Primary Surgical Intervention Research Articles

Predictive parameters for anatomical surgical success in full-thickness macular holes : Aretrospective evaluation of 391eyes

Full-thickness macular hole (FTMH) is arare disease. Not all FTMHs can be closed by primary surgical intervention. This work aims to characterize alarge patient population with FTMHs and to detect possible predictive factors for anatomical treatment success. The study comprises aretrospective analysis of all consecutive idiopathic macular holes between March 2008 and June 2019 at the University Eye Hospital Cologne. Epidemiologic data, preoperative parameters (size of the FTMH), and surgical technique were examined in relation to the closure rate following primary surgery. The anatomical closure rate for idiopathic FTMH after primary surgery was 83.6%. No association between age, gender, and lens status and closure rate could be shown. Regarding anatomical surgical success, the favorable prognostic factors identified were asmall FTMH size, short symptom duration, performance of transconjunctival 23-gauge vitrectomy, and application of the inverted flap technique of the internal limiting membrane (ILM). Surgical treatment represents avaluable treatment option for patients with macular holes due to good prospects of success. Prompt intervention after diagnosis using 23-gauge vitrectomy and an ILM flap with gas tamponade seems to result in the most favorable outcomes.

Radiological predictors of outcomes in hip arthroscopy for femoroacetabular impingement.

Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity.

CLINICAL PRESENTATIONS AND SURGICAL MANAGEMENT OF UTERINE SEPTUM-ASSOCIATED INFERTILITY: A CASE SERIES STUDY

Uterine septum, a congenital uterine anomaly, is implicated in female infertility and adverse reproductive outcomes. This retrospective descriptive case series examines eight patients treated for primary or secondary infertility associated with uterine septum. Diagnostic evaluations, surgical interventions, and postoperative outcomes are presented. Hysteroscopic septum resection emerged as the primary surgical intervention, with varying success rates in achieving pregnancy postoperatively. Factors influencing outcomes include patient age, septum morphology, and associated comorbidities. Individualized treatment strategies and adjunctive therapies such as hormonal manipulation and assisted reproductive techniques are crucial for optimizing fertility outcomes. While promising, long-term reproductive prognosis post-surgery remains uncertain, warranting further research and prospective studies. This study underscores the complexity of uterine septum-associated infertility and emphasizes the need for a multidisciplinary approach to management, aiming to enhance reproductive outcomes and fulfill the reproductive aspirations of affected individuals.

Specifics of regional recurrences in lateral tissue of the neck after surgical treatment of highly differentiated thyroid cancer

Introduction. Despite the fact that highly differentiated thyroid cancer is included in the group of malignant neoplasms with a favorable prognosis, data on the high frequency and recurrence of relapses are reported. The presence of metastatic lymph nodes in HDTC increases the risk of regional relapse by up to 27%. According to the literature, the factors that increase the risk of recurrence are: histological type, stage, depth of extrathyroid invasion, the presence of metastatic lymph nodes, age, and the volume of primary surgical intervention. Lateral neck dissection should be performed in patients with morphologically verified metastatic thyroid cancer, but there is still no clear consensus on the volume of dissection.Aim. Assessment of factors affecting the risk of regional recurrence in the lateral neck tissue and the localization of recurrence.Materials and methods. The study included 56 patients with HDTC, in whom metastatic lateral neck nodes were identified and verified. All patients previously underwent unilateral or bilateral neck lymph node dissection in various institutions. During the period of dynamic follow-up, these patients revealed regional recurrences in the lateral tissue of the neck. The patients were observed and treated for recurrence at the N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia.Results. Age over 55 years is a prognostically significant factor affecting the frequency of regional relapse in the lateral neck tissue (p=0.002). The presence of metastatic nodes in the lateral tissue of the neck at the initial treatment is a prognostically significant factor that increases the risk of regional recurrence in the lateral tissue of the neck (p=0.017). According to the results of a single-factor analysis, a statistically significant effect of the stage on the risk of regional relapses in the lateral neck tissue was noted (p=0.014). In 35.7% of cases, recurrent nodes were localized in the level V.Conclusion. Main risk factors for relapse are clinico-morphological, such as age, aggressive type of HDTC, stage of the disease, N1b status after primary surgery, as well as technical defects during primary surgical treatment.

