Invasive Alternatives Research Articles

Production of Polyvinyl Alcohol/Amoxicillin – Chitosan/Collagen Hybrid Bilayer Membranes for Regeneration of Gingival Tissues

AbstractPeriodontal diseases, if untreated, can cause gum recession and tooth root exposure, resulting in infection and irreversible damage. Traditional treatments using autologous grafts are painful and often result in postoperative complications. Scaffolds offer a less invasive alternative, promoting cell proliferation and healing without additional surgery, thus enhancing comfort for patients and doctors. This study developed Chitosan (Chit)/Collagen (Col) film surfaces and drug‐loaded Polyvinyl Alcohol (PVA)/Amoxicillin (AMX) nanofibers using solvent casting and electrospinning methods, respectively. The surfaces are characterized by scanning electron microscopy (SEM), mechanical testing, Fourier Transform Infrared Spectroscopy (FTIR), and differential scanning calorimetry (DSC). Biocompatibility and antimicrobial properties are assessed using NIH/3T3 fibroblast cells and bacterial cultures. SEM images confirmed the structural integrity of AMX‐loaded 13% PVA nanofibers, while FTIR analysis validated the compositional integrity of PVA/AMX nanofibers and Chit/Col film hybrid surfaces. Cell studies showed over 90% viability for Chit/Col film + PVA/AMX nanofiber hybrid bilayer membranes, confirming their biocompatibility. The antimicrobial assessment indicated that the Chit/Col film + PVA/AMX (0.2%) nanofiber hybrid bilayer membrane exhibited superior efficacy against Streptococcus mutans. These findings suggest that this hybrid bilayer membrane can enhance cell growth, promote proliferation, and enable controlled drug release, offering significant promise for regeneration of gingival tissues.

Neurofilament light chain: a biomarker at the crossroads of clarity and confusion for gene-directed therapies.

Neurofilament light chain (NfL) is a promising biomarker for neurodegenerative diseases, measurable in both CSF and blood upon neuroaxonal damage. While CSF analysis was traditionally used, blood-based assays now offer a less invasive alternative. NfL levels correlate with disease severity and progression in conditions like Alzheimer's disease, amyotrophic lateral sclerosis, multiple sclerosis and Huntington's disease. Clinical trials demonstrate its utility as a pharmacodynamic biomarker in MS and ALS. The FDA's approval of Tofersen for SOD1-ALS based on NfL reduction underscores its growing acceptance as surrogate marker. However, challenges remain in standardizing assays, interpreting clinical correlations, low specificity and understanding the dynamics between CSF and blood NfL levels. Addressing these issues is crucial for maximizing NfL's potential in neurodegenerative disease management.

Ethanol sclerotherapy in pediatric rectal prolapse: efficacy, complications, and influencing factors.

Rectal prolapse is prevalent in children and the elderly, impacting quality of life significantly. Traditional surgical interventions carry risks, especially in pediatric patients. Ethanol sclerotherapy offers a less invasive alternative, inducing fibrosis and thickening of the rectal wall. Despite its potential benefits, procedural complications are possible, emphasizing the need for careful patient selection and procedural expertise. This study aims to evaluate the safety and efficacy of sclerotherapy in treating rectal prolapse in a tertiary referral center in southern Iran. Patient records from Nemazee Hospital covering January 2014 to December 2023 were retrospectively analyzed. Pediatric patients undergoing ethanol sclerotherapy for rectal prolapse were included. Data on demographics, presentation, procedures, and outcomes were collected. Ethical approval was obtained, and specific inclusion/exclusion criteria were applied. Statistical analyses were conducted using SPSS version 26. One hundred thirtypatients were evaluated, with a mean age of 10.74 ± 5.320years. Most patients experienced constipation (56.9%). 74.2% responded well to sclerotherapy, with 12.9% needing a second injection. Complications were minimal, with bleeding being the most common (4.6%). Recurrence occurred in 18.6% of cases. Male patients showed a higher total complication rate (P = 0.010). Diarrhea-dominant patients had no recurrences post-sclerotherapy. Age significantly influenced treatment response and recurrence (P = 0.017, P = 0.035). Male predominance contradicted global pediatric rectal prolapse ratios, possibly influenced by cultural factors. Sclerotherapy remains effective, though response rates vary. Older age correlated with lower response rates and higher recurrence. Constipation-dominant prolapse was associated with increased recurrence risk. Male patients had a higher complication rate, highlighting the need for tailored management strategies.

