Lateral Extension Research Articles

Different types of combined endoscopic and transcranial approaches for complex giant pituitary adenomas: how I do it

BackgroundSurgery for giant pituitary adenomas (GPAs) poses significant challenges, particularly when the tumor cannot be fully addressed using either the endoscopic endonasal approach (EEA) or the microscopic transcranial approach (MTCA) alone.MethodWe utilized two combined approaches for complex GPAs: 1) expanded endoscopic endonasal approach (EEEA) combined with microscopic pterional approach (MPA), and 2) EEEA combined with endoscopic transventricular approach (ETVA).ConclusionThe combined approach is an effective surgical technique for complex GPAs. The EEEA-MPA approach is suitable for GPAs with superior and lateral extension, while the EEEA-ETVA approach is beneficial for tumors with lateral ventricular invasion.

SUPRAORBITAL AND ENDONASAL APPROACHES: TAILORING SURGICAL TECHNIQUES FOR TUBERCULUM SELLAE MENINGIOMAS BASED ON PREOPERATIVE GRADING SYSTEMS.

Background Tuberculum sellae meningiomas (TSM) tend to compress the optic apparatus and an ideal surgical route, whether transcranial or endonasal, is still debated. Another issue is if the minimally invasive supraorbital (SO) approach offers the same results compared to the more invasive craniotomy. Aiming to guide approach selection, preoperative grading systems have been described. Method All cases of TSM treated from 2013 to 2018 by extended endoscopic endonasal (EEA) or SO approach have been reviewed and classified according to three preoperative grading system: McDermott scale, Optic Nerve Laterality Score and Yaşargil criteria. Results A total of 15 patients with TSM were treated with the EEA (n=6) or the SO (n=9) approach. Globally, gross total resection was obtained in 87% (n=13) of cases and was higher with the SO (100%, n=9) compared to the EEA (67%, n=4). Visual function improved in all but one patient (n=14). Compared to the EEA group, patients treated by the SO approach had larger tumors (32.3 mm vs 24.5 mm), higher rate of optic canal invasion (4/9 vs 0/6) and arterial encasement (6/9 vs 1/5). Patients with McDermott total point of 1-2 (7/15) were treated mainly by the EEA; all patients with McDermott total score ≥3 (8/15) were treated by the SO approach. All patients with optic canal invasion (4/15) and lateral extension of the tumor (ONL score = 1-3) were treated by the SO approach. Conclusions The SO and EEA are two minimally invasive approaches safe and effective for treating TSM. For tumors with lateral extension (optic nerve laterality score = 1-3), larger diameter (> 30-35 mm), vascular encasement or optic canal involvement (McDermott total point = 2-3), the SO craniotomy is preferred. For small and median tumors with no optic canal invasion or vascular encasement (McDermott total point = 1-2), the EEA represents a valid option.

PREDICTORS OF POSTOPERATIVE COMPLICATIONS AND FUNCTIONAL OUTCOMES IN PEDIATRIC PATIENTS WITH SURGICALLY TREATED FOURTH VENTRICLE TUMOR

Background Tumors of fourth ventricle are frequently treated pathologies in pediatric neurosurgery. Data regarding predictors for permanent neurological deficits, long-term functional outcomes, cerebellar mutism (CM), the extent of resection (EOR), and oncological outcomes are scarce. We attempt to contribute to this topic with analysis of our institutional cohort. Methods A retrospective single-center study of patients aged ? 19 years who underwent primary surgical resection of fourth ventricular tumor over a 15-year period (2006–2021). Predictors analyzed included: age, gender, surgical approach, anatomical pattern, tumor grade, EOR, tumor volume, and others as appropriate. Results 106 patients were included (64 males, mean age 7.3 years). Rate of permanent neurological deficit was 24.2%; lateral tumor extension (p = 0.036) and tumor volume greater than 38 cm3 (p = 0.020) were significant predictors. Presence of deficit was the only significant predictor of reduced (less than 90) Lansky score (p = 0.005). CM occurred in 20.8% of patients and was influenced by medulloblastoma histology (p = 0.011), lateral tumor extension (p = 0.017), and male gender (p = 0.021). No significant difference between transvermian and telovelar approach in development of CM was detected (p = 0.478). No significant predictor was found for EOR. EOR was not found to be significant predictor of overall survival for both low-grade and high-grade tumors, however, gross total resection (GTR) was protective against tumor recurrence compared to near-total or subtotal resection (p < 0.001). Survival was found to be better in older patients (? 7.0 years, p = 0.019). Conclusion The overall rate of postoperative complications remains high due to the eloquent localization. Older patients (>7 years) have been found to have better outcomes and prognosis. Achieving GTR whenever feasible and safe has been shown to be critical for tumor recurrence. CM was more common in patients with medulloblastoma, and in patients with tumors extending through the foramen of Luschka. The telovelar approach uses a safe and anatomically sparing corridor, however, it has not been associated with a lower incidence of CM and neurological sequelae in our series, showing that each case should be assessed on an individual basis.