Use of Artificial Intelligence in the Prediction of Chiari Malformation Type 1 Recurrence After Posterior Fossa Decompressive Surgery.

Purpose The purpose of this study was to train a deep learning-based method for the prediction of postoperative recurrence of symptoms in Chiari malformation type 1 (CM1) patients undergoing surgery. Studies suggest that certain radiological and clinical features do exist in patients with treatment failure, though these are inconsistent and poorly defined. Methodology This study was a retrospective cohort study of patients who underwent primary surgical intervention for CM1 from January 2010 to May 2020. Only patients who completed pre- and postoperative 12-item short form(SF-12) surveys were included and these were used to classify the recurrence or persistence of symptoms. Forty patients had an improvement in overall symptoms while 17 had recurrence or persistence. After magnetic resonance imaging (MRI) data augmentation, a ResNet50, pre-trained on the ImageNet dataset, was used for feature extraction, and then clustering-constrained attention multiple instance learning (CLAM), a weakly supervised multi-instance learning framework, was trained for prediction of recurrence. Five-fold cross-validation was used for the development of MRI only, clinical features only, and a combined machine learning model. Results This study included 57 patients who underwent CM1 decompression. The recurrence rate was 30%. The combined model incorporating MRI, pre-operative SF-12 physical component scale (PCS), and extent of cerebellar ectopia performed best with an area under the curve (AUC) of 0.71 and an F1 score of 0.74. Conclusion This is the first study to our knowledge to explore the prediction of postoperative recurrence of symptoms in CM1 patients using machine learning methods and represents the first steptowarddeveloping a clinically useful prognostication machine learning model. Further studies utilizing a similar deep learning approach with a larger sample size are needed to improve the performance.

Assessment of the quality of life of children having the treatment for congenital hip dislocation

Long-term surgical treatment outcomes in children with congenital hip dislocation can be various and depend on many factors, including the age in time of surgery. The quality of life assessment systems are modern tools to study the effectiveness of previous treatment, as well as to plan subsequent comprehensive rehabilitation. Material and methods. The study included 68 children divided into the groups according to the age of the primary surgical intervention. There were three groups: group 1 – 21 patients under 1.5 years, group 2 – 22 children aged 1.5–4-years, group 3 – 25 children over 4 years. Objective medical assessment of the clinical outcomes was carried out with the McKay’s criteria. The PedsQL4.0 questionnaire, pediatric and parental forms were used to assess the patients’ quality of life. Results. The majority of children in the 1st age group had excellent results (52.3%), in the 2nd and 3rd groups there were fewer such results (40.9 and 32 %, respectively). Having analyzed the data of the questionnaires for children and their caregivers we found that the both categories from group 3 demonstrated the lowest quality of life parameters. Conclusions. The frequency of consequences such as discomfort, limping, limb length discrepancy was also higher in children underwent surgery at the age of over 4 years old. It correlates with the questionnaire results and demonstrates a lower quality of life in children from group 3.