Abstract 4145834: Comparison of 30-Day Outcomes of TAVR vs. SAVR in Patients with Prior CABG: A Meta-Analysis

Introduction: Managing severe aortic stenosis in patients with a history of coronary artery bypass grafting (CABG) is challenging. Traditionally, surgical aortic valve replacement (SAVR) was the standard treatment, but transcatheter aortic valve replacement (TAVR) offers a less invasive alternative. This meta-analysis compares the 30-day outcomes of TAVR versus SAVR in patients with prior CABG. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Studies comparing TAVR and SAVR in patients with prior CABG were included. The primary outcomes were 30-day (cardiovascular) CV mortality, all-cause mortality, stroke, and myocardial infarction. Heterogeneity was assessed using the Chi-squared test and I-squared statistic. P value <0.05 was considered statistically significant. Results: Nine studies with a total of 8,487 patients were included for the 30-day outcomes. The pooled odds ratio (OR) for 30-day CV mortality was 1.00 (95% CI: 0.48-2.06), with no significant difference between TAVR and SAVR (p=0.99). For 30-day all-cause mortality, the pooled OR was 0.75 (95% CI: 0.51-1.10), also showing no significant difference between TAVR and SAVR (p=0.14). The pooled OR for 30-day myocardial infarction was 0.34 (95% CI: 0.09-1.27), indicating no significant difference between TAVR and SAVR (p=0.11). However, the pooled OR for 30-day stroke was 0.67 (95% CI: 0.50-0.90), showing a significantly lower incidence with TAVR compared to SAVR (p=0.007). Detailed results in Figure 1. Conclusion: In patients with a history of CABG, TAVR appears to have comparable 30-day outcomes to SAVR in terms of CV mortality, all-cause mortality, and myocardial infarction. However, TAVR is associated with a significantly lower incidence of 30-day stroke. These findings suggest that TAVR may be a safer option in the short term for this high-risk patient population. Further research is needed to confirm these results in larger, randomized controlled trials.

Upper Airway Block Using Lidocaine Nebulisation Versus Targeted Nerve Block for Awake Fibre-Optic Intubation in Patients with Head and Neck Burns: A Randomised Controlled Trial

Background: A difficult airway is a scenario in which an adequately trained anesthesiologist faces challenges with mask ventilation, endotracheal intubation, or both. Various anesthetic techniques have been proposed to prepare adequately for awake flexible fiber-optic intubation (AFOI), including nerve blocks for the upper airway, topical anesthesia via a specialized cannula, and lidocaine nebulization (LN). Proper anesthesia of the upper airway is crucial for successful AFOI. Objectives: This study aimed to evaluate the efficacy of airway block (AB) by LN compared to traditional upper AB techniques. Methods: This prospective, randomized, single-blinded study was conducted on 100 patients with head and neck burns scheduled for reconstructive surgery. Participants were randomly assigned to two groups of 50 patients each. In the AB group, AFOI was performed following an AB, while in the LN group, AFOI was performed 30 minutes after LN. The primary outcome measured was the time to successful awake nasal fiber-optic intubation. Secondary outcomes included the number of failed attempts and the revised nonverbal pain scale score. The time to successful awake nasal fiber-optic intubation showed no significant difference between the two groups. Results: Although the AB group had a higher number of failed attempts compared to the LN group, statistical analysis revealed no significant difference. Additionally, there was no significant difference in hemodynamic parameters between the groups. Conclusions: Both AB and LN are effective for awake nasal fiber-optic intubation, with comparable intubation times. However, LN offers a less invasive alternative.

IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management.

