged between 20 and 30 years had an odds ratio of 1.440 compared with those aged &gt;30 years. Female patients had an odds ratio of 1.253 (95% CI, 1.087-1.446; P = .0019). A surgical delay &gt;12 months was associated with an odds ratio of 3.134 (95% CI, 2.640-3.720; P &lt; 0001). The presence of meniscal and chondral lesions had odds ratios of 1.784 (95% CI, 1.570-2.028; P &lt; .0001) and 1.761 (95% CI, 1.426-2.171; P &lt; .0001), respectively. Conclusion: Increased age at surgery was positively associated with a remnant size ≥20% of the ACL. Female sex, longer delay between accident and surgery, and associated injuries of intra-articular structures were risk factors for a remnant size &lt;20%.

Outcomes of internal fixation with Femoral Neck System (FNS) for intracapsular femoral neck fractures

Abstract Background: Internal fixation of hip fractures is associated with high reoperation rates. This study investigated the reoperation rates after internal fixation with the femoral neck system (FNS). Materials and Methods: A single-institution cohort study was conducted on patients aged 18 years or older who sustained intracapsular femoral neck fractures and underwent internal fixation with a fixed-angle implant. Surgeons, patients, and investigators were not blinded. The primary outcome was any hip reoperation at the final follow-up. Secondary outcomes were to characterize a cohort of patients regarding demographics, fracture classification, intraoperative findings, postoperative fracture complications and union rates, and postoperative pain. Results: This study found that internal fixation with FNS for intracapsular femoral neck fractures was associated with a 23% rate of revision surgery. Of the initial 94 patients who received FNS internal fixation, 44 patients were included for analysis; of those, 10 patients underwent revision surgery. Patients had a 22% rate of in-hospital medical adverse events with a 30-day readmission rate of 9%. Increasing body mass index was associated with increased revision rates (P = 0.037). Patients who sustained displaced femoral neck fractures had a significant decrease in SF-12 Mental Health Composite, SF-12 Physical Health Composite, and quality-of-life subscale scores. Conclusions: The FNS is a viable alternative for internal fixation of intracapsular femoral neck fractures. The observed rate of revision after internal fixation was comparable with previously published outcomes following fixation with cannulated screws and sliding hip screws. Level of Evidence: Level IV, Therapeutic Study.

Endoscopic Endonasal Approach for Calcified Sellar/Parasellar Region Pathologies: Report of 11 Pituitary Adenoma Cases

Calcification in pituitary adenomas is a rare occurence and its differential diagnosis typically includes other sellar masses.Common calcifications in pituitary adenomas are classified into two morphological forms: capsular(eggshell-like)and multiple small nodular calcifications located within the adenoma.Also,there is a pituitary stone term.This study aims to present the results of calcified pituitary adenoma case series who underwent endoscopic endonasal approach(EEA)and the clinical,histopathological characteristics and surgical outcomes of these cases. This study conducted a retrospective cohort analysis of patients with calcified pituitary adenoma operated on by EEA between August 1997 and February 2024.The inclusion criteria were as follows:proven radiological calcification on pre-operative neuroimaging,intraoperative findings of calcification and definitive histopathological diagnosis of calcification.Among these patients,11 cases were included. The mean follow-up duration was 51.45±37.24 (6-118)months.Based on the pre-operative paranasal sinus computed tomography(CT)scans of patients,nine patients(81.8%)had intratumoral calcification,one(9.1%)had capsular(eggshell like)calcification and one(9.1%)had both intratumoral and capsular calcification.Moreover,stone-like calcifications were observed in four patients(36.4%),soft type calcifications in three(27.3%),hard-type calcifications in three(27.3%)and soft and hard-type calcifications in one(9%).Gross total resection(GTR)was achieved in nine patients(81.8%).Pathologic subtypes included non-functioning(n = 4),prolactin secreting(n = 3),growth hormone secreting adenoma(n = 2)and pituitary apoplexy(n = 2).Ten patients had psammomatous type calcifications and one had extensive ossification and osteoid metaplasia. Pre-operative radiological evaluation,intraoperative classification of calcification,and post-operative histopathological assessments are crucial in the treatment of calcified adenomas.Bases on these findings,the EEA,with its advantages,is an approach that can be effectively used in the management of these calcified adenomas.

