Postoperative Volume Research Articles

Optimizing Surgical Outcomes: A Case Series on BREAST-V for Treating Breast Asymmetries.

Breast asymmetry occurs when there is a discrepancy in the shape, volume, or positioning of the breasts. Various factors, including unequal development of breast buds, endocrine disorders, chest wall deformities, and surgical or posttraumatic sequelae, can contribute to this condition. Although breast asymmetry is common, clinically severe cases are rare and often require surgical correction because of potential postural, aesthetic, and psychological issues. Accurate assessment of the breast volume is crucial for planning and evaluating surgical interventions. This prospective, non-randomized, interventional study was conducted between 2019 and 2024 at the Breast Reconstruction Section of the Federal University of São Paulo, Brazil. Forty patients with breast asymmetry were evaluated using the BREAST-V, which calculates the breast volume based on three linear measurements. Patients underwent various surgical procedures, including augmentation, reduction mammoplasty, and mastopexy, tailored to their specific type of asymmetry. Preoperative and postoperative breast volumes were compared to assess the effectiveness of surgical correction RESULTS: The study included 40 participants, with an average age of 25.2 years. The mean preoperative breast volumes were 469.6g (right) and 448.8g (left). The postoperative volumes decreased to 338.3g (right) and 331.1g (left), showing an average reduction in asymmetry of 72.9%. The minimal clinically important difference (MCID) for pre-treatment asymmetry was 65.4g. The BREAST-V tool has significant potential for the objective assessment of breast asymmetry. Reliable volumetric measurements can aid in surgical planning and postoperative evaluation, ultimately enhancing the clinical outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

NCMP-10. EFFECT OF EXTENT OF RESECTION ON GLIOMA SEIZURE OUTCOMES BASED ON MOLECULAR GROUPS

Abstract INTRODUCTION Increased extent of resection (EOR) is a known predictor of seizure freedom in glioma patients. However, it is unknown how tumor genomic alterations affect EOR-induced seizure control. OBJECTIVE To evaluate the genotype-specific impact of EOR on post-operative seizure control METHODS Records of 553 glioma patients who underwent tumor resection from 2012-2023 were reviewed. All patient tumors were analyzed with next generation sequencing and FISH analysis. The unsupervised machine learning algorithm non-negative matrix factorization (NMF) was used to cluster the genomic data. Clinical variables including extent of resection of contrast enhancing tumor and non-enhancing tumor, temozolomide therapy, and radiation therapy were analyzed using Cox Proportional Hazards models. RESULTS NMF clustering of tumor sequencing data revealed four molecular groups: Group 1 (n=56): CDKN2a loss, EGFR copy number gain or mutation, TERT promoter (TERTp) mutation, and MGMT methylated; Group 2 (n=27): IDH mutation, TP53 mutation, and MGMT methylated; Group 3 (n=60): TP53 mutation, TERTp mutation and MGMT methylated; Group 4 (n=244): MGMT unmethylated. Thresholds in the post-operative residual non-enhancing tumor volume (NETV) were identified which marked the most difference in seizure control. For patients in Group 1, the NETV threshold that led to improved epilepsy outcomes was <94.7 cc (p=0.047), whereas the threshold for Group 4 was <89.1 cc (p=0.016). When analysis was conducted for Group 2, the threshold of 10.2 cc failed to reach significance (p=0.1). Interestingly, the threshold analysis for Group 3 found that having a NETV of > 10.1 cc showed improved seizure outcomes (p=0.016). A multivariable cox proportional hazard analysis found that twelve-month seizure freedom was predictive of better OS in group 1 (HR 0.02, p=0.05) and group 4 (HR 0.21, p=1.63e-9). CONCLUSION Our study reveals clinically distinct molecular groups of glioma that display different seizure responses. This data suggests a tumor-specific approach to aggressiveness of extent of resection in order to achieve optimal seizure control.

