Lateral Resection Research Articles

Effects of strabismus surgery on cornea

Background Strabismus is a common disorder that is mostly treated surgically. Extraocular muscle surgery may induce refractive and corneal topographic changes. Aim To study the effect of horizontal strabismus surgery on corneal topography Patients and methods This prospective interventional randomized study was carried out on 20 patients aged from 5 to 30 years old diagnosed with horizontal strabismus who did not undergo any ocular surgery before. They were divided into four groups. We did lateral rectus recession in the first group, lateral rectus resection in the second group, medial rectus resection in the third group, and medial rectus recession in the fourth one. We compared the spherical equivalent and the corneal topographic parameters (K1, K2, the power and the axis of the astigmatism) preoperative, at 1 month postoperative, and at 6 month postoperative. Results There was myopic shift in the spherical equivalent in all groups and it was more significant after recession surgery. There was a statistically significant change in K1, K2, and astigmatism power after recession of medial and lateral recti muscles which persisted till the postoperative sixth month. The change after resection of medial and lateral recti muscles was insignificant. The change in the axis was insignificant in all groups. Conclusions Recession surgery of medial or lateral recti has more effect on refraction and corneal topography than resection. Horizontal strabismus surgeries induce a significant myopic shift in the spherical equivalent and do not induce a significant change in the axis.

Advantages and limitations of orbital rim resection in transorbital endoscopic approach: an anatomical study.

Endoscopic transorbital approach (eTOA) has been recently proposed as an alternative skull base approach. However, its feasibility for deeper lesions can be hampered by a reduced surgical maneuverability. Aim of this study is to consider how its extension through orbital rim resection can overcome this limitation, and to compare two different techniques for its removal. Both sides of seven cadaveric fresh frozen head were dissected. Three different surgical approaches were performed consequentially (standard eTOA, its expansion with lateral orbital rim hinge removal, and with its complete resection). Distance to target and angle of attack have been measured for superior orbital fissure (SOF), lateral wall of cavernous sinus (LWCS), anterior clinoid process (ACP), foramen rotudum (FR) and foramen ovale (FO). The angle of attack to the SOF (p = 0.01), to the LWCS (p = 0.001), to the ACP (p = 0.01), to the FR (p = 0.01) and to FO (p = 0.01) resulted larger in extended approaches with orbital rim resection, as well as the distance to target of LWCS (p = 0.04). Particularly, we observed that hinge lateral orbital rim removal improved the angle of attack to SOF (p = 0.02), APC (p = 0.01), FR (p = 0.01 and FO (p = 0.01) in comparison to the standard eTOA. Our study confirms that the lateral orbital rim resection could significantly expand the surgical room and the instruments maneuverability for the considered target skull base targets. Its hinge removal could balance the clinical outcome with the increase of the angles of attack for the more medial and deeper structures.

C1 lateral mass reconstruction using a titanium cage following total resection of the aneurysmal bone cyst: illustrative cases and literature insights

Introduction: There are limited reports of C1 lateral mass reconstruction using a titanium mesh cage following the surgical removal of an aneurysmal bone cyst (ABC). We describe two uncommon and challenging cases of C1 ABC, highlighting the obstacles and complexities involved in selecting the appropriate approach for tumor resection, C1 stabilization, and reconstruction. Case discussion: Case 1: A 12-year-old boy presented with 3 months of progressive upper cervical and occipital pain with no history of trauma. A heterogeneous lytic lesion with fluid-fluid levels in the right lateral mass of the atlas was detected. A gross total resection(GTR) of the C1 lateral mass ABC was performed through a posterior approach, followed by constructing the C1 lateral mass. Case 2 : An 11-year-old girl presented with cervical pain for the past 6 months. A cervical computed tomography (CT) scan without contrast revealed a lytic-expansile mass lesion with bony erosion in the right transverse process of the C1 vertebra. A similar surgical plan was tailored for this patient. A follow-up examination at 6 weeks demonstrated complete pain relief, and routine neurologic evaluations were uneventful. Discussion: ABCs are uncommon, non-malignant, and highly vascular tumors, accounting for approximately 1% of all bone tumors and 15% of primary spinal tumors. The treatment of choice in this region is total resection, followed by C1 reconstruction. Conclusion: C1 lateral mass reconstruction using an expandable cage with vertebral artery (VA) preservation is recommended for extensive C1 lateral mass resection due to ABC.