Tricuspid repair: short and long-term results of suture annuloplasty techniques and rigid and flexible ring annuloplasty techniques

BackgroundFunctional tricuspid regurgitation may arise from left heart valve diseases or other factors. If not addressed concurrently with primary surgical intervention, it may contribute to increased morbidity and mortality rates during the postoperative period. This study investigates the impact of various repair techniques on crucial factors such as systolic pulmonary artery pressure (SPAP), tricuspid valve regurgitation, and New York Heart Association (NYHA) functional capacity class in the postoperative period.Materials and methodsFrom April 2007 to June 2013, 379 adults underwent open-heart surgery for functional tricuspid regurgitation. Patients were categorized into four groups: Group 1 (156) with De Vega suture annuloplasty, Group 2 (60) with Kay suture annuloplasty, Group 3 (122) with Flexible Duran ring annuloplasty, and Group 4 (41) with Semi-Rigid Carpentier-Edwards ring annuloplasty. Demographic, clinical, operative, and postoperative data were recorded over a mean follow-up of 35.6 ± 19.1 months. Postoperative SPAP values, tricuspid regurgitation grades, and NYHA functional capacity classes were compared among the groups.ResultsNo statistically significant differences were observed among the groups regarding age, gender, preoperative disease diagnoses, history of previous cardiac operations, or echocardiographic characteristics such as preoperative ejection fraction, SPAP, and tricuspid regurgitation. Hospital and intensive care unit length of stay and postoperative complications also showed no significant differences. However, patients in Group 3 exhibited longer Cardio-Pulmonary Bypass duration, cross-clamp duration, and higher positive inotrope requirements. While the mortality rate within the first 30 days was higher in Group 1 compared to the other groups (p: 0.011), overall mortality rates did not significantly differ among the groups. Significant regression in functional tricuspid regurgitation and a notable decrease in SPAP values were observed in patients from Group 3 and Group 4 (p: 0.001). Additionally, patients in Group 3 and Group 4 showed a more significant reduction in NYHA functional capacity classification during the postoperative period (p: 0.001).ConclusionAmong the repair techniques, ring annuloplasty demonstrated superiority in reducing SPAP, regressing tricuspid regurgitation, and improving NYHA functional capacity in functional tricuspid regurgitation repairs.

Retinoblastoma Incidence in Taiwan Over a Recent 20-Year Period: A Comprehensive Nationwide Study.

Continuous advancements in medical diagnostic technology and the growing availability of resources suggest a potential for fluctuations in the incidence rate of retinoblastoma (Rb). This study aimed to analyze incidence data of Rb patients in Taiwan from 1999 to 2018, utilizing the nationwide Taiwan Cancer Registry (TCR) database. Additionally, we investigated the treatment modalities used for these Rb patients and compared them with those observed in other countries. We conducted a retrospective cohort study utilizing data from the TCR database. The study cohort comprised individuals who were newly diagnosed with Rb between 1999 and 2018. The incidence of Rb was calculated as the number of patients with Rb per million live births, both for the entire population and for different gender groups and time periods. The trends in Rb incidence from 1999 to 2018 across various age groups and sexes were presented with the linear trend test. From 1999 to 2018, a total of 248 cases of Rb were identified. The overall incidence rate over this 20-year period was 60.20 cases per million live births, corresponding to 1 case per 16,611 live births. Incidence rates for each 5-year period between 1999 and 2018 exhibited no significant differences. The study cohort was predominantly male, with 134 cases (54.03%) being males and 114 cases (45.97%) being females, resulting in an overall male-to-female sex ratio of 1.18. Females had lower relative risk than males (RR: 0.92, 95% CI: 0.72-1.19). Primary surgical intervention was the preferred treatment modality for over 75% of the cases. This retrospective epidemiology study, using TCR from 1999 to 2018, indicated that no discernible trend of retinoblastoma incidence in Taiwan. Nevertheless, continuous monitoring of incidence rates and exploration of treatment strategies for retinoblastoma within the Taiwanese population are important to address potential changes in developing medical practices.

Analysis of risk factors for lateral lymph node metastasis in T1 stage papillary thyroid carcinoma: a retrospective cohort study.