Exploration of Bituminous Materials Using 2D Electrical Resistivity Imaging, Kurdistan Region, NE Iraq

Solid bituminous materials are widely spread in the Iraqi Kurdistan Region, they are filled so many locations, such as fracture zones, fault planes, and bedding planes. These materials can be used in several industries like pavement road, roofing, bituminous paint and waterproof, etc. The study aims to find an economical quantity of these materials by using 2D resistivity imaging in three locations that are different in geology and tectonic settings. These locations are Alla Syaw, Mera De, and Nasalih villages. The data are collected using Syscal R1 plus resistivity meter, for the sake of following up horizontal and vertical extension of these materials Wenner-Schlumberger array is used with 72 electrodes and a spacing interval of 5 m. Three profiles were conducted for each location, which have lengths equal to 360 m. The data processing was carried out by using the RES2DINV, and the smoothness was performed using finite difference forward modeling. The results show that all the bituminous materials are detected in shallow depths and only in the sandstone layers of the Tanjero, Gercus, and Injana formations filling the fracture zones and fault planes. This is also attributed to the more brittle behavior of the sandstone layer than other layers of these formations which deforms easily by applying external stresses. In the Tanjero Formation bituminous body is detected at a depth of about 10 m, which has an extension of more than 50 m from profile-1 to profile-2 (this is a lateral extension). The average width and height of the body are about 8m and 20 m, so it forms an approximate total volume equal to 8000 m3. The study concludes that the preliminary estimation of the total volume of the detected bituminous bodies is about 20000 m3, which has great importance as raw material for different industries. The bituminous material has a high resistivity value in most of the profiles reaching more than 200 ohm.m.

Factors affecting D90 High-risk Clinical Target Volumes (HR-CTV dose) of intracavitary and interstitial brachytherapy in locally advanced cervical cancer

IntroductionIntracavitary brachytherapy (IC) alone covers a limited target volume; however, intracavitary and interstitial brachytherapy (IC/IS) can increase the dose coverage. We aim to assess the factors that impact D90 HR-CTV dose. We also assess clinical outcomes and toxicities for 3D image-based brachytherapy. Material and methodsWe included a total of 424 cervical cancer patients with FIGO stage IB1 to IVA who received chemoradiation and high-dose-rate brachytherapy between 2014 and 2023. Target delineation was per GEC-ESTRO guidelines with the aim to achieve total dose of ≥ 85Gy (D90 HR-CTV) in EQD2. Implantation, tumor size, lateral extension, and HR-CTV volume were analyzed. ResultsThe median follow-up time was 24 months (range 1 -107). The overall 2-year local control, progression free survival, and overall survival rate were 90.3%, 75% and 95.5%, respectively. Of 424 patients, 86.8% received a total dose of at least 85 Gy of D90 HR-CTV in EQD2. In multi-variate analysis, IC/IS brachytherapy and HR-CTV volume were significant factors associated with HR-CTV D90 ≥ 85Gy in EQD2 (p=0.012 and p=0.000, respectively). Subgroup analysis of patients with HR-CTV volume > 35 ml found that IC/IS was a significant factor in achieving HR-CTV D90 ≥ 85Gy in EQD2 (p=0.017). At the median follow-up, patients with D90 HR-CTV ≥ 85 Gy achieved local control rates of 72.08% in small volume (<20 cm3) group, 68.42% in intermediate volume (21-30 cm3) group, 71.68% in high intermediate volume (31-60 cm3) and 17.67% in larger volume (>60 cm3) group (p=0.005). Grade 3 toxicities including proctitis, cystitis and vaginal stenosis were 7.1%, 1.9% and 0.2%, respectively. ConclusionIC/IS brachytherapy may be used in patients with HR-CTV volumes greater than 35 ml to achieve total doses of D90 HR-CTV ≥ 85Gy in EQD2. IC/IS brachytherapy also provide good local control with favorable toxicity profile.