Obesity is a significant global health issue. Metabolic and bariatric surgery (MBS) is the gold standard in the treatment of obesity due to its proven effectiveness and safety in the short and long term. However, MBS is not suitable for all patients. Some individuals are at high surgical risk or refuse surgical treatment, while others do not meet the criteria for MBS despite having obesity-related comorbidities. This gap has driven the development of endoscopic solutions like endoscopic sleeve gastroplasty (ESG), which offers a less invasive alternative that preserves organ function and reduces risks. A recent IFSO International Delphi consensus study highlighted that multidisciplinary experts agree on the utility of ESG for managing obesity in patients with class I and II obesity and for those with class III obesity who do not wish to pursue or qualify for MBS. This IFSO Bariatric Endoscopy Committee position statement aims to augment these consensus statements by providing a comprehensive systematic review of the evidence and delivering an evidence-based position on the value of ESG within the spectrum of obesity management. A comprehensive systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Cochrane guidelines. Systematic Review: The systematic review included 44 articles encompassing 15,714 patients receiving ESG. The studies varied from large case series to cohort studies and a randomized controlled trial (RCT). The mean baseline BMI was 37.56kg/m2. The review focused on weight loss outcomes and safety data. Time point Mean %EWL Mean %TBWL 6months 48.04 15.66 12months 53.09 17.56 18months 57.98 16.25 24months 46.57 15.2 36months 53.18 14.07 60months 45.3 15.9 These results demonstrate significant weight loss following ESG. The pooled serious adverse event (SAE) rate was 1.25%. This low rate of SAEs indicates that ESG is a relatively safe procedure. The quality of evidence from the included observational studies was assessed as very low, primarily due to the inherent limitations associated with observational study designs, such as potential biases and lack of randomization. In contrast, the quality of evidence from the single randomized controlled trial was rated as MODERATE, reflecting a more robust study design that provides a higher level of evidence despite some limitations. The IFSO Bariatric Endoscopy Committee, after conducting a comprehensive systematic review and meta-analysis, endorses endoscopic sleeve gastroplasty (ESG) as an effective and valuable treatment for obesity. ESG is particularly beneficial for patients with class I and II obesity, as well as for those with class III obesity who are not suitable candidates for metabolic bariatric surgery. ESG provides significant weight loss outcomes and demonstrates a favorable safety profile with a low rate of serious adverse events. Despite the limitations of the included observational studies, the randomized controlled trial included in the analysis reinforces the efficacy and safety of ESG and provides an evidence-based foundation for the position statement. Thus, the IFSO position statement supports and provides an evidence base for the role of ESG within the broader spectrum of obesity management.

Reporting outcomes of minimally invasive glaucoma surgery.

This review presents guidelines for designing studies and reporting efficacy and safety outcomes in minimally invasive glaucoma surgery (MIGS) research. Adherence to reporting guidelines in MIGS studies is crucial for providers and patients to appraise surgical options. Recent guidelines have outlined appropriate methodology, efficacy outcomes, and safety reporting, so that study results are presented in an interpretable and uniform manner. MIGS are changing the glaucoma treatment paradigm by offering safer, less invasive alternatives to traditional filtering surgery. However, inconsistent reporting of outcomes in MIGS trials hampers comparison and clinical decision-making. Recent guidelines have aimed to highlight appropriate methodology and encourage standardization in reporting outcomes to improve the quality of MIGS literature. Key considerations include defining baseline intraocular pressure, reporting standardized demographic data, using consistent endpoints, presenting standardized figures, evaluating medication use, and documenting adverse events. By adhering to these guidelines, MIGS trials can offer clearer insights into surgical outcomes, aiding both surgeons and patients in treatment decisions.

Benefits of prophylactic carotid revascularization in patients with asymptomatic carotid artery stenosis undergoing coronary artery bypass surgery: A narrative review.

Patients undergoing coronary artery bypass grafting (CABG) are at increased risk of perioperative stroke. Carotid atherosclerosis has been identified as an independent risk factor for stroke during and in the early postoperative period of cardiac surgery. However, the pathogenesis of peri-CABG stroke is multifactorial and frequently involves other noncarotid causes, such as cardiac emboli and aortic atheroma. Therefore, routine population-wide screening of carotid stenosis is not recommended, but target screening of patients at high risk of carotid-related perioperative stroke can have benefits. Carotid duplex sonography is recommended as an initial screening tool. Elimination of carotid stenosis before cardiac surgery is indicated in patients in whom carotid atherosclerosis is suspected to be the primary contributor to perioperative stroke. In patients with advanced carotid atherosclerosis, an individualized revascularization approach, including simultaneous or staged procedures, is advocated. The prevailing consensus is that synchronous surgery is safer than staged procedures. Carotid artery stenting represents a less invasive alternative, but its role in high-risk patients requires further investigation. In conclusion, the risk of perioperative stroke in patients undergoing CABG involves different factors, and carotid artery stenosis is involved in its pathogenesis only in some patients. Therefore, individualized approaches and careful consideration of patient risk factors are essential in determining the need for carotid screening and revascularization before CABG.

MiRNA in Machine-Learning-Based Diagnostics of Oral Cancer.