The occurrence of cervical lymph node metastasis in T1 stage papillary thyroid carcinoma (PTC) is frequently observed. Notably, lateral lymph node metastasis (LLNM) emerges as a critical risk factor adversely affecting prognostic outcomes in PTC. The primary aim of this investigation was to delineate the risk factors associated with LLNM in the initial stages of PTC. This retrospective analysis encompassed 3,332 patients diagnosed with T1 stage PTC without evident LLNM at the time of diagnosis. These individuals underwent primary surgical intervention at West China Hospital, Sichuan University between June 2017 and February 2023. The cohort was divided into two groups: patients manifesting LLNM and those without metastasis at the time of surgery. Additionally, T1 stage PTC patients were subdivided into T1a and T1b categories. Factors influencing LLNM were scrutinized through both univariate and multivariate analyses. The incidence of LLNM was observed in 6.2% of the cohort (206 out of 3,332 patients). Univariate analysis revealed significant correlations between LLNM and male gender (P<0.001), tumor localization in the upper lobe (P<0.001), maximal volume of the primary tumor (P<0.001), largest tumor diameter (P<0.001), multifocality (P<0.001), and bilaterality (P<0.001), with the exception of age (P=0.788) and duration of active surveillance (AS) (P=0.978). Multivariate logistic regression analysis identified male gender (P<0.001), upper lobe tumor location (P<0.001), maximal primary tumor volume (P<0.001), and multifocality (P<0.001) as independent predictors of LLNM. However, age categories (≤55, >55 years), maximum tumor diameter, bilaterality, and surveillance duration did not exhibit a significant impact. Comparative analyses between T1a and T1b subgroups showed congruent univariate results but revealed differences in multivariate outcomes. In the T1a subgroup, gender, tumor location, and multifocality (all P<0.05) were associated with elevated LLNM risk. Conversely, in the T1b subgroup, tumor location, dimensions, and multifocality (all P<0.05) were significant predictors of LLNM risk, whereas gender (P=0.097) exerted a marginal influence. The investigation highlights several key risk factors for LLNM in T1 stage PTC patients, including gender, upper lobe tumor location, larger tumor size, and multifocality. Conversely, prolonged AS and younger age did not significantly elevate LLNM risk, suggesting the viability of AS as a strategic option in selected cases.

Acute Acquired Comitant Esotropia with Myopia: Longer-Term Follow-Up of Botulinum Toxin vs. Strabismus Surgery in a Western Population

Acute’ Acquired Comitant Esotropia with myopia (AACEM) is an unusual form of non-paretic, diplopia-inducing strabismus. It is a subset of (acute) acquired comitant esotropia with recent reports of increasing prevalence. No reports exist comparing botulinum toxin (BTX) to surgery beyond the six-month therapeutic effect of BTX in a western population. Clinical characteristics of AACEM are defined and immediate and longer-term results of both interventions are reported in this retrospective review of 16 cases from two centres. Eight cases received BTX and eight cases had primary surgical intervention. Mean distance and near angle pre-surgery was 37.50±10.35 prism diopters (PD) and 35.63±12.66 PD respectively. Mean distance and near angle at final follow-up post-surgery (475.88±301.21 days, median 466.5) was 5.62±3.78 PD and 5.88±5.25 PD respectively. Mean distance and near angle pre-BTX was 36.00±15.33 PD and 38.75±14.58 PD respectively. Mean distance and near angle at final follow-up post-BTX (789±548.98 days, median 700) was 20.13±15.57 PD and 22.25±17.85 PD respectively. In this the longer-term follow-up study surgery was found to be superior as compared to BTX post-intervention. Surgical alignment also appeared more stable

Impact of the COVID-19 pandemic on colorectal cancer stage at presentation.