TUMOR THROMBUS INVASION INTO THE IVC WALL — DIAGNOSTIC ASPECTS AND IMPACT ON THE SURGICAL COMPLEXITY OF CAVAL THROMBECTOMY

INTRODUCTION. Tumor thrombus invasion into the IVC wall is a surgical complexity factor of caval thrombectomy, as it can significantly affect the volume of blood loss and duration of the operation, and also require the use of resection and reconstruction of the IVC. We analyzed the results of caval thrombectomy in the presence of this parameter and assessed the factors that can identify caval invasion at the preoperative stage. MATERIAL AND METHODS. The study included 78 (62,9%) men and 46 (37,1%) women. The age of the patients averaged 58.4±10.5 years. Right-sided tumors occurred in 82 (66.1%) cases, left-sided in 42 (33.9%). Caval tumor thrombi had Mayo levels I, II, III, and IV in 35 (28.2%), 36 (29%), 27 (21.8%), and 26 (21%) patients respectively. All surgeries were performed without the artificial circulation. In patients with III–IV thrombus level we used an organ transplant-based approach RESULTS. Tumor thrombus invasion into the IVC wall was detected in 37.1% of cases and was a significant prognostic factor for blood loss over 3L and over 5L, as well as a long duration of surgery. In 4 (3.2%) cases, segmental resection of the suprarenal IVC was performed (1 — IVC prosthetics, 3 — IVC and left renal vein ligation). Lateral IVC resection of varying length occurred in 42 (33.9%) patients and mainly included the subhepatic IVC. Assessment of the probability of caval wall invasion demonstrated the greatest significance of such parameters as thrombus diameter, thrombus flotation in the IVC lumen according to ultrasound data, the presence of a blood thrombus below the tumor thrombus, retrograde spread of the thrombus, and the presence of IVC syndrome. Based on these factors, three groups of thrombi with different invasion probabilities were formed. CONCLUSION. Tumor thrombus invasion into the IVC wall is a serious diagnostic and surgical problem, which significantly affects the complexity of caval thrombectomy. Single parameters have low prognostic information in identifying caval invasion of intraluminal tumor, which requires the use of a comprehensive approach to solving this diagnostic problem.

Extended pelvic evisceration with lateral wall resection in malignant tumors

Patients with tumor involvement of lateral pelvic sidewall represent a peculiar category and were not assessed as the candidates for curative surgery up until recent years. The aim of the current review of literature is to display the working results of the most experienced surgical oncologists in pelvic surgery. We have analyzed issue-related articles, which were published from 1967 till 2023, considering the free margin status as a key prognostic factor. It is elucidated that R0 resection could be achieved in more than a half cases, 5 year overall survival ran up to 50 %, and postoperative mortality was less than 7 %. The majority of authors described high morbidity though (up to 82 %). Exenteration with laterally extended endopelvic resection could improve overall survival rate in patients with locally advanced pelvic malignancies granting sensible patient selection in expert medical care unit.

Surgical Correction of Rectal Diverticulaum through Lateral Resection in Canines

Surgical Correction of Rectal Diverticulaum through Lateral Resection in Canines

Resection of Early Colorectal Neoplasms Using Endoscopic Submucosal Dissection: A Retrospective Multicenter Cohort Study.

