Postoperative Imaging Research Articles

Effects of Interaural Latency and Frequency Mismatch on Speech Recognition for Bimodal Cochlear Implant Users.

Bimodal cochlear implant (CI) users vary in speech recognition outcomes. This variability may be influenced partly by the CI and contralateral hearing aid (HA) programming procedures, which can result in mismatches in latency and frequency. We assessed the performance of bimodal listeners when latency mismatches were corrected and analyzed how frequency mismatches influenced outcomes. Twelve adults with at least 1 year of bimodal use were evaluated in latency mismatched versus matched conditions. Masked sentence recognition was assessed in a 10-talker masker for three spatial configurations: target from the front and the masker either co-located, 90° toward the CI-ear, or 90° toward the HA-ear. Frequency mismatch for the most apical electrode (E1) was determined from postoperative imaging and the filter frequency assignment of their familiar CI map. Participants had significantly better performance when latency mismatches were small or matched between the devices, with an approximately 10% improvement in the configuration with the masker toward the HA-ear. Significantly, poorer performance was observed with larger magnitudes of frequency mismatch, with a 2% drop in performance for every one semitone deviation increase in mismatch. The interaction between latency and frequency mismatch was nonsignificant, suggesting that the benefit of latency matching was approximately additive across the range of frequency mismatches. Detrimental effects of interaural mismatches in latency and frequency were observed, even after long-term device use. These preliminary results suggest that bimodal CI users might benefit from individualized fitting procedures that match latency across devices and minimize frequency mismatch for the CI. 3 Laryngoscope, 2025.

Effect of percutaneous vertebroplasty through UTPP approach on prognosis and quality of life in elderly patients with osteoporotic vertebral compression fractures: a retrospective study

BackgroundTo explore the clinical characteristics of percutaneous vertebroplasty (PVP) via unilateral transverse process-pedicular (UTPP) approach in the treatment of osteoporotic vertebral compression fracture (OVCF) in the elderly.MethodsA total of 120 elderly patients with lumbar OVCF who underwent PVP via unilateral pedicular (UTP) and UTPP approaches in our hospital from January 2022 to January 2024 were retrospectively analyzed. The postoperative VAS score (visual analog scale), ODI score (Oswestry disability index), surgical indicators, and imaging indicators were recorded in the two groups.ResultsThe VAS scores and ODI scores of the two groups of patients were lower than those before surgery 1 day, 6 months, and 12 months after surgery (P < 0.05). The amount of bone cement (BC) injected in the UTPP group was greater than that in the UTP group, the excellent BC distribution rate was higher than that in the UTP group, and the BC leakage rate was lower than that in the UTP group (all P < 0.05). The vertebral anterior edge height and Cobb angle of the UTPP group were significantly different from those of the UTP group 1 day after surgery (P < 0.05).ConclusionsAfter UTPP-PVP, BC is fully diffused, the BC leakage rate is low, and the analgesic effect is good, which can enable patients to get out of bed early and improve their quality of life.

Management of intercostal artery pseudoaneurysm following posterior pedicle screw insertion: illustrative case.

Pedicle screw insertion in posterior spinal surgery can cause vascular injuries, including rare intercostal artery pseudoaneurysms, which are typically discovered incidentally during reimaging. Onyx embolization is an effective treatment for small artery pseudoaneurysms. A 36-year-old man who had initially presented with back pain that remained unresponsive to nonsteroidal anti-inflammatory drugs was diagnosed with a T7-8 sarcomatous lesion confirmed by magnetic resonance imaging and biopsy. He underwent a posterior resection and T5-10 stabilization with pedicle screws. After surgery, significant hemorrhage led to his transfer for digital subtraction angiography, which revealed a prominent vascular tumor blush and a pseudoaneurysm of the right T5 intercostal artery due to screw placement. The tumor and pseudoaneurysm were effectively embolized using superselective catheterization and Onyx. This report highlights the dangers of intercostal artery damage from posterior spinal screws, emphasizing the need for meticulous postoperative imaging. Onyx embolization is an effective treatment for such complications. https://thejns.org/doi/10.3171/CASE24291.