SURG-42. THE T1/T2 RATIO IS ASSOCIATED WITH RESECTABILITY IN PATIENTS WITH IDH-MUTANT ASTROCYTOMAS CNS WHO GRADES 2 AND 3

Abstract PURPOSE IDH-mutant astrocytomas CNS WHO grade 2 and 3 show heterogenous appearance on magnetic resonance imaging (MRI). In the pre-molecular era, the discrepancy between T1 hypointense and T2 hyperintense tumor volume in absolute values has been proposed as a marker for diffuse tumor growth. We set out to investigate if a ratio of T1 to T2 tumor volume (T1/T2 ratio) is associated with resectability and overall survival in patients with IDH-mutant astrocytomas. METHODS Patient data from two centers (Center A: Sahlgrenska University Hospital, Gothenburg, Sweden; Center B: LMU University Hospital, Munich, Germany) were collected retrospectively. Inclusion criteria were as follows: pre- and postoperative MRI scans available for volumetric analysis (I), diagnosis of an IDH-mutant astrocytoma between 2003-2021 (II), and tumor resection at initial diagnosis (III). Tumor volumes were manually segmented. The T1/T2 ratio was calculated and correlated with extent of resection, residual T2 tumor volume, and overall survival. RESULTS The study comprised 134 patients with 65 patients included from Center A and 69 patients from Center B. The median overall survival was 134 months and did not differ between the cohorts (p=0.29). Overall, the median T1/T2 ratio was 0.79 (range 0.15-1.0). Tumors displaying a T1/T2 ratio of 0.33 or lower showed significantly larger residual tumor volumes postoperatively (median 17.9 cm3 versus 4.6 cm3, p=0.03). The median extent of resection in these patients was 65% versus 90% (p=0.03). The ratio itself did not correlate with overall survival. In multivariable analyses, larger postoperative tumor volumes were associated with shorter survival times (HR 1.02, 95% CI 1.01-1.03, p<0.01). CONCLUSION The T1/T2 ratio might be a good indicator for diffuse tumor growth on MRI and is associated with resectability in patients with IDH-mutant astrocytoma. This ratio might aid to identify patients in which an oncologically relevant tumor volume reduction cannot be safely achieved.

Analysis of the Predictability of Postoperative Meningioma Resection Status Based on Clinical Features

Background: Our aim was to investigate the predictability of postoperative meningioma resection status based on clinical features. Methods: We examined 23 clinical features to assess their effectiveness in distinguishing gross total resections (GTR) from subtotal resections (STR). We analyzed whether GTR/STR cases are better predictable if the classification is based on the Simpson grading or the postoperative operative tumor volume (POTV). Results: Using a study cohort comprising a total of 157 patients, multivariate models for the preoperative prediction of GTR/STR outcome in relation to Simpson grading and POTV were developed and subsequently compared. Including only two clinical features, our models showed a notable discriminatory power in predicting postoperative resection status. Our final model, a straightforward decision tree applicable in daily clinical practice, achieved a mean AUC of 0.885, a mean accuracy of 0.866, a mean sensitivity of 0.889, and a mean specificity of 0.772 based on independent test data. Conclusions: Such models can be a valuable tool both for surgical planning and for early planning of postoperative treatment, e.g., for additional radiotherapy/radiosurgery, potentially required in case of subtotal resections.

Impact of Postoperative Neck Radiotherapy Volumes on Long-Term Unstimulated Saliva Flow Following Primary Surgery and Ipsilateral Neck Dissection for Oral Cavity Squamous Cell Carcinoma.

We investigate the association of postoperative radiotherapy (PORT) volumes and salivary function in oral cavity SCC (OSCC). OSCC patients undergoing PORT 2005-2021 underwent modified Schirmer test (MST) pre-PORT, 6 and/or 12 months post-PORT. Hyposalivation rates were compared by PORT volumes. MVA identified predictors for chronic hyposalivation. Among 165 eligible patients, 88 (53%) received bilateral, 66 (40%) ipsilateral, and 11 (7%) no-neck (primary-only) PORT. Baseline characteristics were similar, except more N2b/N2c disease received bilateral PORT vs. ipsilateral or no-neck (60% vs. 36% vs. 0%, p < 0.001). Baseline hyposalivation was similar (26% vs. 30% vs. 18%, p = 0.67). Hyposalivation occurred more frequently in bilateral vs. ipsilateral vs. no-neck PORT at 6 (90% vs. 62% vs. 9%) and 12 months (90% vs. 48% vs. 0%) (both p < 0.001). On MVA, bilateral neck PORT and smoking predicted chronic hyposalivation. Increasing PORT volumes predict saliva function recovery and chronic hyposalivation, informing treatment discussions.

Progressive postoperative atrophy of ipsilateral thalamus, putamen, and globus pallidus in patients with temporal lobe epilepsy: A volumetric analysis.