Background: Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery in the treatment of early colorectal cancer under certain conditions. Aim: The aim of the study was to analyze factors influencing the ESD procedure in early colorectal cancer, with the intention of improving its effectiveness. Patients and Methods: We conducted a multicenter, retrospective cohort study on 214 patients who underwent ESD procedures for early colorectal cancer from January 2016 to October 2023. Results:En bloc resection was achieved in 197 (92.1%) of ESD procedures, R0 resection in 149 (69.6%), and curative resection in 54 (40.9%). The submucosal invasion was classified as level 1 (SM1) in 96 cases (45.3%), level 2 (SM2) in 61 cases (28.8%), and level 3 (SM3) in 36 cases (17%). R0 resection was achieved more often in the rectum-92 (81.4%), compared to the right-24 (64.9%) and left colon-33 (61.1%), p = 0.009. In rectal tumors, R0 resection was achieved in 51 (98.1%) SM1 invasion, 27 (73%) SM2 invasion, and 13 (65%) SM3 invasion (p < 0.001). Lateral and vertical resection margins were positive in 12 (7.7%) and 52 (25.2%) cases, respectively. Vertical resection margins were statistically more often positive in lesions located in the right colon-11 cases (28.9%) and left colon-21 cases (38.9%), than in rectum-20 cases (17.5%); p = 0.010. Complications were found in 32 (15%) cases of ESD procedure-perforation in 12 cases (5.6%) and delayed bleeding in four cases (1.9%). Procedures performed in the right colon were associated with a significantly higher risk of any complications (30%) and perforations (15%) than those performed in the rectum (10.3% and 2.6%) or the left colon (13.8% and 5.2%; p = 0.016; p = 0.015), respectively. Conclusions: ESD for early colon cancer is a viable strategy due to its effectiveness and low complication rate. The ESD technique performed in the rectum yields the best results; however, in the right colon, it still requires careful attention.

The normalization trend of ventricular morphology after lateral ventricular tumor resection without additional diversion

Intraventricular tumors frequently provoke alterations in ventricular morphology. This study aims to quantificational assess perioperative dynamic fluctuations in the cerebrospinal fluid (CSF) volume within the lateral ventricles of patients harboring lateral ventricular tumors. A retrospective review encompassing 90 patients who underwent surgical intervention for lateral ventricular tumors at our institution was undertaken. Comprehensive observations at multiple perioperative time points were conducted, and LVCV analyses were performed to delineate the longitudinal dynamic alterations in ventricular morphology. Additionally, LVCV measurements were juxtaposed with data from 19 healthy subjects to stratify patients into two cohorts: those exhibiting preoperative increased LVCV and those without such changes. After surgical excision of intraventricular tumors, alterations in LVCV were compared between these cohorts, with a factor analysis undertaken specifically among patients demonstrating increased LVCV to elucidate potential influencing variables. 40 patients (44.4%) diagnosed with intraventricular tumors presenting with enlarged preoperative LVCV [74.6 (49.3–101.8) cm3] compared with the normal subject group, and the LVCV demonstrated a significant postoperative [41.3 (27.6–67.5) cm3] reduction in 3 months (p < 0.001). Meanwhile, 50 patients (55.6%) without LVCV enlargement [14.5 (8.1–21.0) cm3] experienced a notable increase following surgery in 3 months [20.2 (14.1–33.3) cm3, p = 0.002]. Preoperative increased LVCV is an important factor leading to the increased LVCV postoperatively (p = 0.022, OR = 26.239), however, compared to healthy subjects, both groups exhibited a trend toward normalization of LVCV value postoperatively (p = 0.165, p = 0.072, respectively). Following appropriate surgical excision of the tumor, the preoperative increased LVCV associated with intraventricular tumors does not hinder the normalization trend of ventricular morphology. Not all ventricular dilation requires preventive long-term external ventricular drainage and aggressive ventriculoperitoneal shunt treatment.

Lateral rectus resection versus lateral rectus plication in patients with residual esotropia

Background Muscle resection or plication is a common treatment for strabismus by strengthening the muscle. Lateral rectus muscle resection is a basic surgical technique for correcting residual esotropia. Plication approach is an alternative surgical technique to resection. Aim Is to compare the result of lateral rectus plication versus lateral rectus resection in patients with residual esotropia. Patients and methods This is a prospective, comparative, randomized interventional study which was carried on 40 eyes of 20 patients with residual esotropia All the patients underwent surgery to both eyes, they were divided into two groups according to surgical technique. Group A: 20 eyes of 10 patients underwent lateral rectus resection surgery. Group B: 20 eyes of 10 patients underwent lateral rectus plication. Results Postoperative success rate in two groups was 80% with main postoperative angle of deviation higher on group B. Conclusion Lateral rectus muscle plication technique is an alternative to resection that has the same effect as resection as obvious by the similar success rate that can be used on horizontal muscles especially when anterior ciliary vessel sparing is needed.

Use of the pectoralis minor and coracoacromial ligament for a biplanar coracoclavicular and acromioclavicular reconstruction: A cadaveric feasibility study.

The aim of this study was to evaluate the feasibility of a novel technique that focuses on vertical and horizontal stabilization of the acromioclavicular joint using two local autologous grafts, the pectoralis minor (Pm) and the coracoacromial ligament (CAL). Ten fresh-frozen shoulder cadaveric pieces were dissected. Length and width of the Pm and CAL were measured in their anatomical position and anatomical variants were noted. The Pm tendon was harvested at the myothendinous junction keeping the insertion at the coracoid process. The CAL was detached from the coracoid process keeping the acromial insertion. The free limbs of both grafts were prepared with the Krackow technique and the Arthrex SpeedWhip technique, respectively. The primary coracoclavicular reduction and fixation were with the button system or with two subcoracoid ultrahigh-strength suture cerclage through and around the clavicle. The Pm graft was fixed inside a clavicular tunnel by a cortical button and the CAL was transferred and fixed to the lateral clavicle using a knotless anchor or intramedullary when lateral clavicle resection was performed. The median length of the Pm was 50 mm (interquartile range [IQR]: 50-54), and the median length of the CAL was 36.5 mm (IQR 34-40) which decreased by 15% and 23% once were prepared with the Krackow and Arthrex SpeedWhip techniques to 44.5 mm (IQR: 30-65) and 30 mm (IQR: 22-32), respectively. The diameter of the prepared Pm graft was 5 mm (IQR: 4.5-6) and the CAL graft 5.5 mm (5-6). All grafts were able to reach the fixation points. The procedure was feasible in 100% of the cases. A biplanar reconstruction using autologous Pm and CAL appears feasible in restoring the acromioclavicular joint stability. Level IV. Basic science, anatomy, cadaveric dissection.

Robotic lateral resection of inferior vena cava extended to liver segment 7 for adrenocortical carcinoma recurrence (with video)

Robotic lateral resection of inferior vena cava extended to liver segment 7 for adrenocortical carcinoma recurrence (with video)

Efficiency assessment of intelligent patient-specific instrumentation in total knee arthroplasty: a prospective randomized controlled trial

BackgroundIn total knee arthroplasty (TKA), the practical use of patient-specific instrumentation (PSI) has been reported previously with both advantage and disadvantage. The application of artificial intelligent (AI) forces overwhelmingly development of medical industries, while the impact of AI on PSI efficiency remains unknown. Thus, this study aimed to assess the efficiency of Intelligent-PSI (i-PSI) in TKA, compared with the conventional instrumentation-TKA (CI).Methods102 late-stage OA patients who met inclusive criteria were recruited in this prospective randomized controlled trial and separated into two groups (i-PSI vs. CI). In both groups, an AI preoperative planning engine was applied for surgery decision making. In CI group, conventional instrumentation was applied for bony resection, while resection of i-PSI group was completed with i-PSI. A convolutional neural network was applied to automatically process computer tomography images and thus produced i-PSI. With the help of three-dimension printing, the workflow of production was largely simplified. AI-driven preoperative planning guided resection and alignment decisions. Resection measurement, perioperative radiography and perioperative clinical outcomes were analyzed to verify efficiency of i-PSI.ResultsIn resection outcomes, smaller deviation of lateral and medial distal femoral resection were found in i-PSI group than CI group (P = 0.032 and 0.035), while no difference was found in other resection planes. In radiography outcomes, postoperative coronal alignments of i-PSI group, including postoperative Hip–knee–ankle axis (HKA) (P = 0.025), postoperative HKA outliners (P = 0.042), Femoral coronal alignment (FCA) (P = 0.019) and Joint line convergence angle (JLCA) (P = 0.043) showed closer to neutral position than CI group. Moreover, Femoral sagittal alignment (FSA) of i-PSI group showed closer to neutral position than CI group(P = 0.005). No difference was found in other alignments. In clinical outcomes, i-PSI group seemed to cost more surgical time than CI group (P = 0.027), while others showed no differences between the two groups.ConclusionIntelligent Patient-specific Instrumentation in TKA achieved simplified production flow than conventional PSI, while also showed more accurate resection, improved synthesis position and limb alignment than conventional instrumentation. Above all, this study proved that i-PSI being an applicable and promising tool in TKA.

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.

Multifeature Fusion Method with Metaheuristic Optimization for Automated Voice Pathology Detection

Voice pathologies occur due to various factors, such as malfunction of the vocal cords. Computerized acoustic examination-based vocal pathology detection is crucial for early diagnosis, efficient follow-up, and improving problematic speech. Different acoustic measurements provide it. Executing this process requires expert monitoring and is not preferred by patients because it is time-consuming and costly. This paper is aimed at detecting metaheuristic-based automatic voice pathology. First, feature maps of ten common diseases, including cordectomy, dysphonia, front lateral partial resection, contact pachyderma, laryngitis, lukoplakia, pure breath, recurrent laryngeal paralysis, vocal fold polyp, and vox senilis, were obtained from the Zero-Crossing Rate (ZCR), Root-Mean-Square Energy (RMSE), and Mel-frequency Cepstral Coefficients (MFCCs) using a thousand voice signals from the Saarbruecken Voice Database (SVD) dataset. Hybridizations of different features obtained from the voices of the same diseases using these three methods were used to increase the model's performance. The Grey Wolf Optimizer (MELGWO) algorithm based on local search, evolutionary operator, and concatenated feature maps derived from various approaches was employed to minimize the number of features, implement the models faster, and produce the best result. The fitness values of the metaheuristic algorithms were then determined using supervised machine learning techniques such as Support Vector Machine (SVM) and K-nearest neighbors (KNN). The F1 score, sensitivity, specificity, accuracy, and other assessment criteria were compared with the experimental data. The best accuracy result was achieved with 99.50% from the SVM classifier using the feature maps optimized by the improved MELGWO algorithms.

Axolotl mandible regeneration occurs through mechanical gap closure and a shared regenerative program with the limb.

The mandible plays an essential part in human life and, thus, defects in this structure can dramatically impair the quality of life in patients. Axolotls, unlike humans, are capable of regenerating their lower jaws; however, the underlying mechanisms and their similarities to those in limb regeneration are unknown. In this work, we used morphological, histological and transcriptomic approaches to analyze the regeneration of lateral resection defects in the axolotl mandible. We found that this structure can regenerate all missing tissues in 90 days through gap minimization, blastema formation and, finally, tissue growth, differentiation and integration. Moreover, transcriptomic comparisons of regenerating mandibles and limbs showed that they share molecular phases of regeneration, that these similarities peak during blastema stages and that mandible regeneration occurs at a slower pace. Altogether, our study demonstrates the existence of a shared regenerative program used in two different regenerating body structures with different embryonic origins in the axolotl and contributes to our understanding of the minimum requirements for a successful regeneration in vertebrates, bringing us closer to understand similar lesions in human mandibles.

A comprehensive approach to lateral ventricular tumor resection: techniques, technologies, and outcomes.

This study reviews lateral ventricular tumors (LVTs), which are rare brain lesions accounting for 0.64-3.5% of brain tumors, and the unique challenges they present due to their location and growth patterns. Once deemed inoperable, advancements in microneurosurgery, imaging, and tumor pathobiology have significantly improved treatment outcomes. This letter summarizes recent studies and key findings in the management of LVTs. Research by S.A. Maryashev et al. identified risk factors for early hemorrhagic complications following the surgical resection of lateral ventricular neoplasms, highlighting the significance of patient characteristics, tumor location, and surgical approach. The study found that factors such as gender, hydrocephalus, tumor blood flow, and Evans index correlate with a higher risk of hemorrhage, with the transcallosal approach having a greater risk compared to the transcortical approach. The utilization of navigation technologies, including fMRI, neuronavigation, and intraoperative brain mapping, has been shown to reduce surgical complications and enhance patient outcomes in the treatment of lateral ventricular meningiomas. Moreover, endoscopic and endoport-assisted endoscopic techniques have proven to be valuable in intraventricular tumor surgery, enabling minimally invasive procedures with better visualization and fewer complications. The integration of advanced surgical techniques, neuroimaging, and neurophysiological monitoring emphasizes the necessity of a multidisciplinary approach to optimize patient outcomes. To improve the study's validity and applicability, further research with larger sample sizes and advanced statistical analyses is needed. This letter advocates for the continued exploration of innovative surgical techniques and technologies to enhance the management of lateral ventricular tumors.

A novel robotic surgical assistant for total knee arthroplasty has a learning curve ranging from 6 to 14 cases and exhibits high accuracy in tibial bone cuts

BackgroundThe adoption of robot-assisted total knee arthroplasty (TKA) aims to enhance the precision of implant positioning and limb alignment. Despite its benefits, the adoption of such technology is often accompanied by an initial learning curve, which may result in increased operative times. This study sought to determine the learning curve for the ROSA (Robotic Surgical Assistant) Knee System (Zimmer Biomet) in performing TKA and to evaluate the accuracy of the system in executing bone cuts and angles as planned. The hypothesis of this study was that cumulative experience with this robotic system would lead to reduced operative times. Additionally, the ROSA system demonstrated reliability in terms of the accuracy and reproducibility of bone cuts.MethodsIn this retrospective observational study, we examined 110 medical records from 95 patients who underwent ROSA-assisted TKA performed by three surgeons. We employed the cumulative summation methodology to assess the learning curves related to operative time. Furthermore, we evaluated the accuracy of the ROSA Knee System in performing TKA by comparing planned versus validated values for femoral and tibial bone cuts and angles.ResultsThe learning curve for the ROSA Knee System spanned 14, 14, and 6 cases for the respective surgeons, with operative times decreasing by 22 min upon reaching proficiency (70.8 vs. 48.9 min; p < 0.001). Significant discrepancies were observed between the average planned and validated cuts and angles for femoral bone cuts (0.4 degree ± 2.4 for femoral flexion, 0.1 degree ± 0.6 for femoral coronal alignment, 0.3 mm ± 1.2 for distal medial femoral resection, 1.4 mm ± 8.8 for distal lateral femoral resection) and hip–knee–ankle axis alignment (0.3 degree ± 1.9 )(p < 0.05) but not for tibial bone cuts. Differences between planned and validated measurements during the learning and proficiency phases were nonsignificant across all parameters, except for the femoral flexion angle (0.42 degree ± 0.8 vs. 0.44 degree ± 2.7) (p = 0.49).ConclusionThe ROSA Knee System can be integrated into surgical workflows after a modest learning curve of 6 to 14 cases. The system demonstrated high accuracy and reproducibility, particularly for tibial bone cuts. Acknowledging the learning curve associated with new robot-assisted TKA technologies is vital for their effective implementation.