Deep learning based decision-making and outcome prediction for adolescent idiopathic scoliosis patients with posterior surgery

With the emergence of numerous classifications, surgical treatment for adolescent idiopathic scoliosis (AIS) can be guided more effectively. However, surgical decision-making and optimal strategies still lack standardization and personalized customization. Our study aims to devise proper deep learning (DL) models that incorporate key factors influencing surgical outcomes on the coronal plane in AIS patients to facilitate surgical decision-making and predict surgical results for AIS patients. A total of 425 AIS patients who underwent posterior spinal fixation were collected. Variables such as age, gender, preoperative and final follow-up horizontal and vertical coordinate vectors, and screw positioning data were preprocessed by parameterizing image data and transforming various data types into a unified, continuous high-dimensional feature space. Four deep learning models were designed, including Multi-Layer Perceptron model, Encoder-Decoder model, CNN-LSTM Attention model and Deep FM model. For the implementation of deep learning, 70% of the data was adopted for training and 30% for evaluation. The mean square error (MSE), mean absolute error (MAE) and curve fitting between the predicted and corresponding real postoperative spinal coordinates of the test set were adopted to validate and compare the efficacy of the DL models. A total of 425 patients with an average age of 14.60 ± 2.08 years, including 77 males and 348 females, were enrolled in this study. The Lenke type 1 and 5 AIS patients accounted for the majority of the included patients. The results showed that the Multi-Layer Perceptron model achieved the best performance among the four DL models, with a mean square error of 2.77 × 10–5 and an average absolute error of 0.00350 on the validation set. Moreover, the results predicted by the Multi-Layer Perceptron model closely matched the actual coordinate positions on the original postoperative images of patients with Lenke type 1 and AIS patients. Deep learning models can provide alternative and effective decision-making support for AIS patients undergoing surgery. Regarding the learning curve and data volume, the optimal DL models should be adjusted and refined to meet future demands.

The Prevalence of Tear Patterns and Their Effects on Tendon Healing After Arthroscopic Surgery in Patients With Full-Thickness Rotator Cuff Tears.

To achieve successful anatomic rotator cuff repair with minimal tension, both the tear pattern and tear size should be considered. However, little information is available concerning the frequency of tear patterns and their effects on tendon healing. To evaluate the distribution of tear patterns in full-thickness rotator cuff tears and whether these patterns affect tendon healing after arthroscopic repair. Case-control study; Level of evidence, 3. Between 2014 and 2021, patients who underwent arthroscopic surgery for symptomatic full-thickness rotator cuff tears with a minimum 2-year follow-up with postoperative magnetic resonance imaging or ultrasound were retrospectively reviewed. After the debridement of degenerative tendon tissue during arthroscopic surgery, the tear pattern was classified as crescent, U, or anterior or posterior L shaped. Intergroup differences in clinical and radiological characteristics were analyzed. In the subgroup analysis, patients were divided into 2 subgroups: small-to-medium or large-to-massive tears. Among the 1037 patients with a full-thickness rotator cuff tear, the most common tear pattern was crescent shaped (39.6%), followed by posterior L, U, and anterior L shaped (26.0%, 21.4%, and 12.9%, respectively). In the subgroup analysis, 713 patients (68.8%) had small-to-medium tears, while 324 (31.2%) had large-to-massive tears. The proportion of large-to-massive tears was significantly higher for the anterior L-shaped tear pattern than for the other tear patterns (24.8%, 28.8%, 52.2%, and 32.6% for crescent, U, and anterior and posterior L shaped, respectively; P < .001). The anterior L-shaped tear pattern had a significantly higher retear rate than the other tear patterns in small-to-medium tears (7.8%, 13.0%, 28.0%, and 10.6% for crescent, U, and anterior and posterior L shaped, respectively; P < .001). The rate of revision surgery because of a symptomatic retear within 2 years after primary surgery was significantly higher for the anterior L-shaped tear pattern than for the other tear patterns (3.8%, 7.5%, 21.6%, and 0.0% for crescent, U, and anterior and posterior L shaped, respectively; P = .002). The prevalence of tear patterns varied depending on the tear size. In small-to-medium tears, the anterior L-shaped tear pattern had the lowest incidence among the tear patterns; however, it had a significantly higher retear rate. Furthermore, the anterior L-shaped tear pattern had a higher incidence of retears requiring early revision surgery than the other tear patterns.

Therapy Potential of Oblique Lumbar Interbody Fusion 360 for Severe Lumbar Spinal Stenosis.