80 Background: The primary study objective was to assess the impact of COVID-19 on the stage at presentation for patients with newly diagnosed colorectal cancer treated within a large cancer center network. Additionally, we aimed to evaluate differences in pathologic stage and treatment modality for patients diagnosed with colorectal cancer both immediately before and during the height of the COVID-19 pandemic. Methods: A retrospective analysis was performed on all subjects newly diagnosed with colorectal cancer between January 2019 and April 2021 at Levine Cancer Institute. Patients had a primary diagnosis of adenocarcinoma of the colon, rectum, or appendix. Patients were categorized into two cohorts based on date of diagnosis, with the pre-COVID-19 group diagnosed between January 2019 and February 2020 and the COVID-19 group diagnosed between March 2020 and April 2021. Chi-squared tests were used to evaluate the association between COVID-19 group and stage at presentation as well as pathologic stage. Results: A total of 1,190 patients were diagnosed with colorectal cancer within the study timeframe. Of the 613 patients diagnosed pre-COVID-19, 159 (25.9%) had metastatic disease at initial presentation. Comparatively, 577 patients were diagnosed during the COVID-19 study period, with 143 (24.8%) presenting with metastatic disease (p = 0.65).Of the 888 patients who presented with non-metastatic disease, 770 underwent primary surgical intervention for the initial treatment of their cancer, with 396 (87.2%) pre-COVID-19 and 374 (86.2%) COVID-19 patients receiving surgery (p = 0.65). Likewise, no significant difference was observed for T-classification, N-classification, or overall pathologic stage among patients undergoing surgical resection between the pre-COVID-19 and COVID-19 groups (p = 0.20; Table). Furthermore, amongst patients who presented with non-metastatic disease, chemotherapy was utilized for 200 (44.1%) patients diagnosed pre-COVID-19 and 190 (43.8%) patients diagnosed during COVID-19 (p = 0.93). Conclusions: We did not observe a significant difference in the proportion of patients presenting with metastatic colorectal cancer during COVID-19 versus those presenting pre-COVID-19. Furthermore, there was no significant difference observed among non-metastatic patients between the two groups for rates of initial surgical resection, pathologic stage, and treatment with chemotherapy. [Table: see text]

Better prognosis in surgical aortic valve replacement patients with lower red cell distribution width: A MIMIC-IV database study.

Surgical aortic valve replacement (SAVR) currently stands as a primary surgical intervention for addressing aortic valve disease in patients. This retrospective study focused on the role of the red blood cell distribution width (RDW) in predicting adverse outcomes among SAVR patients. The subjects for this study were exclusively derived from the Medical Information Mart for Intensive Care database (MIMIC IV 2.0). Kaplan‒Meier (K-M) curves and Cox proportional hazards regression models were employed to assess the correlation between RDW, one-year mortality, and postoperative atrial fibrillation (POAF). The smooth-fitting curves were used to observe the relative risk (RR) of RDW in one-year mortality and POAF. Furthermore, time-dependent receiver operating characteristic (ROC) curves, the continuous-net reclassification index (NRI), and integrated discrimination improvement (IDI) were employed for comprehensive assessment of the prognostic value of RDW. Analysis of RDW revealed a distinctive inverted U-shaped relationship with one-year mortality, while its association with POAF appeared nearly linear. Cox multiple regression models showed that RDW > 14.35%, along with preoperative potassium concentration and perioperative red blood cell transfusion, were significantly linked to one-year mortality (K-M curves, log-rank P < 0.01). Additionally, RDW was associated with both POAF and prolonged hospital stays (P < 0.05). There was no significant difference in length of stay in ICU. Notably, the inclusion of RDW in the predictive models substantially enhanced its performance. This was evidenced by the time-dependent ROC curve (AUC = 0.829), NRI (P< 0.05), IDI (P< 0.05), and K-M curves (log-rank P< 0.01). RDW serves as a robust prognostic indicator for SAVR patients, offering a novel means of anticipating adverse postoperative events.