Male Patient having a Spigelian Hernia, Prince Osman Digna Referral Hospital, Port Sudan City, Red Sea State, Sudan; 2024: A Case Report

Background: Spigelian hernia is a rare type of abdominal hernias; it occurs through a defect in Spigelian aponeurosis of transverse abdominis (Spiegel's fascia). Methods: A 65 years old male, presented to our refer clinic at Prince Osman Digna Referral Hospital; Port Sudan City; Red Sea State; Sudan, on July 2024, complaining of lower abdominal swelling for 2 months without features of obstruction or strangulation; following heavy lifting, obvious during standing and walking, disappear when lying down; and was not associated with gastrointestinal track disturbances. Patient had history of recurrent repaired right inguinal hernia, para-umbilical hernia, and transurethral resection prostatectomy for Benign Prostatic Hyperplasia. No family history of similar conditions. Result: Abdominal examination showed: positive visible cough impulse revealed reducible mass at the left lower abdomen, oval in shape about 15*15cm, without features of peritonism. CT abdomen showed: left lower lateral abdominal wall hernia defect lateral to the rectus abdominis muscle measuring (3*3.7 cm) with hernia sac lie between the external and internal oblique muscles containing bowel loops. Patient diagnosed as Spigelian hernia and planned for mesh hernioplasty. Intra-operative findings revealed: the hernia sac passed through the internal oblique and transverse abdominis muscles, it contained sigmoid colon which released smoothly, sac excised, external oblique aponeurosis sutured by nylon 2, prolene mesh fix onlay, no intraoperative complications. Post-operative course was smooth. Conclusion and recommendations: Spigelian hernia has to be suspected among patients having repeated abdominal hernias. Early diagnosis using CT Abdomen and urgent surgical intervention for such cases were highly recommended.

Computed tomography roadmap for post-operative fundoplication imaging with a novel structured reporting checklist.

With increasing numbers and acceptability of laparoscopic anti-reflux surgery (LARS) procedures over long-term medical treatment in the past decade, it follows that the complications of fundoplication wrap are seen intermittently with recurrent symptoms of heartburn and dysphagia. Endoscopy and barium swallow are the initial investigations performed for suspected fundoplication wrap failures. However, with easy availability of multislice computed tomography (CT) and the multiplanar reconstructions along with reduction in familiarity with barium examinations, it would be prudent for the surgeons to familiarise themselves with various appearances of wrap failure. Currently, there is no accepted standard to report a fundoplication wrap failure. We did a thorough literature review on the use of CT scans for fundoplication wrap failure, created a multidisciplinary hernia team with prominent radiologists and surgeons and discussed the role of CT scans in the management of suspected wrap failure. After completing a pilot study with around 43 patients of wrap failure, we created a standard CT reporting format which helped us in the management of even the most complex cases. This standard reporting format can be used by trainees and surgeons worldwide. This would lead to uniformity in reporting, would help in decision-making and would also help create national and international primary wrap failure and redo fundoplication registry. A total of 43 patients of wrap failure of multislice CT evaluation were analysed for type of failure along with factors responsible for the maintenance of integrity of the wrap. A novel checklist with structured reporting was used for the description of the post-operative imaging findings. The demographic characteristics, post-operative imaging and intraoperative findings were described. The different types of wrap failure - Hinder types and associated pathologies were analysed for relative frequency in wrap failures. The novel structured reporting included wrap integrity and failure complications in post-operative patients of LARS. Fundoplication wrap failure is not an uncommon complication seen after LARS. A novel structured report with checklist will help the surgeons to evaluate the post-operative patient with recurrent symptoms. Multislice CT is the ideal modality for imaging suspected wrap failures after primary endoscopic evaluation. Multiplanar imaging with coronal and sagittal reconstructions is useful for understanding the integrity of the wrap and its ability to detect failure/migration.

Complexity of arachnoid adhesions dictating the outcome of microvascular decompression for trigeminal neuralgia

Objective: Multiple techniques have been used to treat trigeminal neuralgia (TGN), including pharmacotherapy, radiosurgery, rhizotomy and microvascular decompression (MVD). Blood vessels are considered to be the most common cause of offense and compression to trigeminal nerve. We aimed to determine the causes of classic TGN and efficacy of MVD. Methods: This retrospective, cross-sectional study assessed the data of 53 patients, who underwent MVD at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan, from May, 2022 to December, 2023. Information regarding patient demographics, clinical presentation, Barrow Neurological Institute Facial Pain Score (BNI–FPS), intra-operative findings, and postoperative complications were analyzed. Results: The mean age at presentation was 44.33±11.71 years. Unilateral facial pain was the consistent clinical presentation among all patients, with right-sided involvement in 67.92% patients. All patients had involvement of at least two divisions of trigeminal nerve; maxillary and mandibular nerve in 84.91% and 71.70% cases, respectively. BNI–FPS Grade-IVb was found among 49.09% patients on presentation. Arachnoid adhesions, superior cerebellar artery and superior petrosal vein were the most common causes of compression in 71.70%, 50.94% and 43.40% cases, respectively. About 94% patients were discharged home on first post-operative day without complications and with BNI–FPS Grade-I. Conclusions: Microvascular decompression is highly advocated in classic cases of TGN. In the absence of grossly visible offending vascular structure, arachnoid adhesions should be the thorough focus of address. doi: https://doi.org/10.12669/pjms.40.12(PINS).11128 How to cite this: Khokar TI, Cheema ZA, Fatima I, Qadri HM, Bashir R, Bashir A. Complexity of arachnoid adhesions dictating the outcome of microvascular decompression for trigeminal neuralgia. Pak J Med Sci. 2024;40(12):S15-S19. doi: https://doi.org/10.12669/pjms.40.12(PINS).11128 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Revisions after prior stapes surgery: aspects on indication, intraoperative findings and surgical strategies.