The advent of O-arm navigation optimized the oblique lumbar interbody fusion (OLIF) procedure, allowing the operator to simultaneously perform OLIF and percutaneous posterior pedicle screw implantation without patient position change, thus improving the fluency and accuracy of the OLIF procedure (called as OLIF360). Nevertheless, a consensus regarding its suitability for patients with severe spinal stenosis remains elusive. This study aims to investigate the clinical efficacy of OLIF360 and its imaging changes in severe lumbar spinal stenosis cases. This retrospective study analyzed clinical data from 63 patients with severe lumbar spinal stenosis. Fourteen patients were treated with OLIF360, and another 37 patients were treated with posterior lumbar interbody fusion (PLIF). Lumbar spinal stenosis was assessed using the modified Schizas classification. Clinical efficacy scale scores and postoperative imaging parameter changes were compared between the two groups. Shapiro-Wilk, t-tests or Mann-Whitney U tests, repeated measures ANOVA, and Bonferroni post hoc tests were applied for statistical analysis. Both groups showed significant improved pain (p < 0.05). At 1-month and 3-month postoperative follow-ups, OLIF360 group scores superior in Visual Analog Scale than PLIF group (p < 0.05). Greater disc height and lumbar lordosis were displayed in OLIF360 group than PLIF group (p < 0.05). No significant difference in screw placement accuracy between groups was observed. Moreover, significant increases in spinal canal area postoperatively (71.04 ± 6.27 mm2 preop to 109.65 ± 12.34 mm2 postop, p < 0.05) and bilateral foraminal areas were found in the OLIF360 group. OLIF360 can have promising short-term efficacy for severe lumbar stenosis treatment with shorter recovery time than PLIF.

Intentional staged embolization via the "highway bypass" using a radial artery graft for a large posterior circulation aneurysm: illustrative case.

The presence of significant tortuosity in access routes to aneurysms can interfere with catheter guidance and manipulation and significantly impact treatment strategies. In this report, the authors combined intentional staged aneurysm embolization with the construction of a new direct access route, which they call a "highway bypass," for a symptomatic posterior circulation cerebral aneurysm that was difficult to access with a catheter. Notably, the highway bypass is used for catheter passage, and technical tips should be considered. The patient had a symptomatic unruptured cerebral aneurysm in the first segment of the left posterior cerebral artery with bilateral internal carotid artery occlusion and severe tortuosity of the bilateral vertebral arteries. The highway bypass using a radial artery graft was performed in the first stage; in the second stage, the aneurysm was accessed using the graft, and embolization was performed. The catheter was passed through the graft without complications. The aneurysm was successfully embolized, no ischemic lesions were found in the postoperative images, and the patient was discharged without worsening neurological findings. Intentional staged aneurysm embolization combined with the highway bypass effectively treats aneurysms that are difficult to access. Anastomoses should be designed to allow catheters to pass through the graft. https://thejns.org/doi/10.3171/CASE24527.

Pancreatic Fistula and Intraabdominal Fluid Collections after Distal Pancreatectomy: Incidence, Implications, and Natural History.

To investigate the incidence and management of pancreatic fistula and fluid collections (FC) after distal pancreatectomy (DP). Pancreatic fistula and FC are common after DP. The relationship between pancreatic fistula, FC, and surgical drain placement remains unclear. We retrospectively reviewed patients who underwent DP at a single institution between June 2000 and August 2023. 1,212 patients were reviewed. Amongst them, 300 (24.9%) developed a biochemical leak, and 162 (13.4%) developed a postoperative pancreatic fistula (POPF). Of the 949 patients who had at least one postoperative cross-sectional imaging, 500 (52.7%) had a FC. Most FCs were asymptomatic (68%); however, when associated with POPF, the majority (n=121, 89%) became symptomatic and required treatment. Patients with POPF were significantly more likely to develop FC (OR 9.49), whereas biochemical leakage did not significantly increase this risk. Surgical drains did not significantly decrease the likelihood of FC (52% vs. 66%, P=0.06), but did increase POPF (13.9% vs. 4.7%, P<0.001) and the need for intervention for FC (33.6% vs. 12.9%, P=0.019). FC develop in over half of the patients undergoing DP, with approximately one-fourth of these cases associated with POPF. In most instances, FC remain asymptomatic; however, when linked to POPF, they are nine times more likely to become symptomatic and require therapeutic intervention. Although surgical drain placement may not contribute to FC, it was associated with a higher rate of POPF.

Diffusion changes in minimally invasive parafascicular approach for deep-seated tumours: impact on clinical outcomes.