Лікування та профілактика спайкової кишкової непрохідності в дітей

Despite the achievements of modern pediatric surgery, to date there is no single comprehensive approach to the treatment and prevention of adhesive intestinal obstruction (AIO), both primary (prevention of adhesions formation after primary surgery) and secondary (prevention of recurrence). Purpose - to study the clinical effectiveness of treatment, primary and secondary prevention of postoperative intestinal adhesive obstruction in children. Materials and methods. An examination and analysis of medical records of 119 children aged 5 months to 17 years who were treated at the Pediatric Surgery Clinic of Ivano-Frankivsk National Medical University over the past 10 years for post-operative AIO was carried out. In 35 (29.41%) children a positive effect was achieved from conservative treatment. The remaining 84 (70.59%) children were operated on. Two groups of patients were formed: the comparison group - 38 (45.24%) children, who received traditional treatment, and the main group - 46 (54.76%) children, who were intraoperatively applied anti-adhesive gel to prevent recurrence of postoperative AIO. Results. It was established that postoperative AIO occurred in only 1 (1.19%) child after laparoscopic intervention, in the rest of the children primary surgical interventions were performed by an open method. In the comparative assessment of the postoperative course in two groups of patients, we drew attention to a more favorable course in the children of the main group, which was manifested by a faster recovery of peristalsis, a decrease in the duration of gastric stasis, a faster appearance of independent defecation, and a shorter period of inpatient treatment. When comparing the results of treatment between groups of patients, it was established that the frequency of recurrences of AIO in the main group of patients was 5.44 times lower than in children of the comparison group, and the frequency of relaparotomy for recurrent AIO was 7.28 times lower than in patients of comparison group. We did not observe complications associated with the use of anti-adhesive gel. We did not notice a significant difference in the results of treatment between patients who were treated with anti-adhesive gel of different composition (based on carboxymethylcellulose and sodium hyaluronate). Conclusions. The most effective method of primary prevention of postoperative adhesive intestinal obstruction is the use of laparoscopic primary surgical interventions. Intraoperative application of anti-adhesive gel is a highly effective and safe recurrence prevention method of adhesive intestinal obstruction in children. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

PERSONALIZED APPROACH TO THE CHOICE OF BILIARY DRAINAGE TACTICS IN PATIENTS WITH TUMOR-INDUCED MECHANICAL JAUNDICE

Mechanical jaundice resulting from the tumor-induced obstruction of bile ducts is usually the first and quite severe complication of malignant neoplasms of the organs of the hepatopancreatoduodenal zone. Radical treatment for this condition, as reported by various sources, remains below 20-25%. Therefore, the imperative is to select the most effective minimally invasive biliary drainage method to alleviate biliary tract pressure and address the issue of mechanical jaundice. This approach serves both as a preparatory step for potential radical surgical intervention and as a definitive method for palliative treatment in this patient category.&#x0D; The aim of this work is to develop an optimal algorithm for diagnosis and treatment of patients with tumor-induced mechanical jaundice, which will increase the effectiveness of primary surgical intervention and reduce the number of complications and mortality for this category of patients.&#x0D; The investigation focused on examining the results of diagnostic and surgical interventions in 108 patients with tumor-induced mechanical jaundice. These patients underwent biliary drainage operations in surgical hospitals between 2017 and 2023. Analysis of the surgical outcomes revealed that endoscopic drainage and percutaneous transhepatic drainage exhibited similar effectiveness in I and II levels of biliary obstruction. However, endoscopic drainage demonstrated lower complication rates and improved quality of life for patients, establishing it as the preferred method. For level III blockages, percutaneous transhepatic drainage is recommended.&#x0D; The implementation of a diagnostic and treatment algorithm, which considers the level of biliary block, the severity of mechanical jaundice, and the tumor process stage, enables the selection of the most effective minimally invasive biliary drainage method. This approach contributes to a reduction in postoperative mortality.