MicroRNAs (miRNAs) are crucial regulators of gene expression, playing significant roles in various cellular processes, including cancer pathogenesis. Traditional cancer diagnostic methods, such as biopsies and histopathological analyses, while effective, are invasive, costly, and require specialized skills. With the rising global incidence of cancer, there is a pressing need for more accessible and less invasive diagnostic alternatives. This research investigates the potential of machine-learning (ML) models based on miRNA attributes as non-invasive diagnostic tools for oral cancer. Methods and Tools: We utilized a comprehensive methodological framework involving the generation of miRNA attributes, including sequence characteristics, target gene associations, and cancer-specific signaling pathways. The miRNAs were classified using various ML algorithms, with the BayesNet classifier demonstrating superior performance, achieving an accuracy of 95% and an area under receiver operating characteristic curve (AUC) of 0.98 during cross-validation. The model's effectiveness was further validated using independent datasets, confirming its potential clinical utility. Our findings highlight the promise of miRNA-based ML models in enhancing early cancer detection, reducing healthcare burdens, and potentially saving lives. This study paves the way for future research into miRNA biomarkers, offering a scalable and adaptable diagnostic approach for various cancers.

A cost-effectiveness analysis of RefluxStop against relevant therapeutic alternatives for chronic gastroesophageal reflux disease in Sweden

ABSTRACT Introduction The standard treatment for gastroesophageal reflux disease (GERD) is proton pump inhibitors (PPIs). In selected cases, Nissen fundoplication is offered as a surgical treatment option, but alternative endoscopic and minimally invasive surgical alternatives are emerging. RefluxStop is a new technology for the treatment of GERD. Research design and methods A cost-effectiveness analysis of RefluxStop in comparison to PPI therapy and Nissen fundoplication in the Swedish healthcare setting was conducted using a Markov model and available comprehensive population and clinical trial-based long-term data. Benefits were measured in quality-adjusted life-years (QALYs). Uncertainty was determined by deterministic and probabilistic sensitivity analyses. Results The base case incremental cost-effectiveness ratios (ICERs) for RefluxStop in comparison to PPIs and Nissen fundoplications were SEK 48,152 (€ 4,531) and SEK 62,966 (€ 5,925) per QALY gained, respectively. At a cost-effectiveness threshold of SEK 500,000 per QALY gained, RefluxStop has a high likelihood of being cost-effective, with probabilities of 96% and 100% against Nissen fundoplication and PPIs, respectively. The results of the model remained robust with sensitivity analysis. Conclusions RefluxStop may offer a highly cost-effective long-term treatment alternative for chronic GERD patients over lifelong PPI therapy, but also in comparison with laparoscopic Nissen fundoplication.

Fetal Teratomas: Advances in Diagnosis and Management.

Fetal teratomas, though rare, represent a significant proportion of tumors arising during fetal development. These tumors arise from pluripotent cells and can present in varying degrees of severity, ranging from incidental findings to life-threatening conditions. Prenatal imaging, via ultrasound and MRI, is necessary for diagnosis and risk assessment. The management of fetal teratomas, particularly those associated with complications like hydrops or airway obstruction, often requires a multidisciplinary approach. Interventions such as ex-utero intrapartum treatment (EXIT) procedures and minimally invasive alternatives have emerged as critical tools to improve neonatal outcomes in severe cases. Despite advances in fetal therapies, careful prenatal monitoring and individualized management remain essential, especially for tumors with high vascularity or those that risk compromising cardiac output. This review explores the diagnostic methods, management strategies, and outcomes associated with fetal teratomas, highlighting recent advancements that contribute to improving survival and reducing morbidity in affected neonates.

Endoscopic Re-Instrumentation of Intrabony Defect-Associated Deep Residual Periodontal Pockets Is Non-Inferior to Papilla Preservation Flap Surgery: ARandomized Trial.

