Precise Surgical Planning Research Articles

Successful Surgical Treatment of Coronavirus Disease 2019 (COVID-19) Vaccination Related Upper Extremity Lymphedema : Case Report

Lymphedema is rare adverse effect of COVID-19 vaccination which was reported at several literatures. We present a case of surgically treated secondary lymphedema after the COVID-19 vaccination. The patient presented lymphedema at the upper extremity with no specific history except the COVID-19 vaccination 18 months before the visit. LVA and liposuction for the posterolateral aspect of forearm and upper arm was performed. The volume of the affected arm was reduced to more than 54 percent at the postoperative 8 months. With precise surgical planning, secondary lymphedema occurred after the COVID-19 vaccination could be successfully treated surgically.

Marginal Mandibulectomy in Oral Cavity Cancers — Classification and Indications

AbstractSquamous cell carcinoma of the lip and oral cavity (OSCC) is a significant global health issue, particularly in low-income countries, with an estimated 390,000 cases detected annually. Although surgery remains the primary treatment option, complex resections are frequently required to attain clear margins. Traditionally, a part of the jaw bone close to the tumour is resected (segmental mandibulectomy) during the surgery. However, marginal mandibulectomy (MM), involving the resection of the mandibular rim while preserving its continuity, offers a less debilitating alternative to segmental mandibulectomy (SM) in selected cases. This review examines marginal mandibulectomy’s oncological safety and efficacy and its current role in managing oral cavity cancers, as indicated by the most recent literature. MM is an effective treatment for tumours, which abut the mandible without bone invasion and provides comparable oncological outcomes to SM, with fewer functional and cosmetic deficits. The authors also propose a classification based on the plane of resection and location within the mandible. We believe this classification will be helpful in reporting the MM series done in various centres in a uniform fashion. However, there is a need for precise surgical planning before doing an MM for obtaining the optimal results.

A Rare Case Of Desmoid Tumor In The Lower Mandibular Sector Of An Adolescent: Surgical Intervention And Outcomes

Introduction: Desmoid tumors are rare, benign neoplasms known for their locally aggressive behavior and high recurrence rates. They arise from fibroblasts and are characterized by their infiltrative growth, making surgical management challenging. This report presents a case of a desmoid tumor in the lower mandibular sector of a 16-year-old male, focusing on surgical intervention and molecular insights. Case Report: A 16-year-old male presented with a growing mass in the lower right mandible, causing pain and mobility of tooth 47. Imaging revealed an infiltrative lesion eroding the mandibular bone. Histopathological analysis confirmed a desmoid tumor with spindle-shaped fibroblasts and nuclear β-caténine expression. Molecular testing identified a CTNNB1 gene mutation, confirming the diagnosis. Discussion: Desmoid tumors, despite being benign, are challenging due to their aggressive local behavior. Surgical excision with clear margins is the primary treatment, as these tumors are resistant to chemotherapy and radiotherapy. This case highlights the importance of precise surgical planning and the role of β-caténine and CTNNB1 mutations in diagnosis and prognosis. Conclusion: Effective management of desmoid tumors in adolescents requires thorough surgical intervention and comprehensive diagnostic analysis. Long-term follow-up is crucial to monitor for recurrence. The molecular characteristics of the tumor, such as CTNNB1 mutations, play a significant role in guiding treatment and predicting outcomes.

Preoperative markers for identifying CT ≤2 cm solid nodules of lung adenocarcinoma based on image deep learning.