Graphite Made from Coal by High-Temperature Treatment: An Insight into the Nanometric Carbon Structural Evolution

Graphite made from coal will not only widen the graphite mineral resource, but also significantly improve the value of coal utilization. In this study, anthracite coal was heated in the temperature range of 500 to 2900 °C to study the size increase of nanometric graphite crystallites from anthracite to real graphite. The carbon content rapidly increases to 99.2% when heated from room temperature to 1600 °C, and then gradually increases to 100% when the treated temperature increases to 2900 °C. The FTIR results show that methyl, methylene, and aromatic hydrocarbon, preexisting in the raw anthracite, were preserved in the JZS-500 sample, but that when the treated temperature ≥ 1000 °C, these C-H bonds almost disappear. The basic structural units (nano graphitic carbon) grow into distorted columns, and the basic structural units and micro-columns re-oriented and coalesced to form local molecular oriented domains with the temperature increase from anthracite to JZS-1500. When the temperature ≥ 1600 °C, amorphous carbon, onion-like carbon, turbostratic layers, and graphitic carbon co-occur within the graphitized coals. At the sub-micron scale, carbonization is a homogenous process, whereas graphitization is a heterogenous process. The average graphite crystalline size (La, lateral extension; Lc, stacking height) rapidly increases as the treatment temperature increases from 1600 to 2300 °C. Three coal structural transformation stages were classified according to the nanometric carbon structural evolution with temperature. This study will contribute to the efficient and value-added utilization of coal to make graphite materials.

Large non-karst caves of the Altai-Sayan mountain region: morphology and genesis

In the Altai-Sayan mountain region, located in southern Siberia, there are a number of caves developed in rocks in which karst processes are impossible to occur. In East Sayan, these are the Big Oreshnaya and Dudinskaya caves, the total length of which is more than 50 km and 35 km, respectively. Within the Altai Mountains, these are the Altaiskaya and Kek-Tash caves with a total length of 4.7 and 3.2 km, respectively. Mapping of the listed caves revealed that the morphology of their passages and the general structure differ significantly from those of caves in carbonate rocks. The passages have a flattened shape in cross section. Their width is usually meters and tens of meters, vertical extension is tens and hundreds of meters, and lateral extension is hundreds of meters. In general, the pattern of the passages is arranged in a box-like structure, where the pasages fit into a system of disjoint extended subvertical planes with rare short subvertical planes connecting them. The structure of the passages of the studied caves resembles the structure of karst caves, rotated vertically by 90°. The main directions of the passages there are not aligned in subhorizontal planes, but in subvertical ones. The revealed structure corresponds to the geometry of the structural pattern of Late Cenozoic fault systems formed as a result of subhorizontal compression. Signs of abundant argillization (alteration of the initial substance by hydrothermal processes and its replacement by newly formed clay minerals) were found in the studied caves. The formation mechanism of the studied caves is offered: removal of the substrate argillized by hydrothermal processes along the fault zones, by groundwater without significant participation of karst processes.

Feasibility study of underground CO2 storage through Water Alternative Gas (WAG) operation: A case study in Southwestern Ontario

Geological CO2 storage (GCS) offers a promising, low-risk, long-term solution for carbon sequestration. This study assesses the feasibility of GCS water-alternating-gas (WAG) operations in a brine formation targeted for the Western Ontario GCS plan. The Cambrian strata shows potential for CO2 storage but faces challenges like limited lateral extension and geopolitical issues from plume migration. To mitigate these risks, a deep evaluation of CO2 trapping mechanisms is crucial. CO2 dissolution into brine provides secure storage by reducing the free plume. The proposed WAG operation promotes dissolution, using a vertical equilibrium model coupled with a black oil model to estimate CO2 trapping proportions during and post-injection. The Taguchi design of experiments investigates various WAG scenarios with minimal simulations, reducing numerical costs. Sensitivity analysis/optimization of WAG parameters, including water extraction rate (WER), water injection rate (WIT), and CO2 injection time (CIT), ranked their effectiveness in CO2 dissolution. Optimal WAG operations can reduce the free plume by 49 % and increase the dissolution ratio from 0.26 to 0.52. CIT and WIT were found to be the most influential factors, contributing 42 % and 31 % to CO2 dissolution, and 43 % and 34 % to overall CO2 trapping, respectively, while WER exhibited a lower impact of 8–9%.