Cortical atrophy close to medial temporal structures has been described consistently in patients with temporal lobe epilepsy (TLE). Successful TLE surgery may have a neuroprotective effect preventing further atrophy of temporal and extratemporal cortex. However, the effects of epilepsy surgery on subcortical structures demand additional enlightenment. This work aimed to determine how epilepsy surgery affects volumes of subcortical structures in medically refractory temporal lobe epilepsy patients. We compared MRI volumes of subcortical structures in 62 patients with TLE (36 left, 26 right) before and after anterior temporal lobectomy with 38 TLE patients (20 left, 18 right) who were considered to be good surgical candidates and had at least two brain MRIs. There were no volume differences in subcortical structures on preoperative and initial MRIs of non-operated TLE patients. At baseline, the ipsilateral thalamus and putamen in TLE patients were marginally smaller than contralateral structures. Operated patients showed a significant postoperative volume reduction in ipsilateral thalamus, putamen, and globus pallidus. In contrast, there were no significant volumetric reductions in non-operated patients longitudinally. There were no volumetric changes associated with different surgical outcomes or different postoperative cognitive outcomes. Our study demonstrated postoperative volume loss of thalamus, putamen and globus pallidus ipsilaterally to the side of resection. Our findings suggest surgery-related changes, likely Wallerian degeneration within subcortical networks not related to seizure or cognitive outcome. We studied 100 patients with epilepsy, comparing those who had surgery to those who did not. After surgery, the thalamus, putamen and globus pallidus on the same side as the surgery shrank significantly, but not in non-surgery patients. This suggests surgery-related changes in deeper brain structures, unrelated to seizure freedom or cognitive outcomes. This research sheds additional light on the response of the subcortical structure to epilepsy surgery, highlighting potential areas for further study.

Safety and efficacy of transurethral holmium laser enucleation of the prostate versus bipolar transurethral resection of the prostate in the treatment of benign prostatic hyperplasia: a prospective randomized controlled trial.

To evaluate the safety and efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) compared to bipolar transurethral resection of the prostate (bTUR-P) in the treatment of benign prostatic hyperplasia (BPH). A total of 220 BPH patients hospitalized from January 2022 to September 2023 were included in this study. These patients were randomly assigned to HoLEP and bTUR-P groups, with 110 participants in each group. We collected preoperative general information, perioperative data, complications, and postoperative follow-up indicators from both groups of patients. The baseline characteristics of patients in both groups were similar, with no statistical significance (P > 0.05). Compared to the bTUR-P group, the HoLEP group exhibited significantly less intraoperative bleeding (P < 0.001), shorter bladder irrigation time (P = 0.002), shorter catheter retention time (P < 0.001), and reduced postoperative hospitalization (P = 0.002). Additionally, the pain score during urination after catheter removal was significantly lower in the HoLEP group (P < 0.001). Postoperative complications occurred in both groups; however, they were less frequent in the HoLEP group (4 cases), primarily consisting of urinary retention and postoperative bleeding. The bTUR-P group experienced more complications (9 cases). Significant reductions in postoperative residual urine volume (RUV) were observed in both groups (P < 0.001). Both groups also showed significant improvements in Quality of Life (QoL) scores and International Prostate Symptom Scores (IPSS), with the HoLEP group demonstrating a more significant decrease in IPSS (P < 0.001). After comprehensive evaluation, HoLEP was superior to bTUR-P in terms of safety and efficacy. Therefore, HoLEP may be a preferable choice for the treatment of BPH.

Cone-beam CT volumetry: a new method for evaluating osteotomy healing - a clinical evaluation and MDCT comparison.

Fracture healing complications remain a major problem in trauma monitoring. An open wedge osteotomy of the distal radius provides a unique way of evaluating fracture healing. Since the introduction of cone-beam computed tomography (CBCT) at our institution, it has become the method of choice for assessing hand and wrist bones. To date, CT volumetry has been validated for multidetector CT (MDCT) but not for CBCT. To assess osteotomy healing using CBCT volumetry and to evaluate two different segmentation techniques. A total of 36 patients were surgically treated for malunited distal radius fractures with open-wedge osteotomy either leaving the void empty (open wedge empty [OWE]) or filled with bone graft substitutes (BGS). They were scanned using CBCT and MDCT postoperatively and after 3, 6, and 12 months. Segmentation was performed both manually and semi-automatically for volumetric measurement. Inter- and intra-observer reliability were assessed using intraclass correlation (ICC). The median osteotomy volume in the OWE group postoperatively was 0.87 cm3 (range=0.42-2.72). At 3 months, all but one of the OWE volumes had diminished to half or less of their initial volume. In the BGS group, the median postoperative volume was 1.30 cm3 (range=0.73-1.81) and at 12 months, 76% of the initial volume remained. Reliability between CBCT and MDCT volumetry expressed as ICC was ≥0.96. ICC for the two segmentation techniques was ≥0.99 and ICC for inter-observer reliability ≥0.97. CBCT volumetry is a reliable tool and comparable to MDCT to quantify bone healing of an osteotomy.

ANALYSING THE RATE OF RECURRENCE AND LEPTOMENINGEAL DISEASE IN POSTERIOR FOSSA BRAIN METASTASES FOLLOWING POSTOPERATIVE RADIOTHERAPY- SINGLE CENTRE EXPERIENCE

Abstract AIMS The management of posterior fossa brain metastases is complex and necessitates a multidisciplinary approach involving neurosurgeons and oncologists. Post-operative radiotherapy (PORT) to surgical cavity has demonstrated positive oncologic outcomes as well as preserving cognitive function when compared to conventional whole brain radiation therapy. However, larger post-operative volumes in posterior fossa and greater target volume uncertainty due to presence of pseudomeningocele may result in an increased risk of local recurrence (LR) and leptomeningeal disease (LMD). The aim of this retrospective single centre study was to determine the rates of LR and LMD in patients with posterior fossa metastases who underwent PORT to surgical cavity. METHOD Retrospective analysis of data of patient who underwent PORT in between 2017-2022, for posterior fossa brain metastases at our centre. Clinical, imaging and radiotherapy data was collected from electronic medical records. Statistical analysis was performed using SPSS Statistics version 28.0.1. RESULTS We identified 42 patients meeting the study criteria. The median age of the patients was 60.5 years. 71.4% of patients were females, while 28.6% were males. 52.4% of patients had pseudomeningocoele on their radiotherapy planning scans. The median time gap between the date of surgery and initiation of radiotherapy was 34.5 days. 20 out of 42 (47.6%) patients had local recurrence of a posterior fossa brain metastasis and 7 out of 42 (16.7%) patients developed LMD. Out of 7 patients with LMD, 4 patients had pseudomeningocoele present at the time of PORT. The timing of radiotherapy after surgery (≤4 weeks or &amp;gt;4 weeks) showed no statistically significant impact on LR (p-value: 0.413, log-rank test). CONCLUSION The risk of LR remains high despite PORT. This study highlights the challenges in management of posterior fossa metastases. High LR and LMD rates underscore the need for improved treatment strategies.

Effect of incision location and type of fistula on postoperative urinary retention after radical surgery for anal fistula: a retrospective analysis

BackgroundPostoperative urinary retention (POUR) is a common complication characterized by fullness of the bladder without the ability to urinate. Its etiology in proctology surgery is multifactorial. This study aimed to identify the risk factors for POUR after radical surgery for anal fistula.MethodsWe retrospectively reviewed the clinical records of 511 patients who underwent radical surgery for anal fistula at the China-Japan Friendship Hospital from August 2022 to December 2023. Risk factors for POUR were analyzed by means of binary logistic regression analyses.ResultsPOUR occurred in 57 patients (11.2%) within 48 h post-surgery, and males were predominantly affected (84.4%). Independent risk factors included a history of urological disease (OR = 6.048; p < 0.001), incisions at position 1 (OR = 2.228; p = 0.046), high anal fistula (OR = 4.768; p < 0.001), VAS score ≥ 7 (OR = 2.805; p = 0.010), and GAD-7 score ≥ 5 (OR = 2.405; P = 0.024).ConclusionPOUR is a significant complication post-radical surgery for anal fistula, particularly among patients with urological disease, high anal fistula, and incisions at position 1. Surgeons should pay more attention to surgical methods for high anal fistulas and fistulas in the anterior rectum, and monitor postoperative bladder volume in high-risk patients. Enhanced postoperative pain and anxiety management can reduce the incidence of POUR and prevent long-term bladder damage.