Release of retromalleolar flexor retinaculum and combined flexor digitorum longus and flexor hallucis longus Z-plasty in checkrein deformity: a case report

BackgroundCheckrein deformity is a rare abnormality comprising flexor hallucis longus (FHL) tendon entrapment in the posterior foot due to post-traumatic or ischemic retraction of the FHLtendon following soft tissue trauma. The diagnosis is essentially clinical, but complemented by imaging to rule out unrecognized causes and evaluate the fracture healing process. This case report is the first Indonesian study to describe release of the flexor retinaculum and Z-plasty (lengthening) of flexor digitorum longus (FDL) and FHL tendons through a medial retromalleolar approach to repair the deformity. Case DescriptionWe present the case of a 51-year-old male who complained of clawing of his right first and second toes. The interest of this study lies in the fact that this patient had never experienced ankle or distal tibial fractures, only a trivial injury two years back when the patient kicked a stone at work and had a bruise on his right second toe with no fracture. Exploration of FHL tendons was performed at the level of the midfoot. The patient was planned for surgery with a medial retromalleolar ankle approach, which facilitates the release of the flexor retinaculum, in conjunction with a Z-tenotomy on the FHL and FDL tendons. ConclusionA correction was achieved, and two months post-surgery there were no recurrences of the deformity. However, this surgical procedure requires more cases to support an evaluation of its effectiveness. We suggest that exploration at the ankle and midfoot should be the primary surgical intervention in similar cases of checkrein deformity.

Effectiveness and Safety of Burr Hole Evacuation in Chronic Subdural Hematoma Patients – Experience from a Low-Income Country

Background: In contemporary neurosurgery, burr holes are fundamental in cranial procedures, primarily for the evacuation of chronic subdural hematomas (CSDH). CSDH is prevalent, and its clinical course, though not life-threatening, carries morbidity and mortality risks. This study evaluates the effectiveness and safety of Burr Hole Evacuation (BHE) for CSDH, aiming to assess clinical outcomes, immediate postoperative complications, and patient satisfaction. Methodology: This retrospective cohort study analyzed data from patients who underwent BHE for CSDH between March 2015 and August 2023. Inclusion criteria encompassed well-documented CSDH diagnoses, comprehensive medical records, and primary BHE cases, excluding previous neurosurgical interventions and pediatric cases. Data included patient demographics, clinical presentation, imaging findings, surgical details, post-operative outcomes, and patient satisfaction. Analysis was performed using SPSS version 25. Results: The study included 86 patients, predominantly male (85%) with a mean age of 54 years. Clinical presentations varied, with headaches (85%) being the most common symptom. CT scans were pivotal for diagnosis, revealing hypodensities primarily over the convexity. BHE was performed without complications, resulting in favorable post-operative outcomes (93% significant recovery, 7% extended hospital stays). No intraoperative or post-operative mortality occurred, and there were no recurrent hematomas. Patient satisfaction with BHE was high (97%). Conclusion: BHE is a viable primary surgical intervention for CSDH in low-income settings, with positive outcomes, safety, and patient satisfaction. Further studies and collaborative efforts are essential to enhance neurosurgical treatment in these settings and explore long-term outcomes.