The solid pattern is a highly malignant subtype of lung adenocarcinoma. In the current era of transitioning from lobectomy to sublobar resection for the surgical treatment of small lung cancers, preoperative identification of this subtype is highly important for patient surgical approach selection and long-term prognosis. A total of 1489 patients with clinical stage IA1-2 primary lung adenocarcinoma were enrolled. Based on patient clinical characteristics and lung imaging features obtained via deep learning, highly correlated diagnostic factors were identified through LASSO regression and decision tree analysis. Subsequently, a logistic model and nomogram were constructed. A restricted cubic spline (RCS) was used to calculate the optimal inflection point of quantitative data and the differences between the groups. The three-dimensional proportion of solid component (PSC), sex, and smoking status was identified as being highly correlated diagnostic factors for solid predominant adenocarcinoma. The logistic model had good prediction efficiency, and the area under the ROC curve was 0.85. Decision curve analysis demonstrated that the application of diagnostic factors can improve patient outcomes. RCS analysis indicated that the proportion of solid adenocarcinomas increased by 4.6 times when the PSC was ≥72%. A PSC of 72% is a good cutoff point. The preoperative diagnosis of solid-pattern adenocarcinoma can be confirmed by typical imaging features and clinical characteristics, assisting the thoracic surgeon in developing a more precise surgical plan.

Leveraging digital twins for improved orthopaedic evaluation and treatment.

The purpose of this article is to explore the potential of digital twin technologies in orthopaedics and to evaluate how their integration with artificial intelligence (AI) and deep learning (DL) can improve orthopaedic evaluation and treatment. This review addresses key applications of digital twins, including surgical planning, patient-specific outcome prediction, augmented reality-assisted surgery and simulation-based surgical training. Existing studies on digital twins in various domains, including engineering, biomedical and orthopaedics are reviewed. We also reviewed advancements in AI and DL relevant to digital twins. We focused on identifying key benefits, challenges and future directions for the implementation of digital twins in orthopaedic practice. The review highlights that digital twins offer significant potential to revolutionise orthopaedic care by enabling precise surgical planning, real-time outcome prediction and enhanced training. Digital twins can model patient-specific anatomy using advanced imaging techniques and dynamically update with real-time data, providing valuable insights during surgery and postoperative care. However, challenges such as the need for large-scale data sets, technological limitations and integration issues must be addressed to fully realise these benefits. Digital twins represent a promising frontier in orthopaedic research and practice, with the potential to improve patient outcomes and enhance surgical precision. To enable widespread adoption, future research must focus on overcoming current challenges and further refining the integration of digital twins with AI and DL technologies. Level V.

Exotic Keratin Pearl Degradation Mechanism by Giant Cells in Oral Squamous Cell Carcinoma and its Plausible Hypothesis.

Oral squamous cell carcinoma (OSCC) is a formidable malignancy in the Indian subcontinent, characterized by high morbidity and mortality, with a dismal 5-year survival rate of 40-50%. The tumor's histopathological heterogeneity is well documented, particularly in its differentiation status, which ranges from well-differentiated lesions with prominent keratin pearls to poorly differentiated forms lacking such structures. Existing literature has elucidated the role of neutrophils and macrophages in the degradation of keratin pearls, the involvement of multinucleated giant cells (MNGCs) in this process remains cryptic. This study reports a novel case of a 49-year-old male with moderately differentiated OSCC, characterized by ulcerative growth in the left buccal mucosa. Histopathological analysis revealed neoplastic cell infiltration, keratinization, and abnormal mitoses, alongside the degradation of keratin pearls by large foreign body and Langhans MNGCs. This intricate keratin pearl degradation by MNGCs in OSCC highlights tumor heterogeneity and aggressiveness, offering profound insights into surgical, radiotherapy, and chemotherapy strategies. Surgeons must meticulously consider this process as a marker of aggressive behavior, warranting precise surgical planning and a multidisciplinary approach for optimal outcomes. This case emphasizes the critical role of foreign body and Langhans MNGCs in the degradation of keratin pearls within OSCC, revealing a hitherto unrecognized facet of tumor biology. This discovery holds profound implications for understanding OSCC progression, prognosis, and therapeutic responsiveness, warranting further investigation into the molecular mechanisms underpinning this process.

Virtual Surgical Planning and Customized Subperiosteal Implant for Reconstruction of Maxillary Defect After Oncological Resection.