Spring-Assisted Cranioplasty in Unicoronal Synostosis: Analysis of Outcomes

Background: Spring-assisted cranioplasty and successful long-term outcomes for sagittal synostosis has been well described in recent literature. However, there is a paucity of data regarding the application of springs to unicoronal synostosis. Unicoronal synostosis (UCS) presents unique challenges in its causation of skull base scoliosis and orbital asymmetry. Many surgeons feel that the fronto-orbital advancement and vault remodeling is the most effective and reliable strategy to counteract these changes. Here we present our experience and outcomes with spring cranioplasty for unicoronal synostosis. Materials and methods: A retrospective review of non-syndromic unicoronal synostosis patients undergoing spring-assisted cranioplasty was performed. Preoperative and postoperative intracranial volume (ICV), orbital volume (OV), orbital height (OH), orbital width (OW), midface twist (MFT), and skull-base twist (SBT) were measured from DICOM CT data. Analysis was performed with Materialize software (Leuven, Belgium). Paired t-tests were performed using Excel. Results: Ten patients (5 females, 5 males) had springs placed at 100.1 days (avg). Average ICV: preop: 608.2 ± 101.4 cc, postop: 995.2 ± 166.1 cc. Differences in orbital volume and height in the preop affected orbit versus non-affected orbit was significant ( P = .01, P ≤ .001 respectively) whereas no significant difference between the two sides postoperatively was observed ( P = .19, P = .58 respectively). Average preop MFT was 81.1 ± 2° and postop was 87.6 ± 2.6° and preop SBT was 171.9 ± 2.7° and postop was 177.6 ± 2.6°; both showing significant improvement after spring cranioplasty (both P ≤ .001). Conclusion: Our experience and early outcomes with spring cranioplasty for UCS demonstrates that when used in younger patients (&lt;5 months) cranial springs can be a safe and effective strategy to minimize skull base scoliosis, facial scoliosis, and orbital asymmetry, as well as increase intracranial volume. Although long-term data needs to be assessed, we are optimistic that early correction of cranial base scoliosis will translate to stable results as patients reach dentoskeletal maturity.

The Implication of Photodynamic Therapy Applied to the Level of Tumor Resection on Postoperative Cerebral Edema and Intracranial Pressure Changes in Gliomas.

The aim of our study was to explore the factors influencing cerebral edema and intracranial pressure in glioblastoma multiforme (GBM) patients who undergo photodynamic therapy (PDT) after resection. This was a retrospective controlled study of GBM patients treated with PDT-assisted resections of varying scope from May 2021 to August 2023. The baseline clinical data, cerebral edema volumes, intracranial pressure values, and imaging data of the GBM patients were collected for statistical analysis. A total of 56 GBM patients were included. Thirty of the patients underwent gross total resection (GTR), and the other 26 patients underwent subtotal resection (STR). We found that the cerebral edema volume and the mean intracranial pressure in patients who underwent GTR were lower than those in patients who underwent STR. Moreover, univariate analysis showed that the scope of tumor resection was an independent factor affecting cerebral edema and intracranial pressure after PDT. Compared with STR, PDT combined with GTR significantly reduced postoperative brain edema volume and intracranial pressure in GBM patients.

Volumetric evaluation of autologous fat transfer for total breast reconstruction

BackgroundReconstructive surgeons have shifted from correcting contour irregularities using autologous fat transfer (AFT) toward reconstructing full breasts. Although many studies have researched the volumetric aspects of AFT, some outcomes such as volume retention and viability, as well as possible confounders for graft survival, remain unclear. This study aimed to answer these questions. MethodsPost-mastectomy women of the multicenter prospective BREAST-trial were randomized to either AFT breast reconstruction or implant-based reconstruction (IBR). Volumes were assessed using the Vectra 3D imaging system and compared at 12 months postoperative. Volume retention was defined as the augmented volume divided by the lipofilling volume. Significant confounders for graft survival were identified using multivariable regression analysis. ResultsA total of 148 patients (75 AFT, 73 IBR) were included in the final analyses. Postoperative volumes differed significantly at 12 months in favor of the IBR group (83.8ml, p<0.001). For AFT patients, graft survival did not decrease between 6 and 12 months, with a mean graft survival of 37.1% at 12 months. Significant confounders for graft survival included chest circumference (β=1.107, p=0.001), comorbidities (β =28.567, p=0.002), age (β =-0.514, p=0.007) and total lipofilling (β =-0.028, p<0.001). ConclusionPlastic surgeons can reconstruct voluminous breasts post-mastectomy using only AFT, these breast volumes stabilize at six months and VECTRA 3D is reliable for breast volume measurement. About a third of the grafted fat was calculated to survive postoperative and reconstructive surgeons should be aware not to transfer too much fat in one session.

The Ratio of Baseline Ventricle Volume to Total Brain Volume Predicts Postoperative Ventriculo-Peritoneal Shunt Dependency after Sporadic Vestibular Schwannoma Surgery.

Background/Objectives: Obstructive hydrocephalus associated with vestibular schwannoma (VS) is the most common in giant VS. Despite tumor removal, some patients may require ongoing ventriculo-peritoneal (VP) surgery. This investigation explores the factors contributing to the requirement for VP surgery following VS surgery in instances of persistent hydrocephalus (HCP). Methods: Volumetric MRI analyses of pre- and postoperative tumor volumes, cerebellum, cerebrum, ventricle system, fourth ventricle, brainstem, and peritumoral edema were conducted using Brainlab Smartbrush and 3D Slicer. The total brain volume was defined as the sum of the cerebrum, cerebellum, and brainstem. ROC analyses were performed to identify the optimum cut-off values of the volumetric data. Results: Permanent cerebrospinal fluid (CSF) diversion after surgery was indicated in 12 patients (12/71; 16.9%). The ratio of baseline volume fraction of brain ventricles to total brain ventricle volume (VTB ratio) was found to predict postoperative VP shunt dependency. The AUC was 0.71 (95% CI: 0.51-0.91), and the optimum threshold value (</≥0.449) yielded a sensitivity and specificity of 67% and 81%, respectively. Multivariable logistic regression analyses of imaging data (pre- and postoperative VS volume, VTB ratio, and extent of resection (%) (EoR)) and patient-specific factors revealed that an increased VTB ratio (≥0.049, OR: 6.2, 95% CI: 1.0-38.0, p = 0.047) and an EoR < 96.4% (OR: 9.1, 95% CI: 1.2-69.3, p = 0.032) were independently associated with postoperative VP shunt dependency. Conclusions: Primary tumor removal remains the best treatment to reduce the risk of postoperative persistent hydrocephalus. However, patients with an increased preoperative VTB ratio are prone to needing postoperative VP shunt surgery and may benefit from perioperative EVD placement.

Paraspinal muscle volume and fatty infiltration after circumferential minimally-invasive deformity correction

IntroductionParaspinal muscle robustness is an area of growing interest in spinal deformity that may impact biomechanical integrity and patient quality-of-life after reconstructive surgery. Changes in paraspinal musculature after circumferential minimally-invasive (cMIS) deformity correction have not yet been investigated. MethodsWe identified patients who underwent cMIS deformity correction and had lumbar spine MRIs at baseline and at minimum 1-year postoperatively. Using T2-weighted MRI, we measured total muscular volume of the psoas major, erector spinae, and multifidus muscles. We used the threshold method to determine fatty infiltration as percent fat area (PFA) along the length of these scanned regions, encompassing the final surgical construct. ResultsWe identified 10 patients who met inclusion criteria. On average, patients underwent interbody fusion at 3.8 ± 0.9 disc levels and posterior instrumentation at 4.6 ± 1.7 vertebral levels. All constructs included lateral interbody fusion (average 2.7 ± 0.8 levels); 6 were from a right-sided approach. Postoperative MRIs were obtained at 28 ± 14.2 months.There were no significant changes in pre- and postoperative volumes or PFA in any muscle group. There were no significant differences in left/right psoas volume or PFA in patients when stratified by side of lateral approach, nor did the number of lateral interbody fusion levels correlate with psoas volume or PFA. Change in posterior paraspinal musculature characteristics did not correlate with increasing number of fixated levels, nor significantly differ in patients who underwent posterior decompression. Preoperative muscle volumes were strongly correlated with postoperative volumes. ConclusionsIn this pilot series, paraspinal and psoas muscle volumes were preserved after circumferential MIS deformity correction. Fatty infiltration was not increased in paraspinal muscles after multi-level percutaneous instrumentation, nor in the psoas after multi-level trans-psoas approaches. These findings call for more in-depth investigation in a larger cohort of patients with comparison to open deformity correction patients to determine the impact of muscle volume changes on clinical outcomes.