Primary stapes surgery is considered a challenging intervention in ear surgery. Despite an risk of deafness in 0.5-1 percent, this procedure has still a good benefit-risk ratio due to the improvement in hearing and quality of life that is usually achieved. However, revision after prior stapes surgery is considered even more challenging. Revisions after stapes surgery are very heterogeneous procedures, both in terms of the indication and the surgical strategy and are generally considered to be significantly more demanding. Reasons for complications after prior stapes surgery as well as strategies for successful revisions are not well described in the literature. Retrospective cohort study, tertiary referral center. 124 cases of revisions after prior stapes surgery were identified between 2011-2022 and are analyzed based on biographic data, clinical, audiological, and intraoperative findings as well as the eventual therapy. Cases were analyzed regarding indication, intraoperative finding and the surgical strategy chosen. Acute, subacute, and long-term complications of the primary intervention as well as other incidental reasons such as progressive hearing loss can be identified as indication for revision surgery. Preoperative clinical findings were correlated to intraoperative findings and surgical strategies. Audiological results are discussed. Different recommendations for the indication of a surgical revision can be derived depending on the individual preoperative case history and findings. In addition, there are patterns regarding the chances of success of a revision, especially in cases of persistent conductive hearing loss chances of hearing improvement seem possible in more than 80% of cases.

Study on the Clinical Performance of Serum Hyponatremia in the Determination of Complicated Acute Appendicitis in the Adult Population at the General Hospital Zone No. 3, OOAD Aguascalientes

Background: Appendicitis is the most common abdominal infection and is the main surgical emergency worldwide, affecting approximately 1 in 11 people during their lifetime. Nowadays, distinguishing between uncomplicated and complicated appendicitis is increasingly important due to the increasing evidence supporting the possibility of treating uncomplicated appendicitis with antibiotics instead of resorting directly to surgery. This differentiation requires combining clinical findings with laboratory and imaging studies. In our hospital setting, where the use of C-reactive protein, procalcitonin or imaging studies represent an increase in the costs of health services or are not routinely available, the use of prediction systems that include inexpensive and accessible serum markers could improve early identification and therefore prompt management in this group of patients. Objective: To identify the clinical performance of hyponatremia in patients undergoing open appendectomy with transoperative findings of complicated acute appendicitis in the adult population at the General Hospital of Zone No. 3, Aguascalientes, México. Material and methods: Retrospective, cross-sectional and instrumental study, at the General Hospital of Zone No. 3, part of the Mexican Social Security Institute (IMSS), Aguascalientes delegation. By reviewing the records of adult patients undergoing appendectomy with intraoperative findings of complicated acute appendicitis, in the period from February 1, 2023 to February 1, 2024, obtaining preoperative serum sodium values, seeking to identify the diagnostic accuracy of hyponatremia in the determination of complicated acute appendicitis. Results: There was a significant diagnostic performance with hyponatremia at its cut-off point of 133 mEq/L in the determination of complicated acute appendicitis. A sensitivity of 100%, specificity of 81.4%, NPV of 100%, PPV of 45.2%, LR+ of 2.16, LR- of 0.652 and a Youden index of 0.814 were determined. Conclusion: Hyponatremia can be useful in the diagnostic approach to acute appendicitis in hospitals with limited resources, guiding the surgical resolution of the condition, as well as the rapid establishment of a postoperative intravenous antibiotic regimen, reducing hospital expenses after limiting the morbidity generated by severe forms of this disease.

Relationship of anatomical variations of sphenoid sinus and the outcomes of endoscopic endonasal transsphenoidal surgeries: a systematic review.

