Postoperative Imaging Research Articles

Comparative analysis of MRI-based VBQ and EBQ score for predicting cage subsidence in PILF surgery

Background contextAs lumbar degenerative diseases become more prevalent in an aging population, there is an increasing demand for surgical interventions, such as posterior lumbar interbody fusion (PLIF). However, cage subsidence (CS), observed in 23.9–54% of cases postoperatively, remains a significant complication. Several factors, including age, bone quality, and endplate damage, contribute to the risk of CS, with bone quality being among the most critical determinants. Although DEXA and QCT are widely employed to assess bone density, their routine use in preoperative evaluations is restricted by cost considerations and radiation exposure. Recent studies suggest that MRI-based vertebral body quality (VBQ) and endplate bone quality (EBQ) score offer a viable, non-invasive alternative for evaluating bone quality; however, there is limited research comparing their predictive value for CS.MethodsIn this retrospective study, 165 patients undergoing single-level PLIF surgery were included. MRI-based VBQ and EBQ score were calculated using T1-weighted images, and preoperative QCT was employed as a clinical standard. Cage subsidence was assessed based on postoperative imaging at 12-month follow-up. Statistical analyses, including t-tests, chi-square tests, and ROC curve analyses, were used to evaluate the predictive accuracy of VBQ and EBQ for CS.ResultsThe study’s findings demonstrated that both VBQ and EBQ scores were significantly correlated with QCT measurements, thereby validating their utility as indicators of bone quality. ROC analysis revealed that VBQ had superior predictive value for CS (AUC = 0.814) compared to EBQ (AUC = 0.719), with both scores demonstrating significant clinical utility in identifying patients at risk for CS. Notably, VBQ exhibited a stronger correlation with preoperative clinical outcomes compared to EBQ, underscoring its greater reliability as a predictor.ConclusionsThis study highlights the effectiveness of MRI-based VBQ and EBQ score as practical, non-invasive tools for assessing bone quality preoperatively, with VBQ demonstrating superior predictive performance for CS risk. The findings underscore the potential of integrating these MRI-based assessments into routine preoperative planning to improve patient outcomes and minimize complications associated with PLIF surgery.

Low Complication Rates in Olecranon Fracture Fixation With Dual Plating.

Most olecranon fractures are intra-articular, affecting the extensor mechanism of the elbow, and are treated surgically with dorsal plate fixation or tension band. Due to shortcomings of dorsal plates related to prominence, insufficient fixation of sagittal fracture lines, and difficulty matching proximal ulna dorsal angulation (PUDA), dual medial and lateral plating (DP) has been developed. We hypothesized that olecranon fractures treated with DP would have low complication rates and low incidence of hardware removal compared with those treated with traditional methods of fixation. The database of a single institution was reviewed for the period January 2017 to April 2023 for adults with olecranon fractures receiving DP fixation. Open fractures, fracture dislocations, previous elbow injuries, and pathologic fractures were excluded. Demographics, pre- and postoperative imaging, reoperations, and range of motion were collected. PUDA and varus angulation measurements, intra-articular step off, and fracture distraction were recorded. A total of 42 fractures in 41 patients were reviewed. Mean follow-up was 8.7 months (range, 3-36 months). One patient reported symptomatic hardware at 6 weeks that had resolved by 3 months, and 1 reported persistent symptomatic hardware not bothersome enough to warrant removal. Five patients (11.9%) had at least 1 postoperative complication. The hardware removal rate was 2.4%. DP for olecranon fractures represents a valuable strategy in fracture treatment. We report a low hardware removal rate of 2.4%, with removal being done for infection, not symptomatic hardware. DP provides a reliable method of fixation, helps re-create native anatomy, and has a low complication rate compared with standard dorsal plating. [Orthopedics. 202x;4x(x):xx-xx.].