Anatomy-based fitting improves speech perception in noise for cochlear implant recipients with single-sided deafness

Abstract Objective To evaluate objective and subjective hearing outcomes in experienced cochlear implant users with single sided deafness (SSD CI) who used fitting maps created via anatomy-based fitting (ABF) and clinically-based fitting (CBF). Participants Twelve SSD CI users with postlingual hearing loss. Intervention OTOPLAN (Version 3. (MED-EL) was used to determine intracochlear electrode contact positions using post-operative high-resolution flat panel volume computed tomography. From these positions, the corresponding center frequencies and bandwidths were derived for each channel. These were implemented in the clinical fitting software MAESTRO to yield an ABF map individualized to each user. Main Outcome Measures ABF and CBF maps were compared. Objective speech perception in quiet and in noise, binaural effects, and self-perceived sound quality were evaluated. Results Significantly higher speech perception in noise scores were observed with the ABF map compared to the CBF map (mean SRT50: -6.49 vs. -4.8 dB SNR for the S0NCI configuration and − 3.85 vs. -2.75 dB SNR for the S0N0 configuration). Summation and squelch effects were significantly increased with the ABF map (0.86 vs. 0.21 dB SNR for summation and 0.85 vs. -0.09 dB SNR for squelch). No improvement in speech perception in quiet or spatial release from masking were observed with the ABF map. A similar level of self-perceived sound quality was reported for each map. Upon the end of the study, all users opted to keep the ABF map. This preference was independent of the angular insertion depth of the electrode array. Conclusions Experienced SSD CI users preferred using the ABF map, which gave them significant improvements in binaural hearing and some aspects of speech perception.

A comparison of subperiosteal vs subdural drainage in the treatment of chronic subdural haemorrhage

Introduction. Symptomatic chronic subdural haemorrhages (CSDH) continue to be one of the most common diagnoses in modern neurosurgery. The current standard procedure for symptomatic CSDH is a burr-hole craniostomy with irrigation and the installation of close-system drainage. The purpose of this study is to conduct a direct comparison of two surgical procedures for the treatment of symptomatic CSDH that are effective in prior studies. Our main goal was to compare the efficacy of placing a subperiosteal drain (SPD) and a subdural drain (SDD) after a single burr-hole craniostomy and irrigation and to show any significant differences in terms of overall surgical complications, functional outcome and mortality rate at three months, and complications at six months. Materials and methods. From August 2022 to December 2023, the study was conducted in the Department of Neurosurgery at a tertiary care centre, with a total of 25 patients in both treatment groups. Results. Overall, there was no statistically significant difference between the two groups in terms of patient general characteristics, pre-and post-operative symptoms, Markwalder grades, postoperative hematoma volume and recurrence, mortality, and functional outcome at discharge and at three months follow-up. Despite not reaching statistical significance, we found a decreased risk of surgical complications, particularly post-operative cerebral haemorrhage, with SPD system implementation. Conclusions. According to our findings, both therapy modalities are extremely successful in the treatment of CSDH. therapy with a single burr-hole craniostomy, irrigation, and implantation of the SPD system, on the other hand, has a reduced overall surgical complication rate and can be regarded as a therapy of choice for the management of symptomatic CSDH.

Early clinico-radiological outcomes following neuroendoscopic cysto-cisternostomy for middle cranial fossa arachnoid cysts: a prospective cohort study with illustrative cases.