Reconstructing defects after jaw tumor removal is difficult because of the complex facial skeleton, which affects patient nutrition and self-confidence. Traditional methods like iliac bone or fibula grafts take a long time and may raise aesthetic issues. Advancements in computer-aided three-dimensional (3D) modeling allow precise surgical planning, leading to more symmetrical reconstructions. Moreover, the application of custom-designed prostheses, similar to joint prostheses used in joint surgery, offers promising outcomes, particularly in cases involving the removal of the ramus and temporomandibular joint. A 28-year-old female had a maxillectomy for maxillary myxoma, using 3D-printed implants for reconstruction and dental rehabilitation. "Computer-Aided Design" software optimized implant coordination, reducing soft tissue pressure. Postoperative permanent dentures were successful with few complications. Compared with traditional methods, 3D-printed titanium plates improve patient satisfaction and reduce treatment time, particularly with sufficient soft tissue thickness, offering aesthetic benefits and eliminating extra surgeries for effective defect treatment.

Transpedicular Percutaneous Discectomy for High-Grade Down-Migrated Lumbar Disc Herniation

Objective: The purpose of this study was to evaluate the clinical outcomes of percutaneous endoscopic discectomy using the transpedicular approach for hernias with down-migration.Methods: The study involved a retrospective descriptive analysis of 7 patients who underwent surgery by 2 senior surgeons at 4 different hospitals between 2016 and 2024. The minimum follow-up period was 6 months. All patients were treated with lumbar discectomy through a transpedicular approach with an oblique trajectory. Preoperative and postoperative clinical data were collected for statistical analysis.Results: The surgical procedures were successful and complication-free for all patients. The preoperative and postoperative radicular visual analogue scale and Oswestry Disability Index scores were compared, and the differences were statistically significant (p<0.05).Conclusion: At the last follow-up, 100% of patients had good to excellent results according to the modified MacNab criteria. The transpedicular approach, when using a percutaneous endoscopic technique, requires precise surgical planning and accurate knowledge of the vertebral anatomy. The technique can be made more accessible to inexperienced surgeons by describing it with different instrumentation.

Advancing Precision Rhinoplasty: Preoperative Digital 3D Surgical Planning.

The aim of the study is to assess the efficacy and advantages of utilizing state-of-the-art three-dimensional (3D) reconstruction technology in preoperative planning for rhinoplasty surgery. It is a study of a single rhinoplasty case that was operated at a tertiary hospital. The patient was assessed through a detailed history, blood investigations, radiological investigations and preoperative 3D (three-dimensional) reconstruction of the face and nose. The study utilized high-resolution CT scans and 3D reconstruction software like 3D (three-dimensional) Slicer and Blender 3D (three-dimensional) to analyze nasal anatomy for preoperative planning in rhinoplasty. External and internal nasal measurements were taken, and axial cross-section analysis was conducted to assess nasal structure deviation. The benefits of 3D (three-dimensional) visualization in surgical planning were evaluated, and surgical management was based on preoperative reconstructions. Comprehensive preoperative evaluations were performed, adhering to ethical guidelines.Preoperative 3D (three-dimensional) reconstruction planning methods facilitated precise surgical planning and execution in rhinoplasty with satisfactory outcomes for both the patient and the surgeon. Incorporating 3D (three-dimensional) reconstruction technology in rhinoplasty preoperative planning enhances surgical precision and patient satisfaction, ensuring optimized surgical outcomes while adhering to ethical standards.

3D Cinematic rendering for evaluating femoral pseudoaneurysms in injection drug users.

The inguinal region, specifically the femoral vasculature, is a commonly used site of injection for intravenous drug users (IVDU). Repeated puncture of the vessel wall results in breakdown and subsequent arterial pseudoaneurysm- dilatations or outpouching of blood vessels, which, if left untreated, can result in fatal complications such as rupture with hemorrhage, sepsis, or even limb loss. The current modalities for arterial pseudoaneurysms include Doppler ultrasound and computed tomography (CT) angiography, both of which play important roles in management and surgical planning. However, 3D cinematic rendering (CR), a novel CT post-processing technique, offers timely, highly detailed photorealistic images that more clearly display the relation of anatomical structures, allowing for greater diagnostic confidence and precise surgical planning, particularly useful in the emergency setting. In this pictorial review, we demonstrate role of 3D CR in diagnosis and management of femoral pseudoaneurysms in IVDU through 9 illustrative cases.