Minimally invasive parafascicular surgery (MIPS) with the use of tubular retractors achieve a safe resection in deep seated tumours. Diffusion changes noted on postoperative imaging; the significance and clinical correlation of this remains poorly understood. Single centre retrospective cohort study of neuro-oncology patients undergoing MIPS. The impact of surgical approach-transsulcal (TS) versus transgyral (TG) - and respective entry points in clinical and imaging outcomes was assessed. 82 patients (35 male; 47 female, average age 43.94 ± 22.85years) were included. 84% presented with neurological deficit and glioblastoma was the commonest diagnosis (38.24%). Surgical approach was not relevant for the number of patients that showed postoperative peritubular injury (TS: 20 (37.74%) versus TG: 8 (27.59%), p = 0.354) or its volume (TS: 0.95 ± 1.82cc versus TG: 0.43 ± 1.32cc, p = 0.1435). When adjusted for preoperative volume and depth of tumour, TS approach was associated with less diffusion restriction (p = 0.030). Temporal lobe access points had the highest volume of diffusion restriction (temporal lobe-2.50 ± 3.54cc versus frontal lobe - 1.15 ± 1.53 versus parietal lobe-0.51 ± 0.91cc, p = 0.0096), particularly in the TS approach (p = 0.0152). Superior motor outcomes were demonstrated in the TS versus the TG approach (postoperative improvement: TS: 14.63% versus TG: 6.9%, p = 0.015), especially for parietal approaches (p = 0.039). TS approach was related with a significantly decreased length of stay (TS-11.67 ± 14.19days versus TG - 23.97 ± 18.01days, p = 0.001). Transsulcal approach demonstrated abetter motor outcome profile, particularly in parietal lobe, and shorter length of stay. The superior temporal sulcus was more susceptible to ischaemic changes. Therefore, transgyral route can be considered in temporal lobe MIPS.

Introducing the Caliber-Flow Status Scale (CFSS): a novel tool for assessing covered cortical branch status after flow diverter treatment of middle cerebral artery aneurysms

BackgroundThis study assessed caliber and flow changes of covered cortical middle cerebral artery (MCA) branches using the new Caliber-Flow Status Scale (CFSS), postoperative diffusion-weighted imaging (DWI) lesions, and clinical outcome...

The utility of routine intraoperative CSF during ventricular shunt insertion: a 10-year retrospective cohort study.

Ventricular shunt insertion is a common procedure in pediatric neurosurgical practice. In many areas of medicine there is a push toward rationalization of healthcare resources and a reduction in low-value tests or procedures. The intraoperative sampling of CSF at the time of shunt insertion is one traditional aspect of care that has not been rigorously evaluated. Additionally, the role of CSF cell counts and chemistry in predicting shunt dysfunction is often discussed but poorly studied. A recent meta-analysis found a correlation between elevated CSF protein levels and shunt failure in patients with tuberculous meningitis, but not other pathologies, which limits the generalizability of those findings to Western populations. The aims of this study were to assess the clinical utility of intraoperative CSF sampling during insertion of ventricular shunts and to describe any association of routine intraoperative CSF sample parameters with shunt failure or infection. A retrospective review of a prospectively maintained surgical database covering 10 years of consecutive cases from a quaternary Australian pediatric neurosurgical center serving a population of 5.3 million was conducted. Statewide electronic medical records were reviewed to collate data on demographics, postoperative imaging, CSF biochemistry, instances of shunt failure, shunt revisions, and mortality. Patients undergoing insertion of a new ventricular shunt were included, while all cases of shunt revision were excluded. During the study period, 1485 shunt procedures were performed, of which 427 involved the placement of a new ventriculoperitoneal shunt system. The mean patient age was 5.2 years (range premature-18 years). Of the 427 cases, 377 (88%) underwent routine CSF sampling. The most common indications for shunt revision were proximal catheter obstruction (51/173, 29%), followed by infection (29/173, 17%) and valve blockage (23/173, 13%). During the study period, 3 patients with existing intracranial hardware had overt ventriculitis identified at the time of intraoperative sampling, resulting in shunt removal. One patient with an existing ventricular reservoir had a delayed clinically significant infection identified on intraoperative cultures. Elevated CSF protein levels were associated with shunt failure during follow-up (area under the curve 0.625). The identified cutoff of 300 mg/L was significantly associated with a reduced time to shunt failure in both univariate and multivariate analyses. It may be reasonable to consider omission of routine intraoperative CSF sampling at the time of shunt insertion in patients without existing intracranial hardware. Elevated CSF protein levels are associated with a reduced time to shunt failure in a dose-dependent manner.

Does the audiogram shape influence the intracochlear recording of Electrocochleography during and after cochlear implantation?

During cochlear implant (CI) surgery, it is desirable to perform intraoperative measurements such as Electrocochleography (ECochG) to monitor the inner ear function and thereby to support the preservation of residual hearing. However, a significant challenge arises as the recording location of intracochlear ECochG via the CI electrode changes during electrode insertion. This study aimed to investigate the relationships between intracochlear ECochG recordings, the position of the recording contact within the cochlea relative to its anatomy, and the implications for frequency and residual hearing preservation. Intraoperative ECochG recordings were conducted using the CI electrode (MED-EL) during the insertion of hearing preservation electrodes and after the insertion process. Recordings were continuously conducted using the most apical electrode (contact 1) during insertion. After insertion, the recordings were performed on all different electrode contacts. The electrode location in the cochlea during insertion was estimated using mathematical models and preoperative clinical imaging, while the postoperative electrode position was determined using postoperative clinical imaging. The study involved 10 adult CI recipients. In those with good low-frequency hearing, an increase in signal amplitude was observed, with the highest amplitudes closest to the stimulation frequency generators, and no phase change was observed. Conversely, patients with flat hearing loss exhibited a second peak with an opposite phase in the medial area of the cochlea. This study is the first to suggest that the pattern of the preoperative audiogram may influence the ECochG outcomes measured intraoperatively. Specifically, the ECochG responses during insertion appeared to behave as expected with good low-frequency hearing, while with flat hearing loss there appear to be further effects. These findings indicate that this approach can provide valuable information for the interpretation of intracochlearly recorded ECochG signals.

Feline sacroiliac luxation: comparison of fluoroscopy-controlled freehand vs. computer-navigated drilling in the sacrum—a cadaveric study

IntroductionSacroiliac luxation is a common traumatic feline injury, with the small size of the sacral body being a challenge for surgical stabilization. This study compared an innovative computer-guided drilling method with the conventional fluoroscopy-controlled freehand technique. Neuronavigation, using CT-based planning and real-time tracking, was evaluated against the freehand method for accuracy and time efficiency.Materials and methodsBilateral sacroiliac luxation was induced in 20 feline cadavers. One side of the sacral body was drilled using fluoroscopy, and the other with neuronavigation (Stealth Station S8). A reference frame was affixed to the sacral spinous process for tracking. Ten cats were operated on by an ECVS diplomate and 10 by a resident. Postoperative cone beam CT images were used to assess both techniques, comparing the accuracy of the planned corridor vs. the actual drill hole in the sacrum. A learning curve for both methods was estimated by measuring procedure time.ResultsCT scan assessments showed all 40 drill holes achieved “surgically satisfactory” results. The computer-navigated technique demonstrated an average deviation of 1.9 mm (SD 1.0 mm) at the entry point and 1.6 mm (SD 0.8 mm) at the exit point. The pins of 3/20 reference frames penetrated the vertebral canal, creating a risk for potential clinical complications. The neuronavigation-guided procedures took an average of 23 min and 37 s (SD 8 min 34 s), significantly longer than the freehand technique, which averaged 9 min and 47 s (SD 3 min 26 s). A steep learning curve was observed with neuronavigation.DiscussionThe neuronavigation-guided technique achieved accuracy is comparable to the fluoroscopy-controlled method, is offering real-time feedback and has potential for highly precise surgeries near critical anatomical structures. However, significant attention must be given to the placement of the reference frame, as it is placed blindly and presents a potential risk for errors and complications. Despite its longer duration, the neuronavigation method shows promise for improving precision in complex surgical scenarios.

Clinical and magnetic resonance imaging outcome after proximal hamstring tendon repair at mean 3 years follow-up

PurposeThe purpose of this study was to assess clinical and radiological outcome in patients after proximal hamstring tendon repair. We hypothesized that there is a significant correlation among subjective clinical outcome and interlimb asymmetries in muscle strength, fatty infiltration, and hamstring volume.MethodsThis retrospective monocentric case series included patients with surgical repair after proximal hamstring tendon rupture. Clinical outcome was assessed utilizing: Healthy Days Core Module (CDC HRQOL-4), numeric pain rating scale (NRS), modified Harris Hip Score (mHHS), Tegner Activity Scale (TAS), return to pre-injury activity level (RTPA), and patient satisfaction score. Postoperative hamstring strength was measured using a handheld dynamometer and radiological outcome was determined by postoperative magnetic resonance imaging (MRI).ResultsTwenty-seven patients with a mean age of 51.2 (± 12.6) years were available for follow-up at a mean of 41.11 (± 18.4) months. Patients state a mean of 10.6 (± 11.5) days in the unhealthy days (UHD) index and 88.9% show “good health” in the simple summary score (SSS). Mean subjective outcome scores were as follows: NRS 1.1 (± 2.4), mHHS 90.3 (± 14.8) and TAS 5.7 (± 2.2). A total of 59.3% RTPA and 88.9% state to be somewhat or very satisfied with their surgery. Mean interlimb strength ratio was 0.88 (± 0.21). MRI demonstrated a fully restored muscle–tendon unit, significantly greater fatty infiltration in the injured hamstrings (p = 0.009, d = 0.558), and a mean interlimb hamstring volume ratio of 0.94 (± 0.11). With respect to the 10% benchmark, patients had no significant asymmetries in muscle strength (p = 0.677, d = 0.084) or hamstring volume (p = 0.102, d = − 0.34). Correlation analysis revealed moderate correlation among asymmetries in strength and volume (p = 0.073, r = 0.373). In patients with the operated side inferior to the healthy side (n = 15), there was strong correlation among asymmetries in strength and volume (p = 0.002, r = 0.725). Statistically significant correlation was found between interlimb muscle volume atrophy and increase in fatty infiltration (p = 0.015, r = 0.481).ConclusionProximal hamstring repair results in good clinical outcome with satisfactory recovery of hamstring strength and volume. Interlimb asymmetries, in terms of muscle strength, fatty infiltration, and hamstring volume do not correlate with clinical outcome.Study TypeRetrospective cohort study; Level of evidence, 3.

Evaluation of a patient-specific 3D-printed guide for ventral slot surgery in dogs: An ex vivo study.

To evaluate the accuracy of ventral slot creation in canine cadavers with a three-dimensional (3D)-printed drill guide compared to the freehand technique. Ex vivo study. Eight canine cadavers (23.4-39.8 kg). Computed tomography (CT) data was used to create patient-specific 3D-printed surgical guides for ventral slot creation. Intervertebral sites were randomized to undergo either a guided (n = 12) or freehand (n = 12) ventral slot by a novice surgery resident. Postoperative CT images were used to compare ventral slot dimensions, shape, and position. Free-hand ventral slots were significantly shorter than the intended dimensions (p < .01). Dimensions of the guide-assisted ventral slots were not statistically different from the planned dimensions (p = .88, p = .72). Use of the guides resulted in improved accuracy for ventral slot positioning relative to midline and slot shape (difference in coefficient of variations, 32%, and 40%, respectively). Ventral slot dimensions were more accurate when created with the patient-specific 3D-printed guide compared to the freehand technique. Use of a 3D-printed patient specific surgical guide improves accuracy of ventral slot creation in canine cadavers and improves surgical precision when used by a single novice surgical resident. The results of this study support evaluation of the guides in small breed cadavers and live patients.

Effects of Scalp Nerve Block on Symptomatic Cerebral Hyperperfusion Syndrome After Combined Revascularization Surgery for Moyamoya Disease.

Strict blood pressure control can be used to prevent or treat cerebral hyperperfusion syndrome. This study investigated whether scalp nerve block (SNB) is associated with a reduced risk of postoperative symptomatic cerebral hyperperfusion syndrome (SCHS) by reducing postoperative blood pressure in adult patients who underwent combined revascularization surgery for moyamoya disease. Patients were retrospectively divided into the SNB (n=167) and control (n=221) groups depending on whether SNB was performed immediately before placement of wound dressings at the end of surgery. Postoperative SCHS was defined as new-onset postoperative neurological deficits with a focal increase in cerebral blood flow at the perianastomosis site in the absence of infarction or hemorrhage on postoperative brain imaging. Inverse probability of treatment weighting was used to balance preoperative variables between the 2 groups. The incidence of postoperative SCHS did not differ between the SNB and control groups (61 [36.5%] vs. 102 [46.2%], P=0.072), but its duration was shorter in the SNB group (4 [2-6] vs. 5 [3-7] days, P=0.021). Although of limited clinical relevance, the SNB group had lower postoperative pain scores and systolic blood pressures at postoperative days 0 to 1 and a shorter intensive care unit stay. Despite some potential benefits, SNB was not associated with a reduced incidence of postoperative SCHS in adult patients who underwent combined revascularization surgery for moyamoya disease.

Cerebellar Mutism/Posterior Fossa Syndrome Following Resection of Posterior Fossa Tumor in Pediatric Patients: Assessing Pathophysiology, Risk Factors, and Neuroradiographic Features

Background Cerebellar mutism syndrome (CMS) is a postoperative syndrome of decreased speech seen in children associated with neurobehavioral abnormalities, the incidence of which is up to 40%. Objective To evaluate pediatric patients with posterior fossa tumors for incidence, clinical characteristics, pathophysiology, risk factors, and neuroradiographic features of this syndrome. Materials and Methods The study included 60 pediatric patients with a posterior fossa tumor who underwent surgery by a telovelar approach. Detailed pre- and postoperative clinical and radiological evaluations were done. Patients with CMS were analyzed and compared with those without mutism to find risk factors for CMS. The presentation and characteristics of cerebellar mutism were studied along with the following risk factors:The preoperative, immediate postoperative, and 1-year postoperative imaging results were reviewed to assess the neuroradiographic features in the two groups. Results The incidence of this syndrome was 20%. The mutism was accompanied by some neurobehavioral abnormalities (p-value = 0.05). The most significant finding was the presence of a period of cerebellar dysarthria after the resolution of the muteness (p-value &lt; 0.001) in all cases. Brainstem and related structures' involvement was the most significant risk factor (p-value = 0.03). The presence of brainstem and peduncular edema in the immediate postoperative period (p-value = 0.04) and gross atrophy of posterior fossa structures at 1 year (p-value = 0.01) showed significance toward the development of CMS. There was delayed neurological recovery in patients with CMS with a poor Glasgow Outcome Score at 1 year of follow-up. Conclusion The clinical presentation of this syndrome in context with neuroradiographic features suggests that it results from transient impairment of the afferent and/or efferent pathways of dentate nuclei that are involved in initiating complex volitional movements and are associated with brainstem involvement of tumor and poor functional outcome.

T-branch by partial deployment technique in the endovascular repair of complex aortic and thoracoabdominal aneurysms with narrow or severe angulated para-visceral aorta.

The partial deployment technique (PDT) is an unconventional option of T-branch deployment to allow target arteries (TAs) cannulation/stenting from the upper arm access, in case of narrow (NPA: <25mm) or severely angulated (APA: >60°) aorta. Aim of this study was to report outcomes of the endovascular repair of complex aortic (c-AAAs) and thoracoabdominal (TAAAs) aneurysms by T-branch and PDT. All consecutive patients underwent urgent endovascular repair of c-AAAs and TAAAs by T-branch (Cook-Medical, Bloomington, IN, US) and PDT from 2021 to 2023 were analyzed. Technical success (TS), 30-days mortality, TAs-instability within 30-days and 1-year as well as reinterventions were assessed as primary endpoints. Time of intraoperative pelvic/lower limb ischemia, spinal cord ischemia (SCI) and perioperative stroke were assessed as secondary endpoints. Thirty-three cases were analyzed. There were 6(18%) type I endoleaks in failed EVAR, 9(28%) juxta/para-renal aneurysms, 6(18%) post-dissection and 12(36%) degenerative TAAAs, respectively. The median para-visceral aortic lumen diameter was 23(IQR:19-27) mm and 10(30%) cases had APA. Out of 128 TAs, 111(87%) were cannulated/stented with distally captured aortic graft. The median time of pelvic/lower limb ischemia was 120 (IQR:90-150) minutes. TS was achieved in all patients. One (3%) patient suffered SCI and there were no cases of stroke. An asymptomatic renal artery occlusion was detected at postoperative imaging which was recanalized by thrombus-aspiration/relining. This was the only case of TAs-instability (1/128-0.8%) and reintervention (1/33-3%) within 30-day. Two (6%) patients died within 30-days. Median follow-up was 14(IQR:6-22) months. One (3%) case of bilateral renal artery occlusion occurred at 6-months. No superior mesenteric artery or celiac trunk events occurred, with an overall TAs-instability rate of 2% (3/128). Eighteen (55%) patients completed the radiological follow-up at 1-year with no new case of TAs-instability. Freedom from TAs-instability was 91% at 1-year. T-branch by PDT seems to be safe and effective in the management of c-AAAs/TAAAs with NPA or APA. Results were satisfactory in terms of TS and mid-term TAs-instability, suggesting a possible enlargement of the anatomical feasibility criteria for outer branches in urgent cases.

Comparison of clinical and radiological outcomes of three-column lumbar osteotomies with and without interbody cages for adult spinal deformity.

Correcting sagittal malalignment in adult spinal deformity (ASD) is a challenging task, often requiring complex surgical interventions like pedicle subtraction osteotomies (PSOs). Different types of three-column osteotomies (3COs), including Schwab 3, Schwab 4, Schwab 4 with interbody cages, and the "sandwich" technique, aim to optimize alignment and fusion outcomes. The role of interbody cages in enhancing fusion and segmental correction remains unclear. This study aimed to compare outcomes among these 4 3CO techniques, evaluating the impact of cage use at the osteotomy site on postoperative radiographic imaging and clinical outcomes. This is a multicenter retrospective study utilizing data from a prospective multicenter database of patients undergoing complex ASD surgery. Ninety-seven patients who underwent 1 of 4 3CO techniques for thoracolumbar ASD correction with at least 2 years of follow-up were included. The sample consisted of 29 patients who underwent Schwab 3 osteotomy, 20 Schwab 4, 28 Schwab 4 with interbody cages, and 20 who underwent "sandwich" osteotomy. The Scoliosis Research Society-22 revised (SRS22r) questionnaire evaluating pain, activity, appearance, mental health, and satisfaction was used to evaluate patient reported outcomes and radiographic measures including segmental lordosis and fusion rates determined by 3 blinded reviewers were used to evaluate physiologic outcomes. This study analyzed demographic data, radiographic outcomes, patient-reported outcomes, complications, and fusion rates over a 2-year follow-up period. Fusion status was determined via serial radiographs and evaluated independently by 3 blinded reviewers. Univariate and multivariate statistical analyses were performed to assess differences among the groups and the impact of interbody cage use on outcomes. Patients undergoing "sandwich" osteotomy exhibited worse preoperative leg pain scores and lower SRS22r activity (p=.015), appearance (p=.007), and mental health domain scores (p=.0015). No differences in complications were found among groups (p>.05). Patients who underwent osteotomy with a cage were more likely to have had previous spine fusion (91.7% vs. 71.4%, p=.010). Additionally, these patients had lower preoperative SRS22r mental domain (2.9±1 vs. 3.5±1, p=.009), satisfaction (2.3±1 vs. 2.7±1.2, p=.034), and SRS22r total scores (2.3±0.6 vs. 2.6±0.6, p=.0026) but demonstrated the greatest improvement in the mental health domain (0.9±0.7 vs. 0.3±0.9, p=.002). Cage use was associated with a larger mean change in segmental lordosis at the osteotomy site (32.9±9.6 vs. 28.7±9.5, p=.038). Fusion rates were significantly higher in the cage group (79.2% vs. 55.1%, p=.0012). Regression analysis identified cage use as an independent predictor for fusion (odds ratio, 3.338; 95% confidence interval, 1.108-10.054, p=.032). Interbody cage use at the osteotomy site during 3COs for ASD correction was associated with improved fusion rates and greater segmental lordosis without increasing complication rates. Incorporating cages may provide enhanced alignment and fusion outcomes in complex ASD surgeries.

Supine Traction vs Fulcrum Bending Radiographs in Preoperative Imaging of Scoliosis Patients Treated With Magnetically Controlled Growing Rods (MCGR) - which Technique is Better to Predict Surgical Correction of the Main Curve?

Retrospective Cohort Study. Flexibility radiographs such as traction or bending radiographs are essential in preoperative imaging to assess for curve flexibility and to estimate the amount of operative correction in order to determine the type and length of instrumentation in growth-accompanying scoliosis treatment. Both traction and bending radiographs are controversially discussed in the literature. The predictability of flexibility radiographs of postoperative main curve correction specifically in patients treated with magnetically controlled growing rods (MCGR) has not yet been studied. Juvenile patients with idiopathic or neuromuscular scoliosis that were surgically treated with a primary MCGR implant with pedicle screw fixation between 2018-2022 were retrospectively registered. Patients that underwent prior spine surgery, with supine lying-down radiograph and patients with missing traction or bending radiographs available were excluded. Image analysis was conducted using Surgimap® software. For statistical analysis, t test and ANOVA analysis were used to compare the means between groups with a significance level set at P < 0.05. A total of 50 patients, 34 diagnosed with idiopathic scoliosis (IS) and 16 diagnosed with neuromuscular scoliosis (NMS), were included. Globally, main curve Cobb angles were significantly higher in supine traction compared to fulcrum bending images (44.8° vs 39.6°; P < 0.001) and in the IS subgroup (42.4° vs 37.3°; P < 0.001). Compared to postoperative images, significant differences of supine traction but not fulcrum bending radiographs were detected in total (P < 0.001; P = 0.20) as well as IS (P < 0.001; P = 0.32) and NMS (P < 0.001; P = 0.44) subgroups. Fulcrum bending images displayed significantly higher flexibility rates (FR) and flexibility index (FI) compared to traction images in total (FR: 42.9 vs 35.2, P < 0.001; FI: 1.08 vs 1.58, P = 0.024) and the IS subgroup (FR: 44.2 vs 35.8, P < 0.001; FI: 1.19 vs 1.43, P = 0.033). Fulcrum bending radiographs showed better flexibility and prediction of operative main curve correction compared to supine traction radiographs in total and IS subgroup. Fulcrum bending might be more precise for predicting the postoperative main curve correction potential of primary MCGR surgery in IS patients.