The sphenoid sinus features many anatomical variations between individuals from different populations in the world. The understanding of these variations is important for the surgeons to plan for surgeries which involve intervention through the nasal approach. The aim of the present systematic review was to perform a qualitative synthesis of available studies which assess the effect of sphenoid sinus (SS) anatomical variations on the outcomes of endoscopic endonasal transsphenoidal surgeries (ETSS). The current review followed PRISMA 2020 guidelines. A systematic advanced electronic search was performed in four databases Medline (via PubMed), Scopus, Web of Science (WoS) and Lilacs in December 2023. Studies that assessed the anatomical variations of the SS that affect the outcomes of ETSS were eligible for inclusion. A qualitative synthesis of the methodology and results of the included studies was carried out. Quality assessment was performed using the National Institute of Health (NIH) quality assessment tool (last accessed on December 24, 2023). A total of 14 studies were included in the qualitative synthesis. Most of the studies included in the review found that the sellar pneumatization was the commonest followed by the postsellar type. Single intersphenoid sinus septum (ISS) was found to be the most common variation, which is more frequently found in males compared to females. There was sex difference seen in the attachment of the ISS to the carotid canal. It is more commonly attached to the posterolateral wall of the sinus in males compared to the females. Though complicated cases were less compared to uncomplicated ones, cerebrospinal fluid (CSF) leak was the leading post operative complication amongst the complicated cases and paranasal sinus (PNS) computed tomography (CT) scan showed ISS findings differed from intraoperative findings. It is concluded that the ISS poses the commonest anatomical variations encountered during the ETSS. During planning for transsphenoidal endoscopic procedure, the ISS should thoroughly be assessed to minimize potential surgical complications.

Correlation Between Preoperative HRCT Temporal Bone Findings and Intraoperative Findings in Patients with Chronic Otitis Media Active Squamosal Disease

Correlation Between Preoperative HRCT Temporal Bone Findings and Intraoperative Findings in Patients with Chronic Otitis Media Active Squamosal Disease

A new management strategy for Hemimasticatory spasm.

Hemimasticatory spasm (HMS) is an uncommon movement disorder of the trigeminal motor rootlet characterized by unilateral, involuntary, and paroxysmal contractions of the muscles of mastication. The mechanisms for HMS are still unclear, and an efficient treatment strategy still needs to be developed. This study aims to investigate the clinical features and surgical treatment of HMS. 12 patients with HMS were included in our study. The patient data regarding clinical characteristics, neuroimaging presentations, intraoperative findings and treatment outcomes were analyzed retrospectively. Highly selective trigeminal motor root rhizotomy (HSTR) combined with microvascular compression was performed in 9 cases with neurovascular conflict, while 3 patients without vascular compression underwent HSTR only. Intraoperative findings showed that there is one patient with 6 branches of the trigeminal motor roots, 3 patients with 2 trigeminal motor roots, and the remaining patients have 3-4 trigeminal motor roots. Seven patients had 2 motor branches severed, 3 patients had 1 motor branch severed, and 2 patients each had 3 motor branches severed. 9 patients recovered uneventfully and showed no signs of spasms, and the remaining 2 patients experienced complete disappearance of symptoms within 3 months after surgery. One patient relived immediately postoperatively but recurred 2 years later. The surgical procedures of HSTR can significantly alleviate the clinical symptoms of patients with masseter spasms without bringing serious complications to patients.

Ophthalmic artery feeders in meningioma reduce the effectiveness of transarterial embolization with n-butyl cyanoacrylate

N-butyl cyanoacrylate (n-BCA) is often utilized for preoperative transarterial embolization (TAE) of meningiomas. However, factors affecting the embolization effect with n-BCA remain unclear. This study aimed to clarify the factors associated with the embolization rate after TAE using n-BCA in meningioma, from the aspect of feeder architecture. We retrospectively analyzed 62 patients with meningioma who underwent preoperative TAE with n-BCA between 2016 and 2021. Patient variables, including characteristics, intraoperative findings, and outcomes, were collected. Feeder architecture was classified into seven groups: 1) internal maxillary artery, 2) occipital artery, 3) ascending pharyngeal artery, 4) posterior meningeal artery, 5) infraclinoidal internal carotid artery, 6) ophthalmic artery (OphA), and 7) pial feeder group, based on preoperative angiography. We set primary outcome as the embolization rate, representing the reduction rate of the gadolinium-enhanced lesion volume observed on contrast-enhanced magnetic resonance imaging. Angiographic findings following n-BCA injection were classified as feeder occlusion (FO) or intratumoral embolization (IE). We analyzed the factors associated with the embolization rate. The OphA feeder group showed a decrease in the embolization rate (P = 0.008). The number of feeder groups with IE showed a robust positive correlation (r = 0.557). The OphA feeder group showed an increase in the number of feeder groups (P < 0.001) and larger tumor volume (P = 0.005). The OphA feeder group was associated with a lower embolization rate. Our study suggested that the vascular architecture in meningioma affected the efficacy of TAE with n-BCA.