Usefulness of Preoperative Simulation: Skull Base Approach

Preoperative simulation images creates an accurate visualization of a surgical field. The anatomical relationship of the cranial nerves, arteries, brainstem, and related bony protrusions is important in skull base surgery. However, an operator's intention is unclear for a less experienced neurosurgeon. Three-dimensional(3D)fusion images of computed tomography and magnetic resonance imaging created using a workstation aids precise surgical planning and safety management. Since the simulation images allows to perform virtual surgery, a déjà vu effect for the surgeon can be obtained. Additionally, since 3D surgical images can be used for preoperative consideration and postoperative verification, discussion among the team members is effective from the perspective of surgical education for residents and medical students. Significance of preoperative simulation images will increase eventually.

Fibular free flap with proximal perforator skin paddle due to aberrant anatomy — a case report

BackgroundThe fibular free flap is considered one of the most valuable options for mandible reconstruction. A perforator flap has gained widespread acceptance in oral and maxillofacial reconstruction. Typically, the fibula flap is obtained primarily with the distal perforator due to its reliable blood supply, with less attention given to the proximal perforators during the harvesting process. Normally, the distal perforator of the fibula exhibits stability and shows limited anatomical variations. However, there have been reported cases in which the distal perforator is absent. At times, these vascular abnormalities remain undetectable through Doppler examination or preoperative angiography evaluation. Therefore, this case details the experience of encountering the rare event of vascular abnormality in oral cancer surgery.Case presentationThis article reports the case of a patient who presented with a congenital absence of the distal perforator in the peroneal artery, attributed to a vascular abnormality. Additionally, we provide a review of the concept of utilizing the proximal perforator as an alternative approach in the flap harvesting process.ConclusionsWhile the distal perforator of the peroneal artery is typically utilized for fibula free flap procedures, surgeons must remain cognizant of the potential for its absence due to aberrant anatomy. Recognizing an alternative approach in such cases can be pivotal for precise surgical planning and favorable outcomes in oral and maxillofacial reconstruction

Recent advances of 3D-printing in spine surgery.

The emerging use of three-dimensional printing (3DP) offers improved surgical planning and personalized care. The use of 3DP technology in spinal surgery has several common applications, including models for preoperative planning, biomodels, surgical guides, implants, and teaching tools. A literature review was conducted to examine the current use of 3DP technology in spinal surgery and identify the challenges and limitations associated with its adoption. The review reveals that while 3DP technology offers the benefits of enhanced stability, improved surgical outcomes, and the feasibility of patient-specific solutions in spinal surgeries, several challenges remain significant impediments to widespread adoption. The obvious expected limitation is the high cost associated with implementing and maintaining a 3DP facility and creating customized patient-specific implants. Technological limitations, including the variability between medical imaging and en vivo surgical anatomy, along with the reproduction of intricate high-fidelity anatomical detail, pose additional challenges. Finally, the lack of comprehensive clinical monitoring, inadequate sample sizes, and high-quality scientific evidence all limit our understanding of the full scope of 3DP's utility in spinal surgery and preclude widespread adoption and implementation. Despite the obvious challenges and limitations, ongoing research and development efforts are expected to address these issues, improving the accessibility and efficacy of 3DP technology in spinal surgeries. With further advancements, 3DP technology has the potential to revolutionize spinal surgery by providing personalized implants and precise surgical planning, ultimately improving patient outcomes and surgical efficiency.