Clinical application of mineralized collagen scaffolds in surgical treatment of skull defects

To explore the clinical application value of mineralized collagen (MC) bone scaffolds in repairing various types of skull defects, and to assess the suitability and repair effectiveness of porous MC (pMC) scaffolds, compact MC (cMC) scaffolds, and biphasic MC composite (bMC) scaffolds. A retrospective analysis was conducted on the clinical data of 105 patients who underwent skull defect repair with pMC, cMC, or bMC between October 2014 and April 2022. The cohort included 63 males and 42 females, ranging in age from 3 months to 55 years, with a median age of 22.7 years. Causes of defects included craniectomy after traumatic surgery in 37 cases, craniotomy in 58 cases, tumor recurrence or intracranial hemorrhage surgery in 10 cases. Appropriate MC scaffolds were selected based on the patient's skull defect size and age: 58 patients with defects <3 cm² underwent skull repair with pMC (pMC group), 45 patients with defects ≥3 cm² and aged ≥5 years underwent skull repair with cMC (cMC group), and 2 patients with defects ≥3 cm² and aged <5 years underwent skull repair with bMC (bMC group). Postoperative clinical follow-up and imaging examinations were conducted to evaluate bone regeneration, the biocompatibility of the repair materials, and the occurrence of complications. All 105 patients were followed up 3-24 months, with an average of 13 months. No material-related complication occurred in any patient, including skin and subcutaneous tissue infection, excessive ossification, and rejection. CT scans at 6 months postoperatively showed bone growth in all patients, and CT scans at 12 months postoperatively showed complete or near-complete resolution of bone defects in all patients, with 58 cases repaired in the pMC group. The CT values of the defect site and the contralateral normal skull bone in the pMC group at 12 months postoperatively were (1 123.74±93.64) HU and (1 128.14±92.57) HU, respectively, with no significant difference ( t=0.261, P=0.795). MC exhibits good biocompatibility and osteogenic induction ability in skull defect repair. pMC is suitable for repairing small defects, cMC is suitable for repairing large defects, and bMC is suitable for repairing pediatric skull defects.

A Rare Case of Cervical Rhabdomyosarcoma in an Adolescent- A Case Report

We present a rare case of cervical embryonic rhabdomyosarcoma (ERMS) in adolescents, managed with fertility-sparing surgery and chemotherapy. This type of malignant tumour is rare, and the management is not codified. A 15-year-old girl presented with a tongue-like mass per vagina and abnormal discharge. She underwent vaginoscopy under anaesthesia, which revealed a polyp from the endocervix. Hysteroscopic resection was performed, and histopathology showed ERMS. Postoperative imaging suggests the presence of residual local disease without evidence of distant metastasis. A multidisciplinary team (MDT) meeting was conducted, and the family opted for fertility-sparing management. The patient underwent repeat hysteroscopy-guided local excision, followed by eight cycles of chemotherapy, with close surveillance. In conclusion, polyps are rather odd in adolescents; malignancy should always be suspected. Fertility-sparing surgery with chemotherapy is a plausible option in well-selected cases.

Changes in the Structure, Function, and Fat Content of the Heart in Patients with Obesity After Bariatric Surgery-A Prospective Magnetic Resonance Imaging Study.

Changes in myocardial fat in addition to changes in cardiac structure and function have not been accurately evaluated in obese patients following surgery. Forty-four obese patients who underwent sleeve gastrectomy and completed preoperative and postoperative cardiac magnetic resonance imaging (CMR) before surgery and at 1, 3, and 6 months after surgery were enrolled, and their clinical and laboratory data were collected. The differences and correlations between clinical, laboratory, and CMR parameters between the preoperative and postoperative groups were analysed. The left ventricular mass (LVM), left ventricle cardiac output (LVCO), pericardial adipose tissue volume (PATV), and myocardial proton density fat fraction (M-PDFF) decreased after surgery (all P < 0.05). The left ventricle global longitudinal strain increased at 6 months after surgery (P = 0.004). A decrease in BMI was positively correlated with the LVCO (r = 0.58, P < 0.001) at 3months after surgery and was positively correlated with the LVM and PATV (r = 0.54, P < 0.05) at 6months after surgery. Six months after surgery, the changes in PATV were positively correlated with the changes in triglycerides (r = 0.61, P < 0.01). There was a moderately positive correlation between the decrease in the LVM and PATV (r = 0.54 ~ 0.71, P < 0.02) after surgery. After surgery, the cardiac structure and function of obese patients significantly improved, the PATV and M-PDFF decreased, and there was a correlation between the structure and function of the heart and several clinical and laboratory indicators.

Quality and Consistency of Rhinoplasty Photos on Social Media: Prevalence of Potentially Misleading Before-and-After Images.

Introduction: There is significant variability in how rhinoplasty results are presented on social media. This study aims to evaluate the quality and consistency of preoperative and postoperative rhinoplasty photos on the social media platform Instagram. Methods: Instagram was queried on April 4, 2024 using the search term #rhinoplastybeforeandafter. Posts meeting our inclusion criteria were analyzed for inconsistencies in background, makeup, use of personal photo, and variations in face size between preoperative and postoperative images. Account demographics and time since surgery were also noted. Results: A total of 888 sets of before-and-after rhinoplasty photos were included, with nearly all (n = 882) posted by surgeon accounts. Of the posts analyzed, 23.7% had a ≥10% face size discrepancy, and 5.1% had a ≥10% face rotation discrepancy. Only 35.7% of posts were considered "high quality," with no significant photo discrepancies between postop and preop images and with postoperative time interval reported. Conclusion: Instagram before-and-after rhinoplasty photos evaluated in this study exhibited significant heterogeneity in quality and consistency regarding image background, image source, face size, face rotation, and brightness. Surgeons should prioritize consistency between preoperative and postoperative photos when sharing their results to minimize the potential for misleading the public.

Comparison of robot versus fluoroscopy-assisted pedicle screw instrumentation in adolescent idiopathic scoliosis surgery: a Meta-analysis

AimTo investigate the safety and accuracy of robot-assisted pedicle screw placement in adolescent idiopathic scoliosis (AIS) surgery.MethodsPubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for studies utilizing the clinical data of adolescent idiopathic scoliosis patients (robot-assisted and fluoroscopy-assisted group) who underwent posterior pedicle screw fixation to collect preoperative, postoperative and follow-up indexes and imaging parameters, including screw implantation accuracy, the number of intraoperative fluoroscopy times, amount of bleeding, operation time, postoperative VAS score and postoperative Cobb angle.ResultsSix studies were included in this meta-analysis, including 154 patients in the intervention group and 171 patients in the control group. Our results showed that screw implantation accuracy (WMD 1.07, 95% CI (1.01,1.14), P = 0.03) was higher than that in the control group. The number of intraoperative fluoroscopy times (WMD -6.11, 95% CI (-9.60, -2.62), P = 0.0006) and operation time (WMD 31.52, 95% CI (5.70,57.35), P = 0.02) in the robot group were less, and the differences were statistically significant. Intraoperative blood (WMD -59.05, 95% CI (-212.81,94.70), P = 0.45), postoperative VAS score (WMD -0.07, 95% CI (-0.24,0.11), P = 0.46), preoperative Cobb angle (WMD 0.79, 95% CI (-1.12,2.69), P = 0.42) (Fig. 7), postoperative Cobb angle (WMD -0.25, 95% CI (-1.12,0.62), P = 0.57) (Fig. 8) had no statistical significance in the robot group compared with control group.ConclusionThe robot navigation system can improve screw implantation accuracy and reduce the operation time and radiation exposure during the operation.

Iodinated contrast dye-diluent combination exhibits longer time to full dye saturation compared to lidocaine, bupivacaine, and water in porcine cadaveric nervous tissue.

Dye-diluent combinations have different nerve-staining behavior, making locoregional cadaveric dye study findings difficult to compare. The objective of this study was to quantify the effect of 4 diluents on nerve color saturation when used in combination with commercial food dye. 48 unpreserved brachial plexus nerves were randomized into 4 diluent groups. Lidocaine, bupivacaine, iodinated contrast, and sterile water were combined with commercial food dye (10:1), and prosected nerves were immersed in one of these groups for 1, 15, 30, or 60 minutes. Images at baseline and at each timepoint were processed using ImageJ. Color saturation was divided into quartiles (dark, medium dark, medium light, or light). The percentage of nerve area stained in each quartile was compared using a 2-way ANOVA and post hoc Tukey test. At 1 minute, water and bupivacaine had a higher percentage of area of dark saturation compared to contrast. At 15 and 30 minutes, dark and medium-dark saturation percentages of area were also larger in lidocaine, bupivacaine, and water compared to contrast. There were no differences in saturation percentages of areas between groups at 60 minutes. Within groups, all diluents had darker percentages of area saturation at 15, 30, and 60 minutes compared to minute 1. In porcine nerves, the staining profiles of 2% lidocaine, 0.5% bupivacaine, and sterile water combined withcommercial food dye appear similar and may be used interchangeably after 15 minutes of exposure. When using iodinated contrast, exposures over 60 minutes yield comparable results to other diluents. Diluents contribute to heterogeneous nerve-staining behavior and should be considered when comparing study outcomes. If contrast is used as the diluent in cadaveric studies with postoperative imaging, researchers should be aware of the significant delay to reach a saturation level comparable to other diluent combinations.

Primary Cuff Repair Augmented With a Balloon Spacer in a Large and Massive Rotator Cuff Tear Series: A Technique and Short-term Outcome and Imaging Study

Massive rotator cuff tears are a challenge for patients and surgeons. We explored the outcomes of patients with massive rotator cuff tears primarily treated with primary cuff repair augmented with a subacromial balloon spacer. The mean age of the patients was 64.3 years, with 24 (71%) having massive cuff tears and the remaining 29% having large cuff tears. Most patients (61%) exhibited significant fatty atrophy (at least grade 3 Goutallier). At 6 months, patients showed improved Constant score, UCLA score, and Oxford Shoulder Score. Pain scores also significantly decreased. A phase 1 study of postoperative imaging indicated balloon disintegration in 50% of cases at 6 weeks. Augmenting primary cuff repair with a subacromial balloon spacer demonstrates promising short-term outcomes. Our postoperative images suggest that balloon disintegration may occur as early as 6 weeks. We recommend caution in using a balloon spacer as a standalone therapy. [ Orthopedics . 202x;4x(x):xx–xx.]

Impact of postoperative cauda equina clumping on recovery after biportal endoscopic decompression for severe lumbar stenosis.

This study determined the prevalence of cauda equina clumping among patients with Schizas grade C or higher central stenosis after decompression and compared the radiographic and clinical outcomes between patients with and without clumping. We conducted a single-center retrospective cohort study involving 98 patients who underwent biportal endoscopic spine surgery between January 2019 and June 2022. Based on postoperative magnetic resonance imaging findings, the patients were divided into the clumping (n = 40) and non-clumping (n = 58) groups. Clinical outcomes were assessed using the visual analog scale for back and leg pain, Oswestry Disability Index (ODI), and EuroQol 5-Dimension (EQ-5D-5L) questionnaire at 1, 3, 6, and 12 months postoperatively. Radiographic evaluations included measuring the cross-sectional area of the dural sac preoperatively and 1 month postoperatively using the PACS software. Postoperative cauda equina clumping was observed in 40.8% of the patients. Despite an average dural sac expansion of approximately 270%, the clumping group exhibited significantly higher radiating pain at 3 and 6 months (p < 0.05) than the non-clumping group. The ODI and EQ-5D scores were worse in the clumping group at 3 months (p < 0.05). At 12 months postoperatively, differences in clinical outcomes between the two groups were not significant. Patients in the clumping group required longer duration of postoperative medication than those in the non-clumping group (p = 0.024). Post-decompression cauda equina clumping is commonly observed in patients with severe lumbar stenosis and impacts intermediate-term clinical recovery. Although long-term outcomes at 1 year are similar, tailored postoperative care is essential for patients exhibiting clumping to effectively manage prolonged symptoms.

Comparable postoperative outcomes in patients treated with either open or arthroscopic trochleoplasty for patella dysplasia

BackgroundThe aim of this study was to compare the clinical and radiologic results of the arthroscopic and the open trochleoplasty techniques.MethodsA total of 83 trochleoplasties in 83 patients were performed between 2014 and 2021 in one institution. Surgical indications for trochleoplasty were recurrent patellofemoral instability and a lateral trochlear inclination angle (LTI) ≤ 11˚ and a trochlear depth ≤ 6 mm. Of the trochleoplasties, 40 were done by open technique (OT) and 43 by arthroscopic technique (AT). In every case an additional medial patellofemoral ligament (MPFL) reconstruction was performed. Additional tuberosity tibia transfer and/or de-rotation of the femur were done when indicated. Pre- and postoperative magnetic resonance imaging (MRI) were analyzed in respect to LTI, trochlear depth, and lateralization of the patella. Postoperative subjective clinical assessment was done using the Kujala Score, Banff II Score, Tegner Score, and Marx Score.ResultsOf the patients, 15 with OT and 20 with AT were available for follow-up. The mean follow-up was 29.9 months in the OT group and 12.7 months in the AT group. No re-dislocation was observed in either groups. A significant reduction of LTI, increase of trochlear depth, and a reduction of lateralization of the patella was observed between the pre- and postoperative MRI scans in both groups. No significant difference in the observed MRI parameters was found between the two groups. Neither was there a difference in the postoperative Kujala Score, Banff II Score, Tegner Score, and Marx Score between the two groups. Length of stay was on average 6.2 days in the AT group and 8.1 days in the OT group. The surgical time was on average 141 min in the OT group and 160 min in the AT group.ConclusionWe found that patients undergoing an arthroscopic trochleoplasty had a comparable outcome with respect to clinical and radiological parameters compared with patients treated by open trochleoplasty.

Symptomatic arachnoid cysts in adults: illustrative cases.

Although intracranial arachnoid cysts are often asymptomatic, a small subset of patients develop debilitating symptoms. A cohort of patients with arachnoid cysts with varying presentations underwent endoscopic cystoventriculostomy, with a significant reduction in symptoms. Three patients presented with chronic complaints, all involving headache in addition to other symptoms, and were noted to have large intracranial arachnoid cysts on imaging. Following endoscopic cystoventriculostomy, symptom reduction was both rapid and significant. Postoperative imaging revealed slight changes in cyst size and improvement in mass effect. Endoscopic cystoventriculostomy for symptomatic arachnoid cysts in adults can decrease the chronic symptoms related to mass effect. Careful planning of the surgical trajectory to target the portion of the arachnoid cyst nearest to the ventricular wall allows for a safe and effective intervention that can lead to significant improvement in symptoms. https://thejns.org/doi/10.3171/CASE24428.

Patient reported outcomes and decision regret scores in redo-paraesophageal hernia repair.

Recurrent paraesophageal hernia (PEH) repair presents significant technical challenges, with limited data weighing the benefit to the operative risk. This study aims to describe our experience with recurrent PEH repair, including long-term surgical and patient reported outcomes(PROs). We conducted a retrospective review of recurrent PEH repairs from June 2018-March 2023 using our institutional database. A blinded review of post-operative imaging was conducted to assess for recurrence. Quality of life (QOL) and decision regret were measured using the GERD Health-Related Quality-of-Life (GERD-HRQL) questionnaire and Decision Regret Scale (DRS) at maximum follow up. Eighty-eight patients underwent recurrent PEH repair at our institution for PEH, classified as type II (13.6%), type III (72.7%) and type IV (13.6%). There was significant heterogeneity in operative techniques used: one-third of patients had mesh placed at the hiatus, 11.4% had a Collis gastroplasty, and one-third of patients underwent fundoplication. Intraoperative complications included gastric (5.7%), esophageal (2.3%), vascular (1.1%) and pulmonary (1.1%) injuries. Follow up was available for 73 patients with median follow up of 35.2months. Of patients with radiographic follow up, 20 (35.7%) had a radiographic recurrence: 12 (21.4%) were 2-5cm and 8 (14.3%) were > 5cm. Patients reporting PROs (53 patients; 60.2%) reported low symptom severity (mean GERD-HRQL 13.1 ± 12) and low decision regret (mean DRS 13.3 ± 19.4) with 75.5% scoring in the lowest quartile (DRS < 25). Radiographic recurrence was associated with worse QOL (p < 0.05), but no significant difference in decision regret (p = 0.125). We found significant heterogeneity amongst recurrent PEH repair techniques with continued high recurrence rate during follow up. Radiographic recurrence was correlated with worse QOL, yet patients reported low symptom severity and low decision regret, suggesting continued value in these challenging operations. Future studies should aim to identify more effective techniques to reduce recurrence rates in this patient population.

Electrode contact estimation based on preoperative versus postoperative imaging as a basis for anatomy-based fitting

Abstract Anatomy-based fitting (ABF) has the potential to lead to better outcomes than conventional clinically-based fitting (CBF). It has already been shown that anatomy-based fitting based on postoperative imaging (postopABF) can improve speech understanding. Moreover, it was demonstrated that patients preferred anatomy-based fitting maps based on preoperative imaging (preop ABF) over CBF. The goal of this study was to examine if a difference between preopABF and postopABF could be observed. Via the software OTOPLAN4 (CAScination, MED-EL) the electrode position was calculated based on preoperatively, as part of the clinical routine, obtained imaging (CT or MRI). If necessary, after the cochlear implantation surgery the selected electrode array was adapted if a different array was chosen intraoperatively. This data was exported into the fitting software MAESTRO to enable a preopABF. The same process was done based on postoperative imaging (CT) so that 1) the frequency bands were compared between preopABF and postopABF data and 2) the difference was displayed in semitones. 27 Patients could be included who got a postoperative CT scan. In addition, subjective tinnitus and dizziness or imbalance issues did not significantly change from the pre-operative appointment over the first fitting to the control fitting one month later. In this study, we could show that there is no significant difference between apical to medial and a significant difference for medial to basal electrode contacts between the preopABF and postopABF regarding the frequency bands. Thus, preopABF is an easy, clinically practicable way to implement ABF, which is promising to lead to better outcomes without extra costs and the radiation burden that comes with postopABF. If patients subjectively prefer either preopABF or postopABF is still to be examined.

CT-based radiomics predicts adjacent vertebral fracture after percutaneous vertebral augmentation.

Adjacent vertebral fracture (AVF) is a frequent complication following percutaneous vertebral augmentation (PVA). While radiomics is widely utilized in the field of spinal medicine, its application for assessing the risk of AVF in post-PVA patients remains limited. We aim to develop and validate predictive models using machine learning algorithms for radiomics and clinical risk factors to assess the risk of AVF after PVA. This retrospective study included 158 patients with osteoporotic vertebral compression fractures who underwent PVA at our hospital, of which 48 patients had AVF within 2years. The patients were divided into train and test cohorts in a ratio of 7:3. Radiomics features of the surgically intervened vertebrae were extracted from CT images, and selected using Mann-Whitney U-test and LASSO regression to construct a radiomic signature. Machine learning algorithms (SVM and LR) were then employed to integrate the radiomics signature with clinical data to develop predictive models. The performance of the model was assessed using Receiver Operating Characteristic (ROC) curves and calibration curves. Nine optimal radiomics features were selected to form the radiomics model, while five clinical features were identified for the clinical model. The AUCs of the radiomics, clinical, and combined models developed using the SVM algorithm were 0.77, 0.77, and 0.83 on the test cohort, and those of the LR algorithm were 0.78, 0.81, and 0.86. Radiomics and machine learning modeling using postoperative CT images demonstrate noteworthy capability in assessing the risk of AVF following PVA.

Image fusion for intraoperative evaluation of microwave ablation in non-small cell lung cancer: a retrospective cohort study.

Patients with early-stage non-small cell lung cancer (NSCLC) who are intolerant to surgery have a poor prognosis. Microwave ablation is an effective treatment method. However, the density of the lesion may occasionally be similar to that of the ablation zone, thus rendering it difficult to identify the relative position of the lesion and ablation zone during ablation. This study aimed to use image fusion technology to help confirm the relative position of lesions and ablation zones and to facilitate immediate assessment of the residual lesions. This retrospective study was conducted in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, between August 2019 and August 2021, and consecutively included patients who had undergone computed tomography (CT)-guided percutaneous microwave ablation for NSCLC. A single radiologist manually fused the intraoperative CT images alignment of the lesions. Two other clinicians examined the postoperative CT images and the fused CT images to determine whether a lesion remained and to measure the minimum ablative margin (MAM). One of the clinicians assessed the complete ablation rate on CT images 6 months after ablation. The Chi-squared test was used to calculate the kappa coefficients between the two investigators. Binary logistic regression was used to analyze the correlation between each characteristic parameter of the lesion and image quality. The clinicians involved in this study all had over 10 years of work experience. Among the 29 participants, comprising 32 lesions retrospectively included (median age 65 years; 41.4% male), the image fusion success rate was 96.88%, and the median fusion time was10 minutes. The rate of accurate recognition for the relative position of pulmonary nodules and ablation zone on original CT images of the two physicians was 7.52% and 12.90%, respectively, while that achieved from the fused CT images was 87.1% and 86.0%, respectively; in agreement testing, the kappa coefficient between the physicians was 0.859 (P<0.001). The MAM on fused images was 3.05±1.35 mm (range, 1.1-6.7 mm). The quality of fused images was positively correlated with the CT values of focus (P=0.009). The complete ablation rate (93.5%) indicated by immediate image fusion post ablation was consistent with that determined by CT images after 6 months after ablation, with 100% sensitivity and specificity. Image fusion is a valuable strategy for evaluating whether intraoperative ground glass nodules are completely ablated by microwave ablation.

Combined Superior Capsular Reconstruction Using Fascia Lata Autograft and Lower Trapezius Transfer Using Achilles Tendon Allograft is Associated with Improved Surgical Outcomes in Patients with Posterosuperior Irreparable Massive Rotator Cuff Tears.

To evaluate the minimum 12-month clinical and radiological outcomes of combined superior capsular reconstruction (SCR) and lower trapezius transfer (LTT) for posterosuperior irreparable massive rotator cuff tears (IMRCTs). Patients with posterosuperior IMRCTs and severe fatty infiltration (Goutallier grades 3 or more) in the infraspinatus who underwent SCR +LTT were retrospectively reviewed. A double-folded fascia lata autograft with one layer of polypropylene mesh inside was used for SCR and an Achilles tendon allograft was used to connect the tendon of lower trapezius to the greater tuberosity. A thorough preoperative assessment with clinical history, physical examination, and imaging studies is critical for identifying tear patterns that are (ir)reparable and to guide further treatment. The American Shoulder and Elbow Surgeon (ASES) score, visual analog scale (VAS), Constant score, Single Assessment Numeric Evaluation (SANE), and range of motion (ROM) were collected at a minimum 12-month follow-up postoperatively. Radiologic evaluation included the graft integrity and acromiohumeral distance (AHD) at the final follow-up. Postoperative magnetic resonance imaging was used to assess the graft integrity. Minimal clinically important difference were calculated as one-half of the standard deviation of the score changes between the preoperative baseline and the latest follow-up. Fifteen patients were included in this study, with a mean follow-up of 20.6 months (range, 12.2 - 31.2). Significant improvements in clinical and radiological outcomes were found after surgery. The VAS score decreased from 4.1 to 0.7 (P = 0.001). ASES, Constant, and SANE scores improved from 54.5 to 83.7 (P = 0.001), 61.1 to 76.7 (P = 0.001), and 48.7 to 74.0 (P = 0.001), respectively. External rotation (ER) improved from 26.0° to 45.7° (P = 0.009). Postoperative MRIs had a mean final follow-up of 14.2 months (range, 11.9-23.2). The AHD improved significantly from 4.9 mm to 8.1 mm after surgery (P = 0.003). Two patients (13.3%) developed both the fascia lata and Achilles tendon graft tears during follow-up. Minimal clinically important difference was obtained in 80.0%, 66.7%, 53.3%, and 46.7% of patients for ASES, VAS, Constant, and SANE scores, respectively. SCR + LTT contributes to significant pain relief and functional improvements with a graft healing rate of 86.7% at a minimum 12-month follow-up in patients with posterosuperior IMRCTs and high-grade fatty infiltration (FI) in the infraspinatus.

The safety, accuracy, and feasibility of robotic assistance in neuro-oncological surgery.

Over the past 3 decades, robotic technology has advanced significantly across surgical fields, driven by improvements in versatility, stability, skill, and tactile properties. Neurosurgery has led the way in integrating robotics to improve the accuracy and safety of procedures that require high precision. This study aimed to present one of the largest series in the literature and investigate the feasibility and effectiveness of robotic assistance in neuro-oncological surgery. The authors performed a retrospective review of the medical records of patients who underwent stereotactic biopsy only and biopsy and laser interstitial thermal therapy (LITT) using the Robotic Surgical Assistant (ROSA) system. The ROSA system was used for trajectory planning as well as the precise alignment and insertion of the needle and/or laser catheter. All procedures were performed by a single neurosurgeon. Electronic medical records were reviewed for patient demographics, preoperative clinical deficits, diagnosis, preoperative and postoperative MR images, lesion characteristics including location and volume, postoperative complications, and deficits. A total of 348 patients were identified. The mean age at surgery was 61.4 years, with 171 (49.1%) females. The most common presentations were GBM (40.5%, n = 141), metastasis (16.4%, n = 57), and radiation necrosis (9.8%, n = 34). A total of 189 (54%) patients underwent stereotactic biopsy only, and 159 (46%) underwent biopsy and LITT. The diagnostic yield of the cases was 98.6%, with only 5 cases having inconclusive pathology. Two (0.6%) patients experienced postoperative complications that resolved during follow-up. Ten (2.9%) patients developed asymptomatic subcentimeter hematomas following the procedure that did not require further intervention. No long-term consequences or permanent deficits occurred in any case within a median follow-up duration of 4.4 months (IQR 1-11.2 months). These results indicate that a robot-assisted approach for stereotactic biopsies and LITT is associated with a comparable diagnostic yield and safety profile for frameless and frame-based techniques. Its precision, user-friendly interface, and adaptability contribute to its suitability for such procedures. Future research, especially in long-term results and cost-effectiveness, will be crucial in fully understanding the utility and potential of this technology for broader applications in the field.

Comparison between robot-assisted and navigation-guided minimally invasive transforaminal lumbar interbody fusion: a multicenter study.

Both robot and computer navigation have significantly improved the accuracy and safety of percutaneous pedicle screw placement compared with a freehand fluoroscopy-guided technique. However, how the two new technologies compare with each other is unknown. The aim of this study was to investigate the accuracy and safety of robot-assisted and navigation-guided percutaneous pedicle screw placement in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). A multicenter, retrospective study was conducted with patients who underwent 1- to 3-level MIS-TLIF from 2019 to 2022. The surgical indication was symptomatic spinal stenosis and spondylolisthesis that failed conservative management. Screw accuracy and safety were compared between robot and computer navigation systems by obtaining postoperative CT images in all patients. The screw accuracy was determined by the Gertzbein and Robbins classification. A total of 100 patients were divided into robot-assisted (RA; n = 42) and O-arm navigation (ON; n = 58) groups, with 514 percutaneous pedicle screws placed. Clinically satisfactory accuracy was achieved in 100% of the RA group and 92.1% of the ON group (p < 0.001). There were no medial breaches or revision surgeries for screw malposition in either group. The RA group showed similar overall operation time to the ON group (263.54 ± 114.33 vs 243.4 ± 68.96 minutes, p = 0.2821). Subgroup analyses showed that there was no difference in 1-level MIS-TLIF, but the RA group had significantly more operative time for 2-level MIS-TLIF than the ON group (324.67 ± 101.25 vs 266.4 ± 66.38 minutes, p = 0.0264). Screw accuracy was significantly better in the RA group, with slightly more operation time, compared with the navigation group. Neither group required revision surgery or reoperation for screw malposition.

BrainPath Tubular Retractor System for Subcortical Hemorrhagic Vascular Lesions: A Case Series of Technique and Outcomes

BACKGROUND AND OBJECTIVES: Hemorrhagic subcortical vascular lesions such as cavernous malformations (CM) and arteriovenous malformations (AVM) can be neurologically devastating. Conventional open surgical resection is often associated with additional morbidity. The BrainPath® (NICO Corp.) transsulcal tubular retractor system offers a less-invasive corridor to deep-seated lesions. Our objective was to describe a single-center experience with the resection of subcortical hemorrhagic vascular lesions in adult and pediatric patients using the BrainPath® system. METHODS: The departmental database was queried for patients who underwent resection of a hemorrhagic CM, AVM, or cerebral aneurysm through the BrainPath® tubular retractor system between January 2017 and September 2021. All patients underwent either postoperative MRI (for patients with CM) or digital subtraction angiography (for patients with AVM or aneurysm). Demographic and clinical characteristics, preoperative and postoperative imaging features, operative details, and surgical and clinical outcomes were extracted through a retrospective review of the medical records. RESULTS: Fourteen patients (mean [SD] age 32.3 [23.9] years; 7 (50%) female) underwent BrainPath®-based resection of a deeply seated CM (n = 7), AVM (n = 6), or ruptured cerebral aneurysm (n = 1). The mean maximal lesion diameter was 21.5 (12.6) mm. The mean operative time was 134 (53) minutes. Residual lesion was present in 2 patients, both of which underwent repeat BrainPath®-assisted surgery for complete resection. All lesions were completely resected or obliterated on postoperative MRI or digital subtraction angiography. At a mean follow-up of 4.1 (1.1) years, the median modified Rankin Scale score was 1 (range 0-6). CONCLUSION: In a well-selected cohort, we show the effective use of BrainPath® tubular retractors for resection or obliteration of subcortical hemorrhagic vascular lesions. This report further exemplifies the expanded role of the endoport system beyond that of intracerebral hemorrhage and tumor. Further study will elucidate the impact of this less-invasive brain retraction technique on clinical outcome in patients with vascular lesions.