Open Operation Research Articles

The Development of a Novel Transient Signal Analysis: A Wavelet Transform Approach

This paper presents a new method for the analysis of transient signals in the frequency domain based on the Continuous Wavelet Transform (CWT). The proposed case study involves test signals measured from an electronic switch considering open and close operations. The source is connected to inductive, resistive, and capacitive loads. Resonance behaviors are introduced and compared with the Discrete Fourier Transform (DFT). Multiple factors, such as reliability, repeatability, high noise attenuation, and the smoothing of the analyzed spectrum, are considered in this study. This proposed study highlights the effectiveness of CWT in signal processing, especially in obtaining a detailed spectrum that reveals the behavior of electrical circuits. Resonance behaviors were analyzed, demonstrating that the signal processing performed by CWT is better for spectrum analysis than DFT. This study shows the potential of CWT to analyze transient electrical signals, specifically for identifying and characterizing the behavior of load connections and disconnections.

Six-year analysis of 30-day post-operative leaks for primary sleeve gastrectomy: a MBSAQIP database study.

Sleeve gastrectomy is the most performed bariatric surgery. Post-operative gastric sleeve leaks, although rare, are dreaded complications. This study aims to perform an updated investigation of the factors associated with sleeve leaks. This retrospective cohort study analyzed 692,554 cases from the MBSAQIP database (2016-2021) with CPT code 43,775 for primary sleeve gastrectomy. We excluded emergency operations, conversions/revisions, endoscopic interventions, patient with prior foregut surgery, and open operations. Multivariate logistic regression analysis (STATA version 15) was performed to identify factors associated with sleeve gastrectomy leaks. Out of 692,554 patients, 600,910 (86.77%) patients underwent laparoscopic sleeve gastrectomy, and 91,644 (13.23%) patients underwent robotic sleeve gastrectomy. 1179 (0.17%) developed leaks within 30days; 177(0.19%) were in the robotic group and 1002 (0.17%) in the laparoscopic group with no significant difference in leak rates between two groups on multivariate analysis. Black patients had lower odds of having leaks as compared to white patients (Odds Ratio (OR): 0.68 (0.56-0.82); p < 0.01). Hispanic patients had lower odds of having leak as compared to non-Hispanics. Factors associated with higher leak odds (p < 0.05) included hypertension, GERD, smoking, immunosuppression, increased operating time, and albumin < 3.5g/dl. Higher odds of leaks were observed in years 2016-2019 vs 2020-2021 (OR: 1.44 (1.25-1.65), p < 0.01). Higher odds of leak in operations with general surgeons compared to bariatric surgeons was found (OR: 1.46 (1.04-2.02), p = 0.02); observed only on robotic group on subgroup analysis (OR: 2.2 (1.2-4.2), p = 0.02). Staple line reinforcement, oversewing, and performance of leak test showed no differences in leak rate. Bougie size and distance from pylorus were not associated with changes in leak rate. This study provides updated insights into the factors associated with sleeve leaks, reinforcing information gained from prior studies. A higher association of leak among general surgeons could represent a learning curve for new robotic general surgeons. The overall decreasing trend for gastric sleeve leak is encouraging and may be a sign of improved techniques.

771. EVOLUTION OF THE SURGICAL MANAGEMENT OF OESOPHAGEAL PERFORATION

Abstract Background Oesophageal perforations historically have been managed with open trans-thoracic operations. With the increasing experience of minimally invasive procedures, we have performed a case series of trans-hiatal repairs for oesophageal perforations. Our unit has maintained a prospective database of oesophageal perforations since 2014. Methods Retrospective review of outcomes of open trans-thoracic operation to laparoscopic trans-hiatal oesophageal perforation repairs. Results From 80 patients, our database demonstrates an evolution in the treatment of oesophageal perforations from open thoracotomy to either endoscopic intervention (20) or trans-hiatal repair (12). Conclusion Laparoscopic Trans-hiatal oesophageal Repair is comparable and feasible in carefully selected patients (a video recording of the repair will be part of the presentation)

Effect of Open Market Operations on Income Inequality

Inequality is particularly relevant for public debates on the disaggregate implications of economic policies since they might have distinct effects across different segments of the population. Impact of monetary easing on inequality have recently attracted increasing attention especially in developing countries. This article examined the effect of open market operations on income inequality in Kenya. A quantitative research design method was adopted. The study utilized a quantitative cross-sectional data from the Kenya Continuous Household Survey Programme (KCHSP) for the years 2020 and 2021. Stepwise regression, forward selection model was executed with a threshold of 0.2. Further, the study was supported by Permanent Income Hypothesis, Kuznets Hypothesis and the modernization theory. Income inequality, measured by the Gini coefficient, was the dependent variable. Open market operations (repo, and reverse repo) was the independent variable in the model. The male headed households had a Gini coefficient of 0.58 while a Gini coefficient of 0.59 was attributed to female headed households, across the 47 counties. The results showed that open market operations (reverse repo) had a coefficient of 0.022, p=0.026&lt; 0.05 which was positive and statistically significant at 5% level. The findings indicate that in order to effectively manage income inequality in the country, policymakers should adopt an interdisciplinary and multifaceted approach. This approach should take into account the differential impacts of various policy instruments on income distribution, with a particular focus on demographic segmentation. Additionally, policymakers should combine careful adjustments to monetary policy with targeted social and fiscal measures. These measures should be continuously informed by rigorous data analysis, with the aim of fostering a more inclusive and equitable economy.

Like Father like Daughter: Surgical Redo Thoracoabdominal Aneurysm Repairs in a Family With Loeys-Dietz Syndrome.

Loeys Dietz Syndrome (LDS) is an autosomal dominant connective tissue disorder resulting from a mutation in the transforming growth factor beta receptor (TGFBR) family of genes. It is commonly associated with the development of aortic aneurysms and dissections. We report the successful open surgical management of thoracoabdominal aneurysms in a father and daughter with Loeys-Dietz Syndrome after failed endovascular repair. The daughter required stent graft explantation, while the stent graft remained in the father. These cases highlight the importance of early genetic testing of both patients and first-degree family members in those with a strong history of aortic disease, even when there is a lack of typical connective tissue disorder associated physical exam findings and open surgical index operations.

Glomus tumor of gastric antrum: A rare differential

Introduction: Gastric glomus tumor is a rare clinical entity. Surgical excision could be avoided in selected patients if the diagnosis of glomus tumor could be made preoperatively. Cross-sectional imaging and endoscopic ultrasound (EUS) provide vital clues to nudge us in the right direction; however, these are inconclusive. Histopathology remains the gold standard for diagnosis of this condition. Case Report: We report a case of a man in his 60s who presented to the surgical outpatient clinic with long-standing history of abdominal bloating and discomfort. Upper gastrointestinal endoscopy revealed a submucosal lesion, and contrast-enhanced computed tomography (CECT) of the abdomen revealed a homogeneously enhancing lesion in the antrum of the stomach. Following successful surgical excision, histopathological examination established the diagnosis of gastric glomus tumor. This case presentation elaborates on the clinical features of this rare clinical entity and the various options available for diagnosis and management. Conclusion: Glomus tumors are rare mesenchymal tumors that need to be differentiated from other submucosal lesions and should be considered as a differential for submucosal lesions in the distal stomach. Endoscopic ultrasound and CT findings may provide clues to guide us toward the diagnosis; however, diagnosis can be confirmed only with histopathology. Surgical excision with negative margins either by laparoscopic or open operation is the treatment of choice.

Transfusion and Anemia in Patients Undergoing Vascular Surgery

This cohort study examines the association between blood transfusion and major adverse cardiovascular events and mortality among people undergoing elective open vascular operations.

Treasury Bill Shortages and the Pricing of Short‐Term Assets

ABSTRACTWe propose a model of post‐Great Financial Crisis (GFC) money markets and monetary policy implementation. In our framework, capital regulation may deter banks from intermediating liquidity derived from holding reserves to shadow banks. Consequently, money markets can be segmented, and the scarcity of Treasury bills available to shadow banks is the main driver of short‐term spreads. In this regime, open market operations have an inverse effect on net liquidity provision when swapping ample reserves for scarce T‐bills or repos. Our model quantitatively accounts for post‐2010 time series for repo rates, T‐bill yields, and the Fed's reverse repo facility usage.

Optimization methods in water system operation

AbstractOperational water management is a critical global challenge, and decision making can be improved by using mathematical optimization. This paper provides an overview of optimization techniques, both exact and heuristic, used in water management. It focuses on the use of optimization techniques in the short term: operational planning in reservoir management, control of open channels, hydropower scheduling, and operation of polder drainage pumps. Principles of model predictive control, methods for optimization under forecast uncertainty, and approaches for conflict resolution are explained with the help of educational examples and practical cases. Challenges and research questions to be addressed in the future are presented as an outlook.This article is categorized under: Engineering Water &gt; Methods Science of Water &gt; Water and Environmental Change Water and Life &gt; Conservation, Management, and Awareness

Treatment of thoracolumbar tuberculosis with robot-assisted and minimally invasive access via transforaminal expansion approach

To investigate the feasibility and effectiveness of robot-assisted posterior minimally invasive access in treatment of thoracolumbar tuberculosis via transforaminal expansion approach. A clinical data of 40 patients with thoracolumbar tuberculosis admitted between January 2017 and May 2022 and met the selection criteria was retrospectively analyzed. Among them, 15 cases were treated with robot-assisted and minimally invasive access via transforaminal expansion approach for lesion removal, bone graft, and internal fixation (robotic group), and 25 cases were treated with traditional transforaminal posterior approach for lesion removal and intervertebral bone grafting (traditional group). There was no significant difference in the baseline data between the two groups ( P>0.05) in terms of gender, age, lesion segment, and preoperative American Spinal Injury Association (ASIA) grading, Cobb angle, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). The outcome indicators were recorded and compared between the two groups, including operation time, intraoperative bleeding volume, hospital stay, postoperative bedtime, complications, ESR and CRP before operation and at 1 week after operation, the level of serum albumin at 3 days after operation, VAS score and ASIA grading of neurological function before operation and at 6 months after operation, the implant fusion, fusion time, Cobb angle of the lesion, and the loss of Cobb angle observed by X-ray films and CT. The differences of ESR, CRP, and VAS score (change values) between pre- and post-operation were calculated and compared. Compared with the traditional group, the operation time and intraoperative bleeding volume in the robotic group were significantly lower and the serum albumin level at 3 days after operation was significantly higher ( P<0.05); the postoperative bedtime and the length of hospital stay were also shorter, but the difference was not significant ( P>0.05). There were 2 cases of poor incision healing in the traditional group, but no complication occurred in the robotic group, and the difference in the incidence of complication between the two groups was not significant ( P>0.05). There were significant differences in the change values of ESR and CRP between the two groups ( P<0.05). All Patients were followed up, and the follow-up time was 12-18 months (mean, 13.0 months) in the traditional group and 12-16 months (mean, 13.0 months) in the robotic group. Imaging review showed that all bone grafts fused, and the difference in fusion time between the two groups was not significant ( P>0.05). The difference in Cobb angle between the pre- and post-operation in the two groups was significant ( P<0.05); and the Cobb angle loss was significant more in the traditional group than in the robotic group ( P<0.05). The VAS scores of the two groups significantly decreased at 6 months after operation when compared with those before operation ( P<0.05); the difference in the change values of VAS scores between the two groups was not significant ( P>0.05). There was no occurrence or aggravation of spinal cord neurological impairment in the two groups after operation. There was a significant difference in ASIA grading between the two groups at 6 months after operation compared to that before operation ( P<0.05), while there was no significant difference between the two groups ( P>0.05). Compared with traditional posterior open operation, the use of robot-assisted minimally invasive access via transforaminal approach for lesion removal and bone grafting internal fixation in the treatment of thoracolumbar tuberculosis can reduce the operation time and intraoperative bleeding, minimizes surgical trauma, and obtain definite effectiveness.

A giant solitary fibrous tumor of the abdominal pelvic cavity: A case report and literature review.

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor, especially the giant one from the abdominal pelvic cavity. We report on a rare case of a giant SFT of the abdominal pelvic cavity to review the existing literature in detail to improve the diagnosis and treatment of SFT. The patient is a 52-year-old female who presented with 2 weeks of abdominal distension. Abdominal magnetic resonance imaging showed a giant mass (>20 cm) in the abdominal pelvic cavity, considered a mesenchymal tumor. She denies a history of tumor disease. A whole abdomen bulge and a mass of about 18 cm × 10 cm on the right side and middle side were found in the physical examination after admission. Abdominal enhanced computed tomography revealed a giant cystic-solid mass located on the middle and right side of the abdominal pelvic cavity, measuring approximately 20.4 cm × 11.7 cm, with multiple cystic changes and necrosis and compression of adjacent organs and tissues, and marked inhomogeneous enhancement. The patient underwent an open abdominal pelvic cavity giant tumor operation to achieve a radical resection, and did not undergo chemotherapy or radiotherapy. The patient underwent open complete resection of a giant abdominal pelvic tumor with no complications and was diagnosed as SFT according to the pathology, immunohistochemistry showed that the tumor tested positive for CD34(+), STAT-6(+), and Ki-67 (10%). Abdominal computed tomography scans were performed 6 months after resection, and no signs of recurrence or metastasis were found. The clinical symptoms and imaging features of giant abdominal pelvic cavity SFT are not typical. Preoperative diagnosis is difficult and has the potential for malignancy. Based on the results of the current study, there is no standard treatment strategy around the world and the therapeutic effect of radiation therapy and chemotherapy is relatively limited. Thus, complete surgical resection and close clinical follow-up are advocated.

Particulate matter emissions from open pit mines; measurement methodologies, instruments, and research undertaken

Particulate matter is one of the primary pollutants in open pit mining operations. Measurements must be taken to control particulate matter created during open pit mining activities and to compare them to the regulatory limits. Numerous studies have been undertaken to estimate particulate matter emissions produced by open pit mining. It was discovered that the research were largely conducted on coal mines (69.4%), with little study done in other mining types. Research studies on particulate matter estimation took into consideration mostly machine characteristics (loader bucket volume, truck capacity, number of truck wheels etc.) and atmospheric conditions (air temperature, wind speed, relative humidity etc.). This study emphasizes on particulate matter measurement methods along with other measuring parameters and equipment for particulate matter estimation (TSP, PM10, PM4, PM2.5, and PM1).

PV system applied on the new PUC-NPC inverter

In this article, the authors present a new competitive Packed-U-cell and neutral point clamped (PUC-NPC) 9-level converter that utilizes a small number of power switches and passive components. Only seven switches are added to a single DC source. However, the proposed converter takes benefits of the neutral point clamped (NPC) converter’s capability to connect capacitors in series, all with a simple control that enables the algorithm associated to the proposed inverter operate correctly in an open loop operation. A technique of pulse width modulation (PWM) is employed to maintain capacitor voltage at desired values. The proposed inverter produces an almost sinusoidal waveform output voltage, as result, a perfectly sinusoidal charge current with minimal impact on the economy and energy consumption are optioned. The converter has been integrated with a photovoltaic system to minimize its impact on the electricity supply and enhance energy efficiency. In order to take a maximum power from the photovoltaic panel, authors employ a maximum power point tracking (MPPT) technique based on disturbance and observe (P and O). When combined with the proposed control technique, it offers a competitive system suitable for standalone use or as an energy source, eliminating the need for PI regulators or additional investments. The proposed 9-level converter has been validated through simulation, utilizing the MATLAB Simulink environment to model the proposed system. Dynamics of this later were verified by changing the load charge.

Impact of operative approach and patient frailty on outcomes for aorto-iliac occlusive disease with critical limb threatening ischemia.

Multiple treatment modalities exist for the management of aorto-iliac occlusive disease (AIOD) including endovascular (endo), extra-anatomic bypass (EAB), and anatomic bypass (AB). The goal of this study was to examine the impact of revascularization strategy and patient frailty on outcomes for AIOD in patients with critical limb threatening ischemia (CLTI). Patients undergoing revascularization for CLTI and AIOD were identified from the NSQIP database over 5years. Demographics, procedural characteristics, and outcomes were recorded. Modified frailty index (mFI-5) was calculated for each patient. Patients were compared based on the type of procedure and frailty (mFi>0.6). From 2017 to 2021, 1777 patients underwent revascularization for CLTI from AIOD. Patients were majority male (56%) with a mean age of 68. A total of 1346 patients (76%) underwent an open operation of which 669 were EAB. When endo (431 patients) was compared with open repair, endo was associated with a higher incidence of tissue loss at presentation (42% vs 33%, p < 0.001), lower rates of bleeding (6.5% vs 15.5%, p < 0.001), fewer MI/stroke (1.6% vs 4.6%, p = 0.004), and fewer wound complications (2.6% vs 11.2%, p < 0.001). There was no difference in re-intervention, amputation, or death based on frailty. For frail patients (184 patients), type of repair did not impact re-intervention, major amputation, or mortality, though there was increased MI/stroke with EAB and increased wound complications with AB/EAB. AIOD revascularization strategies for patients with CLTI have similar 30-day re-intervention, major amputation, and mortality rates. Endovascular repair has less surgical wound complications and is better suited for frail patients.

The learning curve of laparoscopic splenectomy and esophagogastric devascularization for portal hypertension with 10-year follow-up

Introduction and objectivesLaparoscopic splenectomy and esophagogastric devascularization (LSED) are minimally invasive, effective, and safe in treating esophageal-fundic variceal bleeding with portal hypertension (PHT). The study aimed to assess the learning curve of LSED by cumulative summation (CUSUM) analysis. The 10-year follow-up data for LSED and open surgery were also examined.Patients and methodsFive hundred and ninety-four patients were retrospectively analyzed. Operation time, intraoperative blood loss, open operation conversion, and postoperative complications were selected as the evaluation indicators of surgical ability. The learning curve of LESD was assessed by the CUSUM approach. Patient features, perioperative indices, and 10-year follow-up data were examined.ResultsTotally 236 patients underwent open surgery, and 358 underwent LSED. Patient characteristics were similar between groups. The LSED patients experienced less intraoperative blood loss, fewer complications, and faster recovery compared to the open surgery cohort. The learning curve of LESD was maximal for a case number of 50. Preoperative general characteristics were comparable for both stages. But the skilled stage had decreased operation time, reduced blood loss, less postoperative complications, and better recovery compared to the learning stage. The LSED group had higher recurrent hemorrhage-free survival rate and increased overall survival in comparison with cases administered open surgery in the 10-year follow-up. Free-liver cancer rates were similar between two groups.ConclusionsAbout 50 cases are needed to master the LSED procedure. Compared to open surgery, LSED is a safer, feasible, and safe procedure for PHT patients, correlating with decreased rebleeding rate and better overall survival.

Wear Mechanism of an AlCrN-Coated Solid Carbide Endmill Cutter and Machined Surface Quality under Eco-Friendly Settings during Open Slot Milling of Tempered JIS SKD11 Steel

In the die and mold industry, tempered JIS SKD11 steel is selected to manufacture cold-forming dies that require an optimum balance of toughness, strength, and wear resistance. Therefore, the machinability of tempered JIS SKD11 in the milling machining process is challenging. The use of eco-friendly machining settings is intended to diminish tool wear and enhance the quality of the machined surface as well as the accuracy of the machined components. Adapting to the aforementioned factors for cold-forming dies is a pivotal issue. In this study, the machinability of tempered JIS SKD11 steel was analyzed under dry, MQL, cryogenic cooling with liquid nitrogen (LN2), and liquid carbon dioxide (LCO2) machining settings during open slot milling operations with varying input parameters, including cutting speeds and cutting feeds. An in-depth evaluation of output responses, including tool wear, surface roughness, cutting temperature in the cutting zone, and microhardness of the machined surface, was also conducted. The findings unveiled that the flank wear of the cutters and surface roughness of the machined surfaces obtained minimum values of 0.22 mm and 0.197 µm, respectively, during open slot milling operations at a cutting speed of 100 m/min and a cutting feed of 204 mm/min under cryogenic cooling with liquid carbon dioxide (LCO2). The findings from this study suggest that employing cryogenic cooling with LCO2 could serve as a viable substitute for dry, MQL, and cryogenic cooling with LN2 methods to enhance the machinability of hardened JIS SKD11 steel.

The contemporary management of perforated appendicitis in adults: To operate or wait?

ObjectivesThe optimal management of perforated appendicitis remains controversial. Many studies advocate for antibiotics and an interval appendectomy whereas others suggest that performing an appendectomy at the time of presentation decreases post-operative morbidity. Confounding this argument further are the patients who fail non-operative management and end up requiring surgery during their initial hospitalization. This study aims to determine if early operative intervention should be considered for perforated appendicitis. MethodsThis was a retrospective review of all patients who underwent an appendectomy (both laparoscopic or open) for perforated appendicitis between 2015 and 2020 at our institution. ResultsA total of 271 patients met inclusion criteria for this study. Of this group, 250 patients underwent an immediate appendectomy whereas the remaining 21 patients underwent a trial of non-operative management and eventually required an appendectomy during their initial admission. When comparing the immediate versus delayed operative groups, there were no differences in demographic data including age and gender, and no differences in various imaging findings including AAST Grade IV or V appendicitis. Operatively, patients in the delayed group had a longer operative time (83.1 ± 32.9 vs. 64.1 ± 26.2, p = 0.01), were more likely to require an open operation (23.8 % vs. 2.8 %, p < 0.0001), and were more likely to have a drain placed intra-operatively (42.9 % vs 14.4 %, p = 0.004). While there were no differences in 30-day readmission rates, patients in the delayed group had a significantly longer hospital length of stay than patients in the immediate group (9.4 ± 7.4 vs. 3.1 ± 3.3, p = 0.008). ConclusionsPatients undergoing an immediate appendectomy for perforated appendicitis can discharge from the hospital sooner and demonstrate no increase in post-operative morbidity suggesting that surgeons can initially manage this disease process in an operative fashion.

Acute Intraoperative Conversion from Endovascular to Open vs Planned Open Operation for Abdominal Aortic Aneurysm: A Propensity-Score Matched Study from the American College of Surgeons NSQIP-Targeted Database.

Evaluating outcomes for acute intraoperative conversion to open surgery during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) was difficult due to low incidence. This study aimed to compare 30-day outcomes between patients with acute intraoperative conversion during EVAR and planned open surgery, and to identify risk factors associated with acute conversion. Patients who underwent EVAR or planned open AAA repair were identified in American College of Surgeons NSQIP-targeted databases from 2012 to 2021. Patients with acute intraoperative conversion during EVAR were selected. A 1:3 propensity-score matching was used to match demographics, baseline characteristics, surgical indications, aneurysm size and extent, and emergency cases between the conversion open and planned open groups. Thirty-day postoperative outcomes were assessed. Of 20,566 EVAR cases, 177 (0.86%) had acute intraoperative conversion to open surgery. The conversion open group was matched to 504 of 5,249 planned open patients. Conversion open and planned open groups had comparable 30-day mortality (23.43% vs 17.46%, p = 0.09) and organ system complications, including major adverse cardiovascular event (14.86% vs 10.71%, p = 0.17), pulmonary complications (17.71% vs 24.01%, p = 0.09), and renal complications (8.57% vs 11.11%, p = 0.39). The conversion open group had lower bleeding requiring transfusion (48.57% vs 75.60%, p < 0.01), shorter operation time (p < 0.01), and shorter length of stay (p < 0.01). Other postoperative outcomes did not differ. Risk factors associated with acute intraoperative conversion included ruptured aneurysm with or without hypotension. Protective factors included hypertension and aortic distal aneurysm extent. Although this study does not endorse a universal "EVAR first" strategy for all patients with AAA, EVAR can be attempted first in eligible patients with AAA. Even when EVAR is unsuccessful, intraoperative conversion to open surgery still appears to be safe compared with planned open repair.

Narrative review of patient-specific 3D visualization and reality technologies in skull base neurosurgery: enhancements in surgical training, planning, and navigation.

Recent advances in medical imaging, computer vision, 3-dimensional (3D) modeling, and artificial intelligence (AI) integrated technologies paved the way for generating patient-specific, realistic 3D visualization of pathological anatomy in neurosurgical conditions. Immersive surgical simulations through augmented reality (AR), virtual reality (VR), mixed reality (MxR), extended reality (XR), and 3D printing applications further increased their utilization in current surgical practice and training. This narrative review investigates state-of-the-art studies, the limitations of these technologies, and future directions for them in the field of skull base surgery. We begin with a methodology summary to create accurate 3D models customized for each patient by combining several imaging modalities. Then, we explore how these models are employed in surgical planning simulations and real-time navigation systems in surgical procedures involving the anterior, middle, and posterior cranial skull bases, including endoscopic and open microsurgical operations. We also evaluate their influence on surgical decision-making, performance, and education. Accumulating evidence demonstrates that these technologies can enhance the visibility of the neuroanatomical structures situated at the cranial base and assist surgeons in preoperative planning and intraoperative navigation, thus showing great potential to improve surgical results and reduce complications. Maximum effectiveness can be achieved in approach selection, patient positioning, craniotomy placement, anti-target avoidance, and comprehension of spatial interrelationships of neurovascular structures. Finally, we present the obstacles and possible future paths for the broader implementation of these groundbreaking methods in neurosurgery, highlighting the importance of ongoing technological advancements and interdisciplinary collaboration to improve the accuracy and usefulness of 3D visualization and reality technologies in skull base surgeries.

Adherent Peanut Image Segmentation Based on Multi-Modal Fusion.

Aiming at the problem of the difficult segmentation of adherent images due to the not fully convex shape of peanut pods, their complex surface texture, and their diverse structures, a multimodal fusion algorithm is proposed to achieve a 2D segmentation of adherent peanut images with the assistance of 3D point clouds. Firstly, the point cloud of a running peanut is captured line by line using a line structured light imaging system, and its three-dimensional shape is obtained through splicing and combining it with a local surface-fitting algorithm to calculate a normal vector and curvature. Seed points are selected based on the principle of minimum curvature, and neighboring points are searched using the KD-Tree algorithm. The point cloud is filtered and segmented according to the normal angle and the curvature threshold until achieving the completion of the point cloud segmentation of the individual peanut, and then the two-dimensional contour of the individual peanut model is extracted by using the rolling method. The search template is established, multiscale feature matching is implemented on the adherent image to achieve the region localization, and finally, the segmentation region is optimized by an opening operation. The experimental results show that the algorithm improves the segmentation accuracy, and the segmentation accuracy reaches 96.8%.