Deep learning‐based survival prediction of brain tumor patients using attention‐guided 3D convolutional neural network with radiomics approach from multimodality magnetic resonance imaging

AbstractAutomatic survival prediction of gliomas from brain magnetic resonance imaging (MRI) volumes is an essential step for a patient's prognosis analysis. Radiomics research delivers beneficial feature information from MRI imaging which is substantially required by clinicians and oncologists for predicting disease prognosis for precise surgical treatment and planning. In recent years, the success of deep learning has been vast in the field of medical imaging, and it shows state‐of‐the‐art performance in applications like segmentation, classification, regression, and detection. Therefore, in this paper, we proposed a collective method using deep learning and radiomics techniques for the survival prediction of brain tumor patients. We first propose a hierarchical channel attention (HAM) module and a multi‐scale‐aware feature enhancement (MSAFE) to efficiently fuse adjacent hierarchical features in the proposed segmentation model. After segmentation, deep/latent features (LCNN) are extracted from the bottom layer of the proposed segmentation model. Later, we extracted selected radiomics features (histogram, location, and shape) using input images and segmented masks from the proposed segmentation model. Further, the 3D deep learning regressor has been trained for 3D regressor‐based deep feature extraction. We proposed the method of overall survival prediction for the brain tumor patients by combining all the meaningful features including clinical features (age) that also favorably contribute to the survival days prediction for the glioma's patients. To predict the survival days for each patient, the selected features are trained to analyze the performance of various regression techniques like random forest (RF), decision tree (DT), and XGBoost. Our proposed combined feature‐based method achieved the highest performance for survival days prediction over the state‐of‐the‐art methods. We also perform extensive experiments to show the effectiveness of each feature extraction method. The experimental results infer that deep learning‐based features along with radiomic features and clinical features are truly vital paradigms to estimate survival days.

Penetrating trauma to the male external genitalia: Case report and clinical management

Penetrating trauma to the male genital organs, especially involving a foreign body, is an unusual but critical clinical scenario with potential consequences for sexual health, urinary function, and the patient's quality of life. When such injuries occur in the context of a road traffic accident, the complexity of their management is further heightened. This case report presents a unique case of a 26-year-old motorcyclist who suffered open trauma from a 5 cm metallic foreign body projecting at the base of the penis following a car collision. The clinical evaluation, diagnostic challenges, surgical approach, and successful outcome are discussed. Management of penetrating pelvic trauma requires a multidisciplinary approach, careful planning, and postoperative vigilance to minimize complications and promote healing. This case contributes valuable insights to the medical community, emphasizing the significance of imaging, precise surgical planning, and interdisciplinary collaboration for optimal patient care in such rare and severe injuries.

Application and research progress of artificial intelligence technology in trauma treatment

To review the application and research progress of artificial intelligence (AI) technology in trauma treatment. The recent research literature on the application of AI and related technologies in trauma treatment was reviewed and summarized in terms of prehospital assistance, in-hospital emergency care, and post-traumatic stress disorder risk regression prediction, meanwhile, the development trend of AI technology in trauma treatment were outlooked. The AI technology can rapidly analyze and manage large amount of clinical data to help doctors identify patients' situation of trauma and predict the risk of possible complications more accurately. The application of AI technology in surgical assistance and robotic operations can achieve precise surgical plan and treatment, reduce surgical risks, and shorten the operation time, so as to improve the efficiency and long-term effectiveness of the trauma treatment. There is a promising future for the application of AI technology in the trauma treatment. However, it is still in the stage of exploration and development, and there are many difficulties of historical data bias, application condition limitations, as well as ethical and moral issues need to be solved.

Role of Three-Dimensional Printing in Treatment Planning for Orthognathic Surgery: A Systematic Review.

Three-dimensional (3D) printing refers to a wide range of additive manufacturing processes that enable the construction of structures and models. It has been rapidly adopted for a variety of surgical applications, including the printing of patient-specific anatomical models, implants and prostheses, external fixators and splints, as well as surgical instrumentation and cutting guides. In comparison to traditional methods, 3D-printed models and surgical guides offer a deeper understanding of intricate maxillofacial structures and spatial relationships. This review article examines the utilization of 3D printing in orthognathic surgery, particularly in the context of treatment planning. It discusses how 3D printing has revolutionized this sector by providing enhanced visualization, precise surgical planning, reduction in operating time, and improved patient communication. Various databases, including PubMed, Google Scholar, ScienceDirect, and Medline, were searched with relevant keywords. A total of 410 articles were retrieved, of which 71 were included in this study. This article concludes that the utilization of 3D printing in the treatment planning of orthognathic surgery offers a wide range of advantages, such as increased patient satisfaction and improved functional and aesthetic outcomes.