Clinical practice guidelines suggest access flap surgery for managing deep residual pockets after steps 1 and 2 of periodontal therapy. Papilla-preservation flap surgery (PPFS) is the least invasive approach to access and instrument biofilm-contaminated root surfaces. Endoscopic-assisted subgingival debridement (EASD) may enhance the outcomes of repeated instrumentation and provide a minimally invasive non-surgical alternative. This was a single-blind, controlled, randomized, parallel-group, non-inferiority 12-month trial comparing EASD with PPFS. Male and female adults with generalized stage III periodontitis and persistent periodontal pockets associated with an intrabony defect after steps 1 and 2 of periodontal therapy were recruited at Prince Philip Dental Hospital. Inter-group differences in clinical attachment level (CAL) changes at 12 months were the primary outcome. Secondary outcomes included pocket resolution (no pocket > 5 mm and no pocket > 4 with bleeding on probing), radiographic bone changes, treatment time, early wound healing and quality-of-life measurements. Sixty-two subjects (30 EASD and 32 PPFS) were included in the intention-to-treat analysis. CAL gains were 2.0 ± 1.0 and 1.8 ± 1.0 mm for test and controls, respectively. The 95% CI of the inter-group difference was -0.3 to 0.8 mm and within the stipulated 1-mm non-inferiority margin. No inter-group differences were observed (i) in pocket resolution, which was achieved in more than 87% of cases for all groups/time points, and (ii) in radiographic bone healing. The treatment time was significantly shorter for EASD than for PPFS. Better early wound healing index scores were observed for EASD. No inter-group differences in pain, quality of life or safety were detected. EASD was not inferior to PPFS for managing residual pockets associated with intrabony defects. The observed outcome profile supports additional developments and studies to validate EASD as an alternative to surgery for isolated persistent pockets (ChiCTR-INR-16008407).

An Adaptive SCG-ECG Multimodal Gating Framework for Cardiac CTA.

Cardiovascular disease (CVD) is the leading cause of death worldwide. Coronary artery disease (CAD), a prevalent form of CVD, is typically assessed using catheter coronary angiography (CCA), an invasive, costly procedure with associated risks. While cardiac computed tomography angiography (CTA) presents a less invasive alternative, it suffers from limited temporal resolution, often resulting in motion artifacts that degrade diagnostic quality. Traditional ECG-based gating methods for CTA inadequately capture cardiac mechanical motion. To address this, we propose a novel multimodal approach that enhances CTA imaging by predicting cardiac quiescent periods using seismocardiogram (SCG) and ECG data, integrated through a weighted fusion (WF) approach and artificial neural networks (ANNs). We developed a regression-based ANN framework (r-ANN WF) designed to improve prediction accuracy and reduce computational complexity, which was compared with a classification-based framework (c-ANN WF), ECG gating, and US data. Our results demonstrate that the r-ANN WF approach improved overall diastolic and systolic cardiac quiescence prediction accuracy by 52.6% compared to ECG-based predictions, using ultrasound (US) as the ground truth, with an average prediction time of 4.83 ms. Comparative evaluations based on reconstructed CTA images show that both r-ANN WF and c-ANN WF offer diagnostic quality comparable to US-based gating, underscoring their clinical potential. Additionally, the lower computational complexity of r-ANN WF makes it suitable for real-time applications. This approach could enhance CTA's diagnostic quality, offering a more accurate and efficient method for CVD diagnosis and management.

Awareness of Interventional Radiology and The Associated Radiation Exposure Risk Among The Public Population and Primary Care Physicians in Saudi Arabia

Introduction: The imperative for healthcare professionals to possess a comprehensive understanding of radiation doses and the associated risks of the diagnostic imaging processes they recommend is underscored by the evolving landscape of medical diagnostics and treatment. Interventional radiology (IR) plays a crucial role in modern medicine, offering minimally invasive alternatives to traditional surgery. However, public and healthcare practitioner awareness of IR and its associated radiation risks remains inadequately explored, particularly in regions like Saudi Arabia. Purpose: This study aimed to evaluate the awareness of interventional radiology (IR) and the associated risks of radiological procedures among the general public and healthcare practitioners in Saudi Arabia, identify knowledge gaps, and inform future educational initiatives. Methods: Participants undergoing radiological procedures were selected using a random sampling technique, with stratification based on gender, age, nationality, and education level. The survey, conducted in Saudi Arabia, comprised 48 questions in yes-or-no and multiple-choice formats, covering demographic information, comprehension of interventional radiology, and awareness of radiation exposure risks. Results: Out of 625 respondents, 62.7% had no prior knowledge of IR, and 94.2% had never undergone IR procedures. A significant proportion (55%) lacked information about the radiation exposure associated with IR, and 57.9% perceived risks from radiation in imaging devices. In the post-educational video, 88.2% favoured IR over traditional treatment methods, with 57.8% expressing a willingness to undergo IR procedures in the future. Conclusion: The study reveals a substantial lack of awareness and knowledge about interventional radiology and radiation risks among the Saudi Arabian population and healthcare practitioners. There is a critical need to enhance public and professional understanding of IR to ensure informed decision-making and patient consent, necessitating targeted educational programs to bridge these knowledge gaps.

Magnetoelectric nanodiscs enable wireless transgene-free neuromodulation.

Deep brain stimulation with implanted electrodes has transformed neuroscience studies and treatment of neurological and psychiatric conditions. Discovering less invasive alternatives to deep brain stimulation could expand its clinical and research applications. Nanomaterial-mediated transduction of magnetic fields into electric potentials has been explored as a means for remote neuromodulation. Here we synthesize magnetoelectric nanodiscs (MENDs) with a core-double-shell Fe3O4-CoFe2O4-BaTiO3 architecture (250 nm diameter and 50 nm thickness) with efficient magnetoelectric coupling. We find robust responses to magnetic field stimulation in neurons decorated with MENDs at a density of 1 µg mm-2 despite individual-particle potentials below the neuronal excitation threshold. We propose a model for repetitive subthreshold depolarization that, combined with cable theory, supports our observations in vitro and informs magnetoelectric stimulation in vivo. Injected into the ventral tegmental area or the subthalamic nucleus of genetically intact mice at concentrations of 1 mg ml-1, MENDs enable remote control of reward or motor behaviours, respectively. These findings set the stage for mechanistic optimization of magnetoelectric neuromodulation towards applications in neuroscience research.

Mapping and characterization of the liquefaction impacts of the July and October 2022 earthquakes in Northwestern Luzon, Philippines

The 25 July 2022 MW 7.0 and 25 October 2022 MW 6.4 earthquakes caused liquefaction in the lowlands of Northwestern Luzon, Philippines. With the widespread liquefaction occurrence, a methodology was developed for mapping and assessing its impacts, which combined mapping techniques, geomorphological analysis, review of historical liquefaction accounts and empirical equations, utilization of available remote sensing technologies, and application of various geophysical and geotechnical equipment. The majority of liquefaction impacts of the MW 7.0 earthquake occurred along the Abra River delta, while the MW 6.4 earthquake had most of its liquefaction impacts concentrated in river dikes and abandoned channels across the Solsona Basin. Grain size analysis confirmed that the sediments indeed had the potential to liquefy. The soil parameters obtained using the refraction microtremor (ReMi) and screw driving sounding (SDS) tests also showed strong correlations, with liquefaction potential values ranging from low to high. Soil period values were also consistent with the ReMi and SDS results.The results of this study emphasize that: 1) detailed mapping and assessment of areas affected by liquefaction is valuable in aiding researchers and planners in hazard mitigation; and 2) the geophysical and geotechnical approaches employed are suitable and less invasive alternatives in site-specific liquefaction potential assessment.

Advanced tractography-guided laser ablation of a perirolandic long-term epilepsy-associated tumor: illustrative case.

Microsurgical resection of drug-resistant epilepsy-associated perirolandic lesions can lead to postoperative motor impairment. Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRgLITT) has emerged as a less invasive alternative, offering reduced surgical risks and improved neurological outcomes. Electrophysiological tools routinely used for motor mapping in resective microsurgery are incompatible with intraoperative MRI. The utilization of advanced neuroimaging adjuncts for eloquent brain mapping during MRgLITT is imperative. The authors present the case of a 17-year-old athlete who underwent MRgLITT for a perirolandic long-term epilepsy-associated tumor (LEAT). They performed probabilistic multi-tissue constrained spherical deconvolution (MT-CSD) tractography to delineate the corticospinal tract (CST) for presurgical planning and intraoperative image guidance. The CST tractography was integrated into neuronavigation and MRgLITT workstation software to guide the ablation while monitoring the CST throughout the procedure. The integration of CST tractography into neuronavigation workstation planning and laser ablation workstation thermoablation is feasible and practical, facilitating complete ablation of a deep-seated perirolandic LEAT while preserving motor function. Probabilistic MT-CSD tractography enhanced MRgLITT planning as well as intraprocedural CST visualization and preservation, leading to a favorable functional outcome. The limitations of tractography and the predictability of thermal output distribution compared to the gold standard of microsurgical resection merit further discussion. https://thejns.org/doi/10.3171/CASE24139.

Bronchial washing fluid sequencing is useful in the diagnosis of lung cancer with necrotic tumor

BackgroundEarly-stage lung cancers detected by low-dose computed tomography (CT) often require confirmation through invasive procedures due to the absence of endobronchial lesions. This study assesses the diagnostic utility of bronchial washing fluid (BW) sequencing, a less invasive alternative, aiming to identify patient characteristics most suited for this approach. MethodsFrom June 2017 to March 2018, we conducted a prospective cohort study by enrolling patients with incidental lung lesions suspected of early-stage lung cancer at two independent hospitals, and 114 were diagnosed with lung cancer while 50 were diagnosed with benign lesions. BW sequencing was performed using a targeted gene panel, and the clinical characteristics of patients detected with cancer through sequencing were identified. ResultsMalignant cells were detected in 33 patients (28.9 %) through BW cytology. By applying specificity-focused mutation criteria, BW sequencing classified 42 patients (36.8 %) as having cancer. Among the cancer patients who were BW sequencing positive and BW cytology negative, 15 patients (75.0 %) showed necrosis on CT. The sensitivity of BW sequencing was particularly enhanced in patients with necrotic tumors, reaching 75 %. ConclusionsBW sequencing presents a viable, non-invasive diagnostic option for early-stage lung cancer, especially valuable in patients with necrotic lesions. By potentially reducing the reliance on more invasive diagnostic procedures, this method could streamline clinical workflows, decrease patient burden, and improve overall diagnostic efficiency.

The Evolution of Carotid Surgery

This review traces the evolution of carotid surgery from its ancient roots to modern practice. The first significant appreciation of the carotid arteries’ role in cerebral ischemia was made by Johann Jakob Wepfer in his 1658 book on apoplexy, which described the separate blood supply to each cerebral hemisphere by the carotid arteries. The 16th-19th centuries saw initial attempts at carotid ligation, while the 20th century marked significant advancements. The first carotid endarterectomy (CEA) by DeBakey, Cooley, and Eastcott in the 1950s paved the way for a new technique in carotid surgery and many subsequent refinements in surgical techniques related to CEA. The latter half of the 20th century brought innovations such as patch angioplasty, microsurgical techniques, and intraoperative shunting, significantly improving outcomes. Pivotal clinical trials established CEA as the standard treatment for symptomatic carotid stenosis. The emergence of carotid artery stenting (CAS) in the 1980s introduced a less invasive alternative, sparking ongoing debates about optimal treatment strategies. Recent developments include transcarotid artery revascularization (TCAR) and transfemoral CAS, with studies comparing their efficacy to traditional CEA. Current research focuses on plaque morphology and novel diagnostic factors to further personalize treatment strategies for carotid artery stenosis.

Minimal Invasive Resection of Large Retrosternal Thyroid Goiter.

Resecting a large goiter extending into the retrosternal space is challenging, especially when a sternotomy or thoracotomy is required. The transthoracic approach is linked to higher postoperative morbidity, reaching up to 30% when compared to the transcervical approach. Although alternative options like thoracoscopic resection have shown promising results, the morbidity of mediastinal dissection remains a concern. Thoracoscopic-assisted transcervical approach might be a feasible, less invasive alternative. This video outlines the steps and potential pitfalls of the procedure. The patient is positioned supine with an extended neck. Initially, the endocrine surgeon mobilizes the thyroid gland through cervical access. If a transcervical resection is not feasible, the patient is mobilized into a lateral decubitus position, and a second team thoracoscopically guides the mediastinal tumor through the thoracic inlet. This allows a stepwise controlled transcervical dissection of the retrosternal mass until complete resection is achieved, thus eliminating the need for mediastinal dissection. To demonstrate the procedure, we present the case of an 84-year-old male with lymph node-positive oncocytic thyroid carcinoma and a large retrosternal goiter extending posteriorly into the mediastinum up to the aortic arch. Thoracoscopic-assisted transcervical resection was performed. The recurrent laryngeal nerve was identified and monitored with a neurostimulation device during dissection. No palsy was noted in the postoperative evaluation. The patient had an uneventful postoperative course and was discharged on the second postoperative day. Thoracoscopic-assisted transcervical resection of large retrosternal goiter seems a feasible alternative to mitigate risks associated with thoracotomy, sternotomy, or thoracoscopic mediastinal dissection. Potential advantages include decreased postoperative morbidity and length of stay. This technique requires thoracoscopic expertise and may be limited depending on the goiter's size and mediastinal positioning.