A tailored approach to the management of post-haemorrhagic hydrocephalus

PurposeNeuro-endoscopic lavage (NEL) is an increasingly popular intervention for intraventricular haemorrhage (IVH) and post-haemorrhagic hydrocephalus (PHH), with considerable variation in technique dependent on clinician and clinical circumstances. Whilst efforts to standardise the technique are ongoing, this work describes a tertiary centre experience utilising NEL, highlighting potential caveats to standardisation.MethodsA retrospective review of electronic case notes for patients undergoing temporising surgical intervention for IVH between 2012 and 2021 at our centre was performed. Data collected included (i) gestational age, (ii) aetiology of hydrocephalus, (iii) age at time of intervention, (iv) intervention performed, (v) need for permanent CSF diversion, (vi) ‘surgical burden’, i.e. number of procedures following primary intervention, and (vii) wound failure and infection rate. Data was handled in Microsoft Excel and statistical analysis SPSS v27.0Results49 neonates (n = 25 males) were included. Overall mean gestational age was 27 weeks and at intervention 35 + 3 weeks. IVH was the predominant cause of hydrocephalus (93.8%) and primary surgical interventions included insertion of a ventriculosubgaleal shunt (VSGS) in n = 41 (83.6%) patients, NEL in n = 6 (12.2%) patients and insertion of an EVD in n = 2 (4.1%). N = 9 (18.4%) patients underwent NEL at some point during the time interval reviewed; n = 4 (8.2%) received NEL monotherapy and n = 5 (10.2%) also received a VSGS. Rate of conversion to definitive CSF diversion between NEL (n = 8, 88.9%) and VSGS cohorts (n = 37, 92.5%) was not significantly different (p = 0.57), nor between NEL alone (n = 3, 75%) and NEL + VSGS (n = 5, 100%) (p = 0.44). None of the patients that underwent NEL monotherapy had any wound issues or CNS infection as a result of the initial intervention, compared to n = 3 (60%) of those that underwent NEL and implantation of VSGS (p = 0.1).ConclusionBoth NEL and VSGS are effective in temporising hydrocephalus in neonates, occasionally offering a definitive solution in and of themselves. The benefit of dual therapy however remains to be seen, with the addition of VSGS potentially increasing the risk of wound failure in an already vulnerable cohort.

Our experience with management of congenital urological pathologies in adulthood: What pediatric urologists should know and adult urologists adopt in pediatric practice experience.

To summarize our experience in the management of congenital anomalies in the kidney and urinary tract (CAKUT) in adults. We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021. The study included 102 patients with a median age of 25 (interquartile range, 23-36.5). Of these, 85 (83.3%) patients reported normal prenatal ultrasound, and the remaining 17 (16.7%) patients were diagnosed with antenatal hydronephrosis. These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care. All studied adult patients presented with the following pathologies: 67 ureteropelvic junction obstructions, 14 ectopic ureters, 9 ureteroceles, and 6 primary obstructive megaureters, and the remaining 6 patients were diagnosed with vesicoureteral reflux. Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles. Notably, 67% of patients underwent pyeloplasty, 9% underwent endoscopic puncture of ureterocele, 3% underwent ureteral reimplantation, 6% underwent endoscopic correction of reflux, 7% underwent partial nephrectomy of non-functioning moiety, and the remaining 9% underwent robotic-assisted laparoscopic ureteroureterostomy. The median follow-up period after surgery was 33 months (interquartile range, 12-54). Post-operative complications occurred in 5 patients (Clavien-Dindo 1-2). Patients with CAKUT present clinical symptoms later in life. Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility, and children should be appropriately counseled when they enter adolescence. Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.

Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach.

Global brachial plexus injury (GBPI) mainly affects adults and causes severe life-changing consequences that lead to the deterioration of patients' quality of life. Several surgical approaches have been described and reported in the literature to improve patients' functional ability. A literature review is done on PubMed/MEDLINE and Embase using specific keywords to retrieve relevant articles assessing different surgical approaches for GBPI management. Inclusion and exclusion criteria were applied, and eligible articles were included in the review. The literature survey revealed that various surgical options had been used to manage GBPI patients. In this concise review, we discuss and compare the different surgical approaches related to GBPI and its outcome in terms of restoring elbow flexion and extension, shoulder abduction, and wrist and hand function. The primary surgical intervention relies mainly on transferring single or multiple nerves with/without nerve grafts to restore the function of the targeted muscle. Different techniques using a variety of nerve donors and recipients are compared to assess the functional outcomes of each option. Moreover, further options are addressed for delayed GBPI injuries or failed nerve transfer procedures, as in free functional muscle transfer techniques. In addition, information about brachial plexus injury cases faced in our center is presented along with our center's approach to diagnosing and managing partial and GBPI cases.

A brief overview of obstetric brachial plexus palsy

Obstetric brachial plexus palsