Partial Palsy Research Articles

Outcomes of a modified technique of partial parotidectomy and novel parotid tumour position classification from a single surgeon prospective database.

Conservative parotidectomy for benign tumours reduces facial nerve palsy, without increasing local recurrence. We report a modified technique of partial parotidectomy and using a novel description of tumour position, explore relationships between tumour position and histological margins, facial nerve palsy and local recurrence. A prospectively collected single surgeon parotidectomy database was analysed, including tumour location (superficial/deep lobe; central/peripheral) and outcomes. A partial parotidectomy identified the facial nerve and the proximal portion of its branches with a macroscopically clear resection margin. Mean follow up was 5.9 years for pleomorphic adenomas. Three hundred and three patients underwent parotidectomy; 257 (84.8%) were superficial and 46 (15.2%) deep lobe. Tumour position was recorded in 291: 236 (81.1%) were peripheral tumours and 55 (18.9%) central. Histological margin involvement was similar in central and peripheral tumours, both overall and for superficial and deep lobe tumours, but was commoner in central deep lobe tumours, (P = 0.003). Temporary partial facial nerve palsy occurred in 21 (6.9%), with one permanent partial nerve palsy (0.3%). Deep lobe tumours and total parotidectomy were associated with facial nerve palsy (P = 0.01). Facial nerve monitoring reduced the risk of palsy (P < 0.01). Local recurrence of pleomorphic adenomas was uncommon, occurring in 3 (2.0%) of 151 patients. This series confirms the safety and adequacy of more conservative partial parotidectomy for benign tumours, highlighting most tumours are peripheral, but not more prone to histological margin involvement or local recurrence, and with routine intraoperative facial nerve monitoring, is achieved with low facial nerve palsy rates.

MANAGEMENT OF CHRONIC PELVIC DISCONTINUITY DURING REVISION HIP ARTHROPLASTY USING THE “ACETABULAR DISTRACTION TECHNIQUE”: CLINICAL AND RADIOLOGICAL OUTCOMES AT TWO TO TEN YEARS FROM A TWO-CENTRE STUDY

Chronic pelvic discontinuity (CPD) during revision hip arthroplasty is a challenging entity to address. The aim of this study was to evaluate the clinical and radiologic outcomes, and complications of the “acetabular distraction technique” for the management of CPD during revision hip arthroplasty.Patients with CPD, who underwent acetabular revision between 2014 and 2022 at two tertiary care centres, using an identical distraction technique, were evaluated. Demographic parameters, pre-operative acetabular bone loss, duration of follow-up, clinical and radiologic outcomes, and survivorship were evaluated.In all, 46 patients with a mean follow-up of 34.4 (SD=19.6, range: 24–120) months were available for evaluation. There were 25 (54.3%) male, and 21 (45.7%) female patients, with a mean age of 58.1 (SD=10.5, range: 40–81) years at the time of revision surgery. Based on the Paprosky classification of acetabular bone loss, 19 (41.3%), 12 (26.1%), and 15 (32.6%) patients had type 3b, 3a, and 2c defects. All patients were managed using the Trabecular Metal™ Acetabular Revision System; 16 patients required additional Trabecular Metal™ augments. The mean HHS improved from 50.1 (SD=7.6, range: 34.3 – 59.8) pre-operatively, to 86.6 (SD=4.2, range: 74.8 -91.8) at the last follow-up. Two patients (4.3 %) developed partial sciatic nerve palsy, two (4.3%) had posterior dislocation, and one (2.2%) required re-revision for aseptic loosening. Radiologically, 36 (78.3%) patients showed healing of the pelvic discontinuity. The Kaplan-Meier construct survivorship was 97.78% when using re-revision for aseptic acetabular loosening as an endpoint.The acetabular distraction technique has good clinical and radiologic outcomes in the management of CPD during revision hip arthroplasty.

Resurfacing of multiple adjacent defects with free multipaddle SCIAP flaps

BackgroundThe efficient resurfacing of multiple adjacent defects (MADs) requires precise reconstructive strategy. Various approaches (e.g., several flap transferring or prelamination of the recipient site) have been reported, but recipient-site impairments, pain, long hospitalization, and low cost-benefit results fatefully considered them as compromise approaches. This study aims to evaluate the feasibility of MADs reconstruction with free multipaddle superficial circumflex iliac artery perforator (SCIAP) flaps. MethodsFrom Dec 2015 to Dec 2020, we enrolled patients with upper and lower extremity defects treated with various multipaddle SCIAP flaps (2-paddle, 3-paddle, and 4-paddle). Patient demographics and outcomes of each group were collected. ResultsThirty-two, 21, and 6 patients underwent 2-paddle, 3-paddle, and 4-paddle SCIAP flaps transfers, respectively. All multipaddle SCIAP flaps survived without vascular problems, and the donor sites were closed directly. Except for 3 cases of 2-paddle SCIAP flaps drained by superficial circumflex iliac vein venous return, most cases (n = 56) were drained by venae comitans. Minor complications, including partial flap necrosis (4 cases) and lateral femoral cutaneous nerve palsies (11 cases), were treated conservatively. All patients were satisfied with the reconstructive outcome. ConclusionMultiple adjacent defects reconstruction is still a Gordian knot and lacks a golden standard. The free multipaddle SCIAP flap was demonstrated as a promising alternative, not only enriching its versatility but also initially highlighting the “replace need with need” reconstructive demand.

Posterior Cerebral Artery–to–Superior Cerebellar Artery Side-to-Side Bypass via Extreme Lateral Supracerebellar Infratentorial Approach: Technical Note

Background and objectiveDifficult-to-treat aneurysms of the distal posterior cerebral artery (PCA) can often be treated by parent artery occlusion. A cerebrovascular bypass can complement PCA occlusion to curb the risk of ischemic complications.An in-situ bypass may be considered when the occipital artery or superficial temporal artery cannot serve as a bypass donor.This paper describes the use of a side-to-side bypass of superior cerebellar artery (SCA) as a donor to the posterior cerebral artery (PCA) via an extreme lateral supracerebellar infratentorial (ELSCIT) approach. This bypass approach can be a useful surgical strategy for PCA revascularization. MethodsA 40-year-old female patient underwent a side-to-side PCA-SCA bypass via the ELSCIT approach for the treatment of a complex and previously coiled PCA aneurysm.Bypass was followed by endovascular aneurysm and parent artery occlusion. ResultsPostoperatively, the patient experienced transient, partial trochlear nerve palsy of the left eye without ischemic lesions on MRI. The clinical condition was stable and angiography showed a patent bypass and complete aneurysm occlusion 12 months after surgery. ConclusionThe ELSCIT-approach offers access to the medial and distal PCA that is well suitable for a side-to-side PCA-SCA bypass. This type of approach and bypass may be of value when revascularization of a P2-P3 portion of the PCA is needed, but a suitable occipital artery (OA) or superficial temporal artery (STA) is not available.

Bifurcation of the Radial Nerve in the Arm as a Cause of Traumatic Partial Nerve Palsy: A Case Report

Purpose: To describe the case of a traumatic partial nerve palsy following an open crushing arm injury. The partial palsy was due to the presence of radial nerve bifurcation in the proximal arm. Methods: A 23-year-old male was involved in a motor vehicle accident, where his motorbike crushed against a steel road divider sustaining multiple injuries in the spine, thorax, and right arm. On clinical examination, the patient presented a deep, blunt trauma on the posterior aspect of the proximal arm and partial radial nerve palsy was diagnosed with preservation of the brachioradialis and the extensor radialis longus muscle function. Surgical exploration was carried out. Results: An extensible posterior approach to the arm was performed and two main radial nerve branches were found. The lateral, more sizeable nerve, had an epineural hematoma without any distal response during intraoperative stimulation. The medial, thinner nerve trunk was preserved and, when stimulated, elicited response from the brachioradialis. Conclusion: We describe an uncommon variation of the radial nerve which was associated with partial palsy following blunt force trauma. This anatomical variation should be kept in mind in cases like the one described.

Ischemic-Hemorrhagic Stroke in New Onset Type 1 Diabetes Mellitus with Diabetic Ketoacidosis in a Two-Year-Old Toddler: The First Reported Case in Indonesia

Cerebral edema accounts for 90% of intracerebral complications in diabetic ketoacidosis (DKA). Stroke has been reported to account for 10% of intracerebral complications of DKA in children. It may be underrecognized because its presentation may be subtle. This case report aims to raise awareness of stroke presentation and risk factors in pediatric DKA. A previously healthy two-year-old female presented to the emergency department one day before admission with loss of consciousness and was diagnosed with DKA. The recognition of left hemiparesis was on the 9th day of hospitalization. After 14 days of hospitalization, the patient had recurrent seizures. Computed tomography and angiography revealed subacute ischemic transformative to subacute hemorrhagic stroke. During the follow-up, the symptoms of hemiparesis improved with routine physiotherapy, with some partial palsy of the third cranial nerve remaining. Risk factors for stroke in the patient were the severity of dehydration during DKA, younger age of onset, delayed DKA treatment, and iron deficiency anemia. Suspicion of stroke is necessary even if a subtle neurologic deficit occurs.

OGC P57 Are Cervical Lymph Node Dissections in Oesophageal Cancer Patients Undergoing Oesophagectomy Beneficial?

Abstract Background Cervical lymph node dissection in patients undergoing oesophagectomy can be indicated when there is suspicion of involved cervical nodes, although there is controversy around the benefits of this additional procedure on the prognosis of these patients. This study aims to assess the consequences and survival after cervical lymph node dissection, and to weigh the risks and benefits of this procedure. Methods This retrospective study included seven patients with oesophageal squamous cell carcinoma (SCC), and one with oesophageal adenocarcinoma who underwent cervical lymph node dissection in addition to oesophagectomy at the Churchill Hospital. There was a male to female ratio of 1:3, and all had neoadjuvant chemotherapy and were staged with PET-CT. PET staging scan results were compared pre and post neo-adjuvant therapy (NAT) to assess nodal involvement. Final histopathology was also recorded. Results All patients had evidence of cervical nodal involvement on PET scan, two of whom developed nodal involvement only after NAT. Only two patients had neck node involvement on histopathology: one had SCC and showed good response to NAT; the other had undifferentiated carcinoma and showed new para-tracheal node involvement after NAT, later developing supraclavicular node recurrence. Two cases were complicated by recurrent laryngeal nerve (RLN) injury, one with bilateral and one with partial vocal cord palsy. There was a 5-year survival rate of 62.5%, with non-survivors uniquely having recurrent disease. Conclusions Lymph node dissection alongside oesophagectomy achieved good 5-year survival in this small cohort, but with a significant risk of RLN injury. Further studies investigating the proportion of metastatic neck nodes found on dissection, long term survival benefits and cancer reoccurrence are required.

Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example.

Introduction Clival tumors are rare and heterogeneous. Although some benign prototypical sellar lesions may present as clival tumors, the likelihood of malignant disease is higher. Here we define a novel algorithm for the workup and management of clival masses through an illustrative case of colorectal adenocarcinoma metastasis to the clivus. Methods In this case report, the best practice guidelines for managing clival masses are described through a literature review and refined by senior author consensus. We conducted a focused systematic review to characterize the present case in the context of clival metastasis from gastrointestinal malignancy. Results An 83-year-old woman presented with 4 weeks of headaches and blurry vision. Examination revealed partial right abducens and left oculomotor palsies. Magnetic resonance imaging (MRI) identified a large, weakly enhancing sellar and clival mass with sphenoid sinus extension. An aggressive subtotal endoscopic endonasal resection was performed with removal of all sphenoid, clival, and sellar disease without cavernous sinus wall resection. Pathology confirmed colorectal adenocarcinoma; computed tomography (CT) imaging identified an ascending colon mass with metastases to the liver and mesenteric nodes. Palliative oncologic therapies were recommended, but she elected hospice, and died 3 months after initial presentation. Gastrointestinal clival metastases are exceedingly rare among sellar and clival pathologies, with eight prior cases reported, most of which presented with diplopia from abducens nerve involvement. Conclusion Clival masses are uncommon skull base lesions that are associated with more aggressive diseases. We present a consolidated framework for decision-making in these challenging patients, alongside an unusual case example that illustrates the importance of increased suspicion for malignant clinical entities in this setting.

Spectrum of Etiologies and Clinical Presentation of Patients with Extraocular Motility Disorders Presenting to a Neuro-Ophthalmology Clinic

Objective: To provide an account on the demographics, etiology, co-morbidities, presentation findings and frequency of patients with cranial nerve palsies presenting to our Neuro-Ophthalmology clinic. Study Design: Cross-sectional study. Place and Duration of Study: Department of Neuro-Ophthalmology, Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan from Dec 2017 to Jun 2022. Methodology: A total of 82 patients were included in the study. The data was compiled on a single proforma by a single investigator which included Co-morbidities, presentation findings (ptosis, headache, diplopia, extra-ocular movements, Anisocoria, Visual Acuity for both eyes, Media and Fundus examination findings). Contrast Enhanced MRI (CEMRI) results were also tabulated where performed. Potential causes such as diabetes mellitus, hypertension, space occupying lesions, aneurysms and injury were also documented for each patient. Results: A total of 22 patients had 3rd nerve palsy, 9(40.91%) out of them had partial 3rd nerve palsy while 6(27.31%) had ischemic 3rd nerve palsy. Out of 45 cases of 4th and 6th nerve palsy, 13(28.90%) patients had ischemic fourth nerve palsy and 13(28.90%) patients had ischemic 6th nerve palsy, followed by post-traumatic fourth nerve palsy. Conclusion: We have provided an account of the possible etiologies and presentation findings in patients presenting with ocular motility disorders in our setting. Diabetes Mellitus was the most common microvascular cause for ischemic cranial nerve palsies. More sinister pathologies like myasthenia gravis, often presenting as mimickers of isolated cranial nerve palsies were quite common in our study.

A Man with Rapid Speech and Handwriting.

Video 1 Video showing abnormal speech, handwriting, partial supranuclear gaze palsy, and impaired postural reflexes. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Acute-Onset Chronic Inflammatory Demyelinating Polyradiculoneuropathy after Ad26.COV2.S COVID-19 Vaccination (P13-8.006)

<h3>Objective:</h3> NA <h3>Background:</h3> Acute onset demyelinating neuropathy has been reported after coronavirus disease 2019 (COVID-19) vaccination. Only a limited number of cases continued progression and became chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), mostly after ChAdOx1 nCoV-19 vaccination. Here, we report the first case of acute-onset CIDP after Ad26.COV2.S (Johnson &amp; Johnson) vaccination. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 67-year-old man presented with one-week history of progressive left facial droop, unsteady gait, slurred speech, double vision, and patchy numbness; he reported Ad26.COV2.S vaccination three weeks before presentation. On initial examination, he had left facial palsy, partial left abducens nerve palsy, generalized areflexia, severe lower extremities ataxia, and diminished vibratory sensation in toes. Cerebrospinal fluid analysis showed albuminocytologic dissociation. He received intravenous immunoglobulin (IVIG) for five days for presumptive diagnosis of Guillain-Barré syndrome (GBS). Electrodiagnostic studies demonstrated impersistent F-waves, decreased recruitment in lower extremities, and bilaterally absent blink reflexes. He developed right facial weakness on day three and asymmetric appendicular muscle weakness on day five of treatment. Seven weeks after symptom onset, his lower extremities weakness worsened, and received a second cycle of IVIG. The lower extremity weakness did not improve but remained stable until seventeen weeks after symptom onset when he returned with progressive upper extremities weakness and dyspnea. Electrodiagnostic studies demonstrated demyelinating features consistent with CIDP. Neuromuscular ultrasound demonstrated multifocal median nerve enlargements at non-entrapment sites. At this point, given the clinical course, electrodiagnostic and ultrasonographical findings, CIDP diagnosis was established. <h3>Conclusions:</h3> This patient’s acute-onset CIDP and other reported GBS cases after adenoviral vector COVID-19 vaccinations shared similar and atypical presenting symptoms, which were not seen in GBS after mRNA COVID-19 vaccinations. While a causal relationship cannot be established to his COVID-19 vaccination, this case adds to the evolving literature of COVID-19 vaccination-associated neurological events. <b>Disclosure:</b> Dr. Bendi has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Danielson has nothing to disclose.

Percutaneous Rhizotomy of the Gasserian Ganglion in Patients With Mass Lesion-Associated Trigeminal Neuralgia: A Case Series.

Patients with trigeminal neuralgia (TN) secondary to mass lesions are typically treated by directly addressing the underlying pathology. In cases of TN not alleviated by treatment of the pathology, percutaneous balloon compression (PBC) and glycerol rhizotomy (Gly) are simple and effective ways to alleviate pain. However, there is limited literature on the use of these techniques for patients with TN caused by mass lesions. To describe the use of PBC/Gly to treat mass lesion-related TN. We report a retrospective, single-institution, descriptive case series of patients who presented with TN secondary to tumor or mass-like inflammatory lesion from 1999 to 2021. Patients with primary, idiopathic, or multiple sclerosis-related TN were excluded. Outcomes included Barrow Neurological Institute (BNI) pain intensity and hypesthesia scores, pain persistence, and postoperative complications. A total of 459 procedures were identified, of which 16 patients met the inclusion criterion (14 PBC and 2 Gly). Of the 15 patients with tumors, 12 had TN pain despite prior tumor-targeted radiation. Short-term (<3 months) BNI pain intensity improvement occurred in 15 (93.8%) patients. The mean follow-up was 54.4 months. Thirteen (81.3%) patients were pain-free (Barrow Neurological Institute pain intensity scale: IIIa-50%; I-25.0%; II-6.3%) for a mean of 23.8 (range 1-137) months. Ten patients (62.5%) had pain relief for ≥6 months from first procedure. New facial numbness developed immediately postprocedure in 8 (50%) patients. Transient, partial abducens nerve palsy occurred in 1 patient. PBC/Gly is an effective option for medically refractory TN in patients with mass-associated TN and is a viable option for repeat treatment.

Endoscopic endonasal transclival approach for a ventral brainstem epidermoid cyst: illustrative case.

Intracranial epidermoid cysts are benign, slow-growing malformations that most commonly arise at the skull base. Maximizing resection of the cyst contents and the capsule reduces long-term recurrence but can be made difficult by cyst wall adherence to critical neurovascular structures. Expanded endonasal approaches (EEAs) offer an alternative to traditional open transcranial approaches for accessible epidermoid cysts. In this case report, the authors demonstrate a transclival EEA for a large, ventral brainstem epidermoid cyst. A 41-year-old woman who presented with progressive headaches, diplopia, malaise, and fatigue was found to have a 4.7-cm midline, ventral brainstem epidermoid cyst. She underwent an expanded endonasal transclival approach that exposed the brainstem from the level of the dorsum sella to the tip of the basion. A near-total resection was completed with removal of all cyst contents and most of the capsular wall. Reconstruction was completed with Duragen, an autologous fat graft, and a nasoseptal flap. Postoperatively, she had a partial left cranial nerve VI palsy that remained stable 8 weeks after surgery. The expanded endoscopic transclival approach can facilitate effective resection of midline, ventral epidermoid cysts.

RETRACTED: Adenoma replacement due to invasion of a metastatic mass: A case report and literature review

Pituitary composite tumors composed of a metastasis within an adenoma represent a rare yet aggressive manifestation of malignancy. In this report, we present a unique case of a 65-year-old male in whom oesophageal adenocarcinoma metastasized to a prolactinoma, causing partial palsy of the third and sixth cranial nerves. Investigations revealed rapid progression of the parasellar lesion and normalization of prolactin. After partial surgical resection, pathology confirmed the metastasis of the known digestive tract neoplasia. While such dual pathologies are extremely rare, they should be considered as possibilities when diagnosing sellar masses. Clinicians should be mindful of atypical behavior of benign adenomas, particularly rapid growth, spontaneous normalization of prolactin, or progression despite medical treatment, as this could indicate metastatic disease. In presenting this case, we hope to illuminate the importance of its recognition in early diagnosis and a better understanding of this condition.

Strategies for managing strabismus from oculomotor nerve palsy

Addressing ocular misalignment secondary to partial and complete oculomotor nerve palsy presents a special challenge to the strabismus surgeon, particularly when treating patients with binocular diplopia. We review the reported surgical options and, through illustrative cases, provide our own perspective on managing this disorder.

The Diagnosis and Treatment of Arytenoid Dislocation

Vocal fold paralysis and arytenoid dislocation are the differential symptoms for unilateral vocal fold movement disorder. However, their diagnosis is difficult. To diagnose dislocation, it is necessary to understand the movements characteristic of unilateral fold paralysis. A particularly important finding of paralysis is the passive gliding movement that is displaced in the cranial direction during phonation. The presence of this movement is diagnostic of paralysis rather than dislocation. A number of previous reports on dislocation have diagnosed the presence of this passive movement as dislocation. In Japan, the term ‘fixation’ is often used to describe the position of the paralyzed vocal folds, as in ‘mid-position fixation’ or ‘sub-median fixation’. There seems to be a misconception that ‘paralyzed vocal cords are immobilized’. In the case of dislocation, by contrast, the muscular process is unable to move beyond the midline of the articular surface, and the movement of the arytenoid is severely restricted and immobile. It has been misunderstood that immobility is paralysis while wobbling is dislocation. However, paralysis is the presence of wobbling movement (passive gliding movement), and dislocation is immobilization and inability to move. Dislocations have previously been divided into two categories of anterior and posterior dislocations, but vertical dislocations have not been mentioned. In past reports, the terms ‘anterior’,‘posterior’,‘medial’, and ‘lateral’ have been used to refer to the position of dislocation. However, these terms do not indicate the position in the vertical direction. We divided the cricoid facet into four areas: mediocaudal, laterocaudal, mediocranial and laterocranial. We published on recurrent adductor branch paralysis in 2010. Gradually, the concept of partial laryngeal palsy has become more widespread. Looking at previous reports, adductor branch paralysis may have been included in many studies diagnosing posterior dislocation (mediocranial). Understanding the characteristics of adductor branch paralysis is crucial. It is important to understand the three-dimensional arrangement of the arytenoid cartilage for the diagnosis of unilateral vocal fold movement disorder and clarifying the characteristics of paralysis.

MEASUREMENT OF DIAPHRAGMATIC DYSFUNCTION AND PHRENIC NERVE PALSY IN PATIENTS UNDERGOING THORACIC SURGERY FOR LUNG- OR ESOPHAGEAL CANCER

<h3>Introduction and Objective</h3> Thoracic surgery carries a substantial risk of postoperative pulmonary complications. Recent studies have shown that the risk of postoperative pulmonary complications is significantly higher in patients suffering from postoperative diaphragmatic dysfunction. Diaphragmatic dysfunction may be accompanied by phrenic nerve palsy. However, the extent of phrenic nerve palsy and its association with diaphragmatic dysfunction following thoracic surgery is unknown. Therefore, we aimed to quantify changes in diaphragmatic function and phrenic nerve conductance in patients undergoing thoracic surgery for lung- or esophageal cancer using ultrasonographic measures and phrenic nerve conduction studies. <h3>Design and Methods</h3> This was a prospective observational study including patients scheduled for pulmonary lobectomy or esophageal resection. Examinations were carried out the day prior to surgery and respectively 3 days and 10-14 days after surgery. Endpoints for diaphragmatic function included ultrasonographic measurements of diaphragmatic excursion of the posterior part of the right hemidiaphragm, excursion of the hemidiaphragmatic top point, change in intrathoracic area and diaphragmatic thickening fraction. Ultrasonographic measurements were recorded during a standardized respiration cycle. Endpoints for phrenic nerve conductance included baseline-to-peak amplitude, peak-to-peak amplitude and transmission delay of the diaphragmatic compound muscle action potential (CMAP). Measurements for both diaphragmatic- and phrenic nerve recordings were assessed for both the surgical side and the non-surgical side of the thorax and thus measured over time. <h3>Results</h3> We included 40 patients of which 13 had pulmonary lobectomies and 27 had esophageal resections performed. Significant reductions in diaphragmatic excursion were seen on the surgical side of the thorax for all excursion measures (posterior part of the right hemidiaphragm, p < 0.001; hemidiaphragmatic top point, p < 0.001; change in intrathoracic area, p < 0.001) (Figure 1). Conversely, all ultrasound excursion measures did not change significantly on the non-surgical side. Diaphragmatic thickening fraction did not change significantly on either side. For phrenic nerve measures, significant reductions were seen for both CMAP amplitude measures on the surgical side (baseline-to-peak, p < 0.001; peak-to-peak, p < 0.001) and non-surgical side (baseline-to-peak, p < 0.001; peak-to-peak, p < 0.001). Transmission delay also changed significantly between assessments on both the surgical (p =0.041) and the non-surgical side (p =0.021) (Figure 2). <h3>Conclusion</h3> Thoracic surgery caused a significant unilateral reduction in diaphragmatic excursion on the surgical side of the thorax, whereas the contralateral hemidiaphragm's excursion did not decrease significantly. Diaphragmatic compound muscle action potential amplitude was reduced significantly bilaterally. Therefore, our findings show that a postoperative reduction in diaphragmatic excursion is accompanied by partial phrenic nerve palsy, which may be a contributing factor in the pathogenesis of postoperative pulmonary complications.

The application of custom-made 3D-printed titanium augments designed through surgical simulation for severe bone defects in complex revision total hip arthroplasty

BackgroundWith the development of radiology and three-dimensional (3D) printing technology, custom-made 3D-printed titanium augments have been more widely used. However, the radiological and clinical outcomes of custom-made augments lack reports. To better understand the clinical effect of using 3D-printed titanium augments and the significance of accurate placement, the aim of this study was to assess the outcomes when using custom-made 3D-printed titanium augments and to validate the idea that surgical simulation should be done before designing custom-made augments.MethodsA retrospective review was conducted on 31 surgical simulations and revision total hip arthroplasties using custom-made 3D-printed titanium augments. The safe zone, cup position, and hip rotation center were measured on anteroposterior radiographs. Clinical outcomes were assessed with a mean 21.1 months of follow-up.ResultsAll patients were positioned within the safe zone, and none of the acetabular cups nor the custom-made augments had any evidence of migration at the latest follow-up. A strong correlation was found between the planned cup position and the postoperative position. The average vertical position of the center of rotation was significantly increased from 3.55 cm to 2.35 cm. The mean Harris Hip Score was increased from 40.81 preoperatively to 65.46 postoperatively. Complications included gait abnormality, groin pain, fracture of the greater trochanter, and partial palsy of the sciatic nerve. However, patient satisfaction reached 92.3%.ConclusionSurgical simulations help to design custom-made augments accurately and improve surgical plans. Acetabular components supported with custom-made 3D-printed augments is a useful method to bridge severe bone deficiencies. In this study, both the radiologic results and clinical outcomes were favorable.Level of evidenceLevel 4.

Surgical dosing of partial sixth nerve palsy with novel incomitance protocol for improvement of area of single binocular vision

Surgical dosing of partial sixth nerve palsy with novel incomitance protocol for improvement of area of single binocular vision

Standardized reporting of complications of epilepsy surgery and invasive monitoring: A single-center retrospective study

ObjectiveMonitoring adverse effects related to epilepsy surgery is essential for quality control and for counseling patients prior to the procedure. The aim of this study was to analyze the rates of complications related to epilepsy surgery following invasive monitoring and to classify them according to the recently proposed protocol by the E-pilepsy consortium. MethodsThis is a retrospective study of collected data extracted from our routinely updated epilepsy surgery database which consisted of 173 surgical procedures: 89 surgeries for insertion of subdural grids, strips, and/or depth electrodes, and 84 resective surgeries. According to the protocol, complications were defined as unexpected postoperative adverse events and were stratified into transient (lasting less than 6 months) and permanent deficits (lasting 6 months or longer). In addition, we reported patients with postoperative psychiatric disturbances and calculated the rates of transient and permanent postoperative sequelae which were defined as expected postoperative deficits deemed inherent to the surgical procedure. ResultsSix potentially life-threatening complications requiring acceleration of the planned resective surgery occurred during invasive monitoring. Following resective surgery, 12 transient sequelae (8 motor deficits, three language deficits, and one transient dyscalculia) and 10 permanent sequelae (5 mild memory disturbances, four visual field cuts, and one contralateral dysesthesia) occurred. In addition, 7 patients experienced transient motor complications. Four permanent postoperative neurological complications (4.8%) occurred: motor deficits in three patients and a partial peripheral facial palsy in one. Finally, five patients developed de novo psychiatric disturbances (transient in four and permanent in one). ConclusionsThis is the first study to classify complications of epilepsy surgery according to the E-pilepsy consortium protocol. Our findings demonstrate that epilepsy surgery following invasive monitoring is safe and associated with low morbidity when performed in specialized centers. Monitoring these complications according to a unified definition and using a multidimensional protocol will allow for a direct comparison across epilepsy surgery centers, will provide the epileptologists and surgeons with objective percentages to share with their patients and will help in identifying risk factors and improving the safety of epilepsy surgery.