Multidisciplinary Approach and Therapeutic Advances in the Management of Meningioma: A Comprehensive Review

Meningioma, a predominantly benign intracranial neoplasm originating in the meninges, has been the subject of extensive study in the medical community due to its prevalence, clinical diversity, and associated therapeutic challenges. This article aims to provide a comprehensive review of current advances in the understanding, diagnosis and treatment of meningiomas, focusing on the application of multidisciplinary approaches and innovative therapies. Through a detailed exploration of the molecular pathogenesis, updated histopathologic classifications, and varied clinical presentations of meningiomas, an in-depth understanding of the inherent heterogeneity of these neoplasms is sought. The importance of advanced neuroimaging, including diffusion-weighted MRI and positron emission tomography, in the accurate assessment of tumor extent and precise surgical planning will be highlighted. In the therapeutic arena, conventional options, such as surgery and radiation therapy, will be examined in detail and the challenges and limitations associated with these modalities will be discussed. In addition, emerging pharmacologic therapies, such as angiogenesis inhibitors and therapies specifically targeting genetic mutations frequently found in meningiomas, will be reviewed, highlighting their potential to modify the clinical course of the disease. The multidisciplinary approach, involving close collaboration between neurosurgeons, neuroradiologists, pathologists and oncologists, will be explored in detail, highlighting its crucial role in informed clinical decision making and optimizing patient outcomes. Finally, future prospects and areas of ongoing research, such as immunotherapy and gene therapy, which promise to further revolutionize the therapeutic paradigm for meningiomas, will be outlined. This article will provide a comprehensive overview of meningiomas, from their molecular basis to state-of-the-art treatment strategies, with the purpose of enriching medical knowledge and fostering a holistic approach in the care of patients affected by this complex pathological entity.

The eyes see what the mind knows - Interpretation of magnetic resonance imaging.

: In 1978, the advent of magnetic resonance imaging (MRI) was a remarkable volte-face in the world of diagnostics. Employing the phenomenon of nuclear resonance enables us to exploit the properties of differential protons in living tissues. The ability of providing higher and variable contrast and the absence of ionizing radiations make it superior to computed tomography. Being the diagnostic tool of choice, it is an indispensable part of assessment of the location and characteristics of different ocular and orbital pathologies (vascular, inflammatory, and neoplastic). : The intrinsic and extrinsic properties of MRI provide multi-parametric imaging, making it of paramount importance in ophthalmological evaluation. Also, MRI-dynamic color mapping provides non-invasive and quantitative assessment of soft tissues in motion. An in-depth knowledge of the basic principle and technique of MRI aids in diagnosing as well optimal planning of surgical interventions. : In this video, we shall be displaying the anatomical, clinical, and radiological aspects of MRI with an overlap to make it easier to understand the implications of this miraculous invention. : A good understanding of MRI analysis makes the ophthalmologists independent and helps in ruling out the differential diagnoses, exact extent and invasion, precise surgical planning and therefore, avoiding tragic outcomes. This video is an attempt to simplify and emphasize on the importance of MRI interpretation for an ophthalmologist. Video link https://youtu.be/r5dNo4kaH8o.

Presurgical assessment of dentofacial anomalies using computed axial tomography: What the radiologist should always report

Dentofacial anomalies (DFA) are a frequent reason for consultation in maxillofacial surgery departments, since diagnostic imaging is important for surgical planning and follow-up. DFA refers to significant deviation from the normal proportions of the maxillomandibular complex, which negatively affects dental occlusion. The management of these alterations is mainly performed with orthognathic surgery, which seeks the repositioning of dental and facial skeletal components through a combination of procedures. Computerized axial tomography studies allow maxillofacial surgeons to establish the type of anomaly, identify associated findings —breathing alterations—, perform surgical simulations and define precise surgical planning. Interdisciplinary working groups and minimal knowledge of the language used in the management of DFAs allow a better approach to imaging modalities, as well as the reporting of relevant information for the clinical management of patients.