The changes in ocular torsion after unilateral lateral rectus recession-medial rectus resection for intermittent exotropia

We aim to explore the alterations of objective ocular torsion after unilateral lateral rectus recession-medial rectus resection (R&R) for intermittent exotropia (IXT). Seventy-two IXT patients undergoing R&R between March and June 2023 were enrolled. Ophthalmological examinations were performed before surgery and at 1 week and 1 month after surgery, mainly including prism and alternate cover test and optical coherence tomography. The mean disc-foveal angle of eyes showing intorsion significantly increased from − 1.5 ± 0.9° preoperatively to 2.0 ± 2.0° at 1 week (P = 0.0227) and 2.2 ± 1.6° at 1 month postoperatively (P = 0.0054). The mean disc-foveal angle of eyes exhibiting extorsion significantly reduced from 12.8 ± 1.9° preoperatively to 9.8 ± 3.1° at 1 week (P < 0.0001) and 9.7 ± 2.7° at 1 month postoperatively (P < 0.0001). The improvement of ocular extorsion at postoperative 1 month was more pronounced in patients with extorsion in operative eye compared to those with extorsion in inoperative eye (P = 0.0101). The improvement of ocular torsion was observed following R&R for IXT, with a greater effect noted in cases where the surgery was performed on the eye exhibiting extorsion.

Chronologic Changes in Transcranial Motor Evoked Potential During Anterior Temporal Lobectomy in Patients with Temporal Lobe Epilepsy: A Single-Center Cross-Sectional Analytic Study

Despite the benefits of anterior temporal lobectomy with amygdalohippocampectomy in patients with temporal lobe epilepsy (TLE), approximately up to 5% may have hemiparesis as its postoperative complication. This paper aims to describe which step/s of the anterior temporal lobectomy with amygdalohippocampectomy have the highest probability of having the greatest decrease in motor evoked potential (MEP) amplitude. This study used a cross-sectional design of obtaining data from TLE patients who underwent anterior temporal lobectomy with amygdalohippocampectomy with transcranial MEP monitoring. Each of the following steps were evaluated for reduction in MEP amplitude: 1) dural opening, 2) opening the inferior horn, 2) vertical temporal lobe resection 3) subpial dissection, 4) temporal lobe stem resection, 5) lateral temporal lobe resection, 6) hippocampal resection, 7) amygdala resection, 8) uncus resection, and 9) dural closure. Nineteen patients were included in the study. Based on the Friedman Test, 1 or more steps had significantly different average MEP amplitude reductions (Friedman= 50.7, P= 0.0001). When compared with baseline (100%, cutoff P= 0.005), hippocampal resection (z= -3.81, P < 0.0001), T1 subpial dissection (z= -3.2, P= 0.0010), uncus resection (z= -3.48, P= 0.0002), temporal stem resection (z= -3.26, P= 0.001), lateral temporal lobe resection (z= -3.13, P= 0.002), and amygdalectomy (-z= -3.37, P= 0.0005) were significantly lower. Of these, hippocampal resection, uncus resection, and amygdalectomy were deemed highly significant. MEP amplitude tends to decrease during amygdala, hippocampal, and uncal resection because of surgical manipulation of anterior choroidal arteries, which can potentially cause hemiparesis. Careful attention should be paid to changes in MEP during these steps.

The role of lateral rectus muscle resection for severe esotropia after medial rectus muscle myectomy in Graves' ophthalmopathy.

Persistent diplopia after rectus muscle myectomy is not uncommon but challenging in patients with Graves' ophthalmopathy. We investigated the role of lateral rectus muscle resection for patients after medial rectus muscle myectomy in Graves' ophthalmopathy. We retrospectively reviewed and collected data from patients with persistent diplopia after medial rectus muscle myectomy for Graves' ophthalmopathy who underwent unilateral or bilateral lateral rectus muscle resection. The eyeball deviations in the primary and reading positions before and after the operation were measured. A successful surgical outcome was defined as having less than five prism diopters (PD) in the primary gaze and functional binocular vision in the central 30° field postoperatively. A total of fifteen patients were included (mean post-myectomy deviation: 35.9 PD, range: 14 to -75 PD). The lateral rectus muscle resection after medial rectus muscle myectomy achieved an 80.0% success rate, with one patient over-corrected and two patients under-corrected. The lateral rectus muscle resection is an effective and predictable procedure for managing residual esotropia in Graves' ophthalmopathy patients who have previously undergone medial rectus muscle myectomy.