Calonectria eucalyptorum sp. nov., a new leaf blight pathogen of Eucalyptus from India.

In this study, Calonectria eucalyptorum sp. nov. is described from the blighted leaves of Eucalyptus in Indiausing morphological and multi-locus phylogenetic analyses. The new species belongs to the Calonectria cylindrospora species complex, and its unique microscopic features and DNA sequence information enable clear separation from the12 currently accepted species in this complex. Conidia of the new taxon are slightly longer than those of its phylogenetic neighbors. Additionally, this species produces central as well as lateral stipe extensions, which is a feature not known for the other members ofthe C. cylindrospora species complex. Analyses of the combined partial calmodulin, histone, translation elongation factor-1α, and β-tubulingene regions revealed a distinct phylogenetic position for C. eucalyptorum. Recombination analysis provided additional support for the new species hypothesis. Koch's postulates for the new taxon as a foliar pathogen of Eucalyptus were fulfilled. The discovery of novel and pathogenic Calonectria species is important because it sheds light on species diversity, potential threats, and disease control.

7817 A Rare Case of Intrathyroidal Thyroglossal Duct Cyst Presenting as a Rapidly Expanding Left Thyroid Goiter

Abstract Disclosure: C.M. Godar: None. A.J. Spiro: None. K.F. Brown: None. M.K. Shakir: None. T.D. Hoang: None. Introduction: Thyroglossal duct cysts are the most common congenital cyst in the head and neck, found during childhood as a midline neck mass. We present a rare case of a large intrathyroidal thyroglossal duct cyst with left lateral extension in an adult patient. Case Report: A 50-year-old man with family history of familial adenomatous polyposis presented for thyroid nodule evaluation. Thyroid ultrasound for screening of thyroid cancer showed a 4.8 x 4.5 x 2.5cm mixed cystic/solid hyperechoic thyroid nodule with smooth margins in the left lower thyroid lobe. He reported no compressive symptoms. FNA with standard 27G needle was insufficient for evaluation with Bethesda I result. Attempted syringe aspiration did not produce cystic fluid for analysis. The patient returned to clinic 8 weeks later due to visible enlargement of his anterior neck and new neck pressure with swallowing. Physical exam was significant for a new, firm palpable mass over the left thyroid isthmus. Bedside ultrasound noted expansion of the previously visualized mass now extending into the thyroid isthmus. FNA was reattempted with a 25G needle, and cytologic material was again inadequate. He elected to undergo left hemithyroidectomy. Histologic sections demonstrated a 3.4cm simple squamous, non-keratinizing cyst lining overlying a thickened fibrotic wall with mixed acute and chronic inflammation surrounded by benign thyroid tissue, consistent with an intrathyroidal thyroglossal duct cyst. Discussion: The thyroglossal duct derives from epithelial tissue during embryogenesis and atrophies during weeks 8-10 of gestation. A persistent duct may lead to cyst formation in the presence of remnant epithelial tissue secretions and local neck inflammation. A thyroglossal duct cyst is usually located midline in the anterior neck. This stands in comparison to a branchial cleft cyst, which arises due to failure of atrophy of the second branchial groove during embryogenesis and forms a cyst that is usually located in the upper lateral neck compartment. Other common neck masses include lipomas, dermoid cysts, or ectopic thyroid tissue. This case highlights the rarity of intrathyroidal thyroglossal duct cyst in an adult patient and the importance of definitive diagnosis and appropriate management. Presentation: 6/2/2024

Modelling-assisted geometrical optimization of colloidal quantum color convertor based pixels fabricated by dielectrophoretic directed assembly