The dysmorphogenetic arachnoid cysts' pathomechanism is most favoured, and about 50% occur as middle cranial fossa cysts (MCFAC). Still being rare, management options are yet evolving. We described the clinico-radiological features, management and early outcomes of participants with MCFAC in our service. This prospective cohort study involved 29 pediatric participants recruited (from electronic health records, using ICD G93.0 D016080 for arachnoid cysts) between 01/01/2023 and 31/06/2023, following informed consent according to the ethical approval. All participants had neuro-imaging confirmed MCFAC. Baseline and follow-up data were retrieved and analyzed using summary (mean, standard deviation) and inferential (ANOVA, t-test) statistics. They were averagely aged 6.2 ± 4.48years and were mostly males (89.7%). 24.1% were asymptomatic. The commonest symptoms (n = 38) were headaches (23.7%), developmental delays (15.8%), eye complaints (15.8%) and cephalomegaly (7.9%). They were predominantly left-sided (89.7%). Galassi (G) 3 lesions were less (24.1%), with G2 and G1 lesions evenly sharing the rest. The average cyst volume was 58.4 ± 80.83cm3; there were significant differences (F = 4.682; p = 0.018) between the average volumes for G1 (14.4 ± 22.42cm3), G2 (61.7 ± 89.92cm3) and G3 (122.5 ± 94.37cm3) lesions. 44.8% of the participants had rigid-endoscopic cysto-cisternotomy (all between the ICA and oculomotor nerve into the interpeduncular cistern, using ventriculostomy forceps); including all G3, 50% of G2 and no G1 (had serial clinico-radiological observation) lesion. The average pre- (117.42cm3) and post-operative (53.48cm3) cyst volumes showed significant (t = - 2.797, p = 0.021) reductions. Middle cranial fossa arachnoid cysts occur predominantly amongst males, in middle childhood and left-sided. The treatment-related patient series are largely symptomatic, unlike the largely asymptomatic, screening-related series. Higher Galassi grade lesions presented with progressively, significantly larger cyst volumes and higher likelihoods of surgery. The average post-operative cyst volume at follow-up averagely showed almost 60% reduction from the pre-operative. All participants reported clinical remission.

Correlations between intraoperative and postoperative echocardiographic measurements in patients undergoing aortic bioprosthetic valve replacement: a prospective observational study.

Patient-prosthesis mismatch (PPM) should be avoided during surgical aortic valve replacement because PPM would worsen the mortality and morbidity. Diagnosis of PPM could be made using various parameters measured by intraoperative transesophageal echocardiography. However, few studies have examined which parameters correlate most accurately between intraoperative and postoperative values. This single-center prospective observational study analyzed 46 patients who underwent surgical aortic valve replacement (SAVR). Echocardiography was performed at the following 3-time points: preoperatively, intraoperatively, and 1month postoperatively. The correlation between intraoperative and postoperative measurement values, including peak velocity (PV), mean pressure gradient (MPG), effective orifice area (EOA), and effective orifice area index (EOAI), were assessed using Pearson's correlation coefficient. Moreover, to evaluate whether a multivariable linear regression model with intraoperative and postoperative stroke volume added as an explanatory variable improves the correlation, the multiple correlation coefficients were calculated. PV, MPG, EOA, and EOAI measured intraoperatively and 1month postoperatively were significantly correlated. The r values of each measurement were 0.35, 0.344, 0.411 and 0.323, respectively. The multivariable linear regression model showed that the multiple correlation coefficients for MG and EOA were 0.491 and 0.663, respectively. Intraoperative and postoperative PV, MPG, EOA, and EOAI were significantly correlated in patients undergoing SAVR with a bioprosthetic valve. The r value for EOA was 0.441, the largest among the measured values. Adjustment for stroke volume improved the strength of the correlation. Intraoperative evaluation of prosthetic valve function was considered most appropriate using EOA. University Hospital Medical Information Network Clinical Trials Registry, registration number UMIN000046164, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000052695 .

Outcomes of Endoscopic Endonasal Surgery for Tuberculum Sellae and Planum Sphenoidale Meningiomas: A Retrospective Study.

To evaluate clinical outcomes and volumetric changes following endoscopic endonasal approach (EEA) for tuberculum sellae (TS) and planum sphenoidale (PS) meningiomas. Key objectives included evaluating pre- and postoperative tumor volumes, visual assessments and EEA-related complications. A single-center retrospective study was conducted at Foothills Medical Centre, University of Calgary, Canada, from 2009 to 2022 including 24 patients meeting inclusion criteria for midline skull base tumors, confirmed as WHO Grade I or II meningiomas with optic canal extension. EEA achieved gross total resection in 87.5% of cases, with a mean tumor volume reduction of 92.24%. Postoperatively, 91.67% exhibited visual improvement or stability. Cerebrospinal fluid leaks occurred in 12.5% of cases, necessitating revision surgery in one case. Persistent postoperative endocrine dysfunction affected 4.17%. Preoperative tumor volume did not demonstrate a correlation with complications. This study delivers reproducible data for pre- and postoperative tumor volume following the EEA after TS or PS meningiomas. The EEA demonstrated favorable radiographic and clinical outcomes in TS and PS meningiomas, achieving gross total resection with minimal morbidity.