Hypothesis: Building competitive color conversion pixels for microdisplays made of semiconductor nanocrystals requires reaching a deposition thickness high enough to absorb all the blue light from the backlight unit. In the case of dielectrophoretic directed assembly of such nanocrystals, modeling and simulations may help understand what the intrinsic limitations of the process are, and may be used to propose new assembly routes.Experiments: A theoretical model of dielectrophoretic interactions between polarizable nano-spheres and an electrostatically patterned substrate has been developed. Monte Carlo simulations have been run using this model to rationalize the effects of parameters driving the dielectrophoretic directed assembly and to find optimal deposition conditions for reaching a maximal thickness of nanocrystal pixels. Experiments with CdSe quantum plates and with alumina spheres embedding quantum plates (micro-pearls) have been carried out and compared to the model.Findings: Modeling and simulations reveal that the directed assembly of semiconductor nanocrystals is limited essentially by the small object size, which sets the maximum dielectrophoretic force they can undergo. They indicate that using larger objects should allow reaching unprecedented assembly heights, but will induce lateral extension of the assembly. This trade-off has been illustrated with diagrams in the parameter space and confirmed experimentally with micro-pearls.

Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative video

Encephaloceles are considered rare with an approximate incidence of 1 in 35,000, and sphenoid encephaloceles are even more uncommon.2 Two types of sphenoid encephaloceles exist: medial perisellar encephaloceles, and lateral sphenoidal encephaloceles. Surgical correction of the lateral sphenoid recess encephalocele is achieved via one of two endoscopic approaches: extended sphenoidotomy or transpterygopalatine. Extended sphenoidotomy is preferred if the angle between the access door and lateral extension of bone defect is greater than 35°1. Otherwise, the transpterygopalatine approach is used. Intraoperative video demonstrating an extended sphenoidotomy approach to correcting a lateral recess sphenoidal encephalocele has not previously been published.Here we present a case of a 41-year-old female who presented with meningitis, a cerebrospinal fluid leak, and an incidental sphenoid mass. Brain MRI redemonstrated the mass in the sphenoid sinus consistent with an encephalocele occupying Sternberg's Canal. The patient consented to the procedure. The video demonstrates the skull base approach, encephalocele extraction, collagen inlay, and nasal septal bone and vascularized pedicled nasoseptal flap placement. Postoperative imaging confirmed the placement of the collagen inlay and nasal septal bone autograft. The patient recovered from surgery and was discharged on post-operative day 3 with no cerebrospinal fluid (CSF) leak recurrence. Postoperative follow up demonstrated viable nasoseptal graft without evidence of CSF leak.For patients with favorable anatomy, an extended sphenoidotomy approach to lateral sphenoid sinus encephalocele resection is a preferred alternative to the transpterygoid approach. This surgical video demonstrates the technique for managing lateral sphenoid sinus encephaloceles occupying Sternberg's canal, including endonasal approach, encephalocele resection and posterior sphenoid wall repair.

Evaluation of Sphenoid Sinus Variations in Cleft Lip and Palate Patients: A Comprehensive Cone Beam Computed Tomography Analysis.

This study aims to compare sphenoid sinus variations between unilateral and bilateral cleft lip and palate (CLP) patients and healthy controls using CBCT images. It is notable for its large sample size and comparison of unilateral and bilateral cleft patients, cleft and noncleft sides, and different age groups. Retrospective cohort study. University Hospital. CBCT images of 97 CLP patients (76 unilateral, 21 bilateral) and 97 healthy controls were evaluated.Main Outcome Measures: Sphenoid sinus main types, sellar subtypes, clival, and lateral extensions were assessed for all groups. A significant increase in the anterior type was observed in both unilateral and bilateral CLP groups. The bilateral CLP group had a higher prevalence of the lesser wing type. In CLP and control groups, lesser wing, combined type, and lateral type were statistically significantly lower under 13 years of age. The study highlights an elevated prevalence of anterior pneumatization in unilateral and bilateral CLP individuals, emphasizing its significance in surgery planning due to proximity to critical structures like the optic nerve and sphenopalatine artery. The increased prevalence of the lesser wing type in bilateral CLP patients requires extra caution during anterior clinoidectomy. Lower pneumatization rates in CLP patients under 13 suggest their sphenoid sinus development is similar to that of healthy individuals. Understanding these variations is crucial for appropriate surgical planning and avoiding complications during transsphenoidal surgery.

Association of pancreatic atrophy patterns with intraductal extension of early pancreatic ductal adenocarcinoma: a multicenter retrospective study.

Focal pancreatic parenchymal atrophy (FPPA) and upstream pancreatic atrophy (UPA) may indicate the presence of early pancreatic cancer. In early pancreatic cancer, the tumor occasionally spreads laterally along the main pancreatic duct, presenting challenges in determining the extent of surgical resection. This study aimed to investigate the association of pancreatic atrophy pattern and intraductal cancer extension. Thirty-two patients with early-stage pancreatic cancer who underwent surgery at five participating centers were enrolled. Pancreatic atrophy was defined as the narrowing of parenchyma compared to the surrounding parenchyma and was classified as either FPPA (partial atrophy surrounding the pancreatic duct stenosis) or UPA (global atrophy caudal to the site of duct stenosis). Intraductal cancer extension was defined as an extension exceeding 10mm. Preoperative computed tomography revealed FPPA, UPA, and no parenchymal atrophy in 13, 13, and 6 patients. Cases with FPPA or UPA showed significantly longer cancer extensions than those without atrophy (P = 0.005 and P = 0.03, respectively). Intraductal cancer extension was present in all but one case of FPPA. 69% (9/13) of the cases with UPA showed intraductal cancer extension, whereas cases without atrophy showed no intraductal cancer extension. Importantly, two patients with FPPA or UPA showed positive resection margins during surgery and three patients with FPPA or UPA showed recurrence in the remnant pancreas. The presence of FPPA and UPA indicates lateral cancer extension in early-stage pancreatic cancer. Preoperative assessment of the pancreatic parenchyma may provide valuable insights for determining the extent of surgical resection.

Micro- and macro-scale fracture behaviour of brittle rocks: Comparison between the conventional Brazilian test and the advanced universal snap-back indirect tensile test (AUSBIT)

Post-peak behaviour is crucial for the estimation of rock mass fracturing in cave mining operations where hard rocks can exhibit class-II or snap-back response when subjected to loading. Despite the rapid development of research into class-II rocks under compression, the corresponding behaviour in tensile tests has rarely been investigated, which is critical considering the complexity of rock mass fracturing under various stress states. The post-peak response of brittle rocks involves abrupt micro-fracturing, leading to brittle macro-scale behaviour. Controlling the fracture process using the Advanced Universal Snap-Back Indirect Tensile test (AUSBIT) allowed the acquisition of the complete macro-scale class-II behaviour in the post-peak regime, facilitating the use of advanced techniques for insights into both micro and macro-scale fracture. In this study, the AUSBIT tests with digital image correlation (DIC) and acoustic emission (AE) instrumentation were conducted to analyse the progressive failure in Calca granite and Gosford sandstone specimens. Post-test observations of the fracture surfaces were performed using a scanning electron microscope (SEM). From a macroscale viewpoint, the lateral strain control in AUSBIT enabled controlled cracking with significant lateral strain extension prior to failure accompanied by gradual energy dissipation and higher rates of AE activity as smaller magnitudes of energy are being released by each AE hit or microcrack compared to conventional Brazilian tests. The stable microcrack propagation was also identified from SEM observations with more uniform profiles of microcracks and less debris observed in AUSBIT specimens. These findings were more significant in Calca granite, which verified its extreme class-II behaviour while also demonstrating the efficiency of AUSBIT in controlling the violent failure of high-strength brittle rocks commonly encountered in deep mining projects, leading to the acquisition of more accurate material behaviour in terms of micro and macro-scale post-peak features which was unattainable from conventional indirect tensile tests.

A Multidisciplinary Geophysical Approach to Characterize a Fracture Zone: The Southern Limit of the Mining District of Linares-La Carolina, Spain

In many cases, the lateral extension of economically valuable mineral deposits is linked to fractures. Knowing the characteristics of these tectonic structures is crucial for determining the continuity of mineralization in the subsoil and, consequently, for planning their exploitation. To address this challenge, a multidisciplinary study was carried out using various geophysical techniques and direct field observations to analyze the effectiveness of each technique in the investigation of fractures. For this purpose, the mining district of Linares-La Carolina in southeastern Spain, known for hosting Philonian deposits of galena (PbS), was chosen. At the southern boundary of this mining district, the seams stopped being exploited when they lost their continuity due to the presence of a regional normal fault. This fault zone was responsible for hiding the seams under a thick sedimentary cover. Detailed geological mapping allowed us to deduce the presence of two fracture systems. The geophysical techniques of electrical resistivity tomography and the time domain electromagnetic method were used, allowing us to identify the positions and the vertical displacement of these faults. Furthermore, using magnetometry, the presence of a third system of fractures was deduced. The results showed that this multidisciplinary analysis provides information of interest concerning the complex structure that configures the limits of this mining district.

Palmar Fibromatosis, Updated Review With Relationship to the A1 Pulley, Trigger Finger, and Presence of the Sonographic Comb Sign.

Updated retrospective review of the sonographic appearance of palmar fibromatosis (PF) with evaluation of the utility of the Comb Sign previously described in plantar fibromas. Additional evaluation was conducted on the location relative to the flexor tendon, anatomic proximity of palmar fibromas to the A1 pulley and evaluate any potential association with trigger finger. Medical record and imaging review was performed from 2017 to 2023, for patients with a new onset ultrasound or clinical diagnosis of PF. Clinical associations and imaging morphology were reviewed including presence of the Comb Sign, fibroma association with the A1 pulley, and fibroma association with trigger finger. Exactly 87 total fibromas in 53 patients were evaluated. The Comb Sign was present in 39% of fibromas, usually seen in transverse plane, more prevalent in multifocal disease and larger fibromas. Most (72%) palmar fibromas were within 1 cm of, contacted, or covered the A1 pulley (P < .001). Lateral extension beyond the flexor tendon axis can be seen (44%). Trigger finger and tenosynovitis were rare. However, volume and SI dimension of fibromas were associated with tenosynovitis (P < .0001) and all nine patients with concomitant trigger finger had fibromas within 1 cm from the A1 pulley. The Comb Sign can aid in sonographic diagnosis of PF. Lateral extension of fibromas can occur. Most palmar fibromas have a significant intimate association with the A1 pulley, and presence of trigger finger with adjacent palmar fibroma can exist and is important for hand surgeons to know preoperatively.

Paleoenvironmental factors controlling organic-rich formations deposition in the Babouri-Figuil Basin (Northern Cameroon)

The Babouri-Figuil Basin is an intracratonic basin (half-graben) in northern Cameroon that is genetically connected to the Benue Trough from Nigeria, and is an area of interest in terms of petroleum prospectivity. Recent studies highlighted the presence of organic-rich formations in the basin. However, none of these works have identified factors that governed the accumulation of organic matter (OM) in the sediments. The main objective of this work is the characterization of these formations through palynofacies and organic geochemical techniques (total organic carbon - TOC, total sulfur, insoluble residue and biomarkers), in order to determine the organic facies, their depositional environments and the main drivers for organic enrichment in the basin. The current study reveals that black shale and massive claystone lithologies constitute the main organic-rich formations in the basin, with TOC reaching up to 26.08 wt%, being characterized by a dominance of bacterially-derived amorphous OM. Palynofacies and biomarker data revealed that these formations are positively associated with anoxic conditions and a partly highly saline and stratified lake water column. The deposition of organic-rich formations in the Babouri-Figuil Basin was mainly controlled by restriction conditions which developed in connection with the regional tectonic framework. The Lower Cretaceous rifting episode in the West and Central African Rift System (WCARS) basins led to the formation of accommodation space, a reduction in water levels, and the development of anoxic conditions within the basin, facilitating the deposition of organic-rich formations. Therefore, the organic enrichment of the Babouri-Figuil Basin has been predominantly controlled by its tectonic evolution, particularly during the syn-rift phase. This phase created favorable conditions for the deposition and preservation of OM, including the establishment of anoxic conditions. Additionally, the paleoclimate (arid conditions), the development of bacterial biomass, and the basin's paleogeography all played a significant role in this process. The organic-rich formations of the Babouri-Figuil Basin show characteristics of prospective petroleum source rocks (high organic content, high proportion of oil-prone kerogen, significant thickness and lateral extension). The combination of organic-rich formations with sandstone deposits above and extensive claystone/shale deposits on top can indicate the presence of an oil play in the basin. A detailed study with broader sampling is needed to investigate thoroughly the variation of organic facies and the influence of paleoenvironmental factors that control the deposition of thick source rock intervals.

Simultaneous combined keyhole mini-transcranial approach and endoscopic transsphenoidal approach to remove multi-lobulated pituitary neuroendocrine tumor with suprasellar extension

BackgroundTranssphenoidal surgery (TSS) is the main method to remove pituitary neuroendocrine tumor (PitNET), but large or multi-lobulated one is still challenging. ObjectiveThe less invasive simultaneous combined keyhole mini-transcranial approach and standard transsphenoidal approach was used to remove multi-lobulated or hourglass-shaped non-functioning PitNET to avoid the specific complications related to extended TSS. MethodsTwenty-one patients of large multi-lobulated or hourglass-shaped PitNET (6 patients were recurrent cases after TSS or transcranial approach) were treated by this simultaneous combined approach. The supraorbital or midline keyhole approach was performed under the operating microscope so that the fine arteries feeding optic apparatus were dissected from the tumor capsule safely and securely and the suprasellar part of the tumor was removed in the extra-capsular fashion in combination with transsphenoidal approach. ResultsVisual function improved after the surgery in 14 (74 %) of 19 patients with preoperative disturbance of the visual fields. Four patients (19 %) developed postoperative deterioration of pituitary endocrine functions requiring permanent hormonal replacement. One patient (4.2 %) suffered cortical laminar necrosis without permanent disorders and another patient (4.2 %) suffered cerebrospinal fluid rhinorrhea but neither was permanent. Postoperative computed tomography detected no subarachnoid hemorrhage in any patient. Gross total removal was achieved in 15 patients (71 %). Five patients (24 %) with subtotal removal and one patient (4.2 %) with partial removal had lateral tumor extension with Knosp classification 3 or 4. ConclusionThe combined method is an effective treatment option to remove complex PitNET safely and securely with dissecting fine arteries on the tumor capsule.

Addressing sagittal plane imbalance in primary total knee arthroplasty.

Sagittal plane imbalance (SPI), or asymmetry between extension and flexion gaps, is an important issue in total knee arthroplasty (TKA). The purpose of this study was to compare SPI between kinematic alignment (KA), mechanical alignment (MA), and functional alignment (FA) strategies. In 137 robotic-assisted TKAs, extension and flexion stressed gap laxities and bone resections were measured. The primary outcome was the proportion and magnitude of medial and lateral SPI (gap differential > 2.0 mm) for KA, MA, and FA. Secondary outcomes were the proportion of knees with severe (> 4.0 mm) SPI, and resection thicknesses for each technique, with KA as reference. FA showed significantly lower rates of medial and lateral SPI (2.9% and 2.2%) compared to KA (45.3%; p < 0.001, and 25.5%; p < 0.001) and compared to MA (52.6%; p < 0.001 and 29.9%; p < 0.001). There was no difference in medial and lateral SPI between KA and MA (p = 0.228 and p = 0.417, respectively). FA showed significantly lower rates of severe medial and lateral SPI (0 and 0%) compared to KA (8.0%; p < 0.001 and 7.3%; p = 0.001) and compared to MA (10.2%; p < 0.001 and 4.4%; p = 0.013). There was no difference in severe medial and lateral SPI between KA and MA (p = 0.527 and p = 0.307, respectively). MA resulted in thinner resections than KA in medial extension (mean difference (MD) 1.4 mm, SD 1.9; p < 0.001), medial flexion (MD 1.5 mm, SD 1.8; p < 0.001), and lateral extension (MD 1.1 mm, SD 1.9; p < 0.001). FA resulted in thinner resections than KA in medial extension (MD 1.6 mm, SD 1.4; p < 0.001) and lateral extension (MD 2.0 mm, SD 1.6; p < 0.001), but in thicker medial flexion resections (MD 0.8 mm, SD 1.4; p < 0.001). Mechanical and kinematic alignment (measured resection techniques) result in high rates of SPI. Pre-resection angular and translational adjustments with functional alignment, with typically smaller distal than posterior femoral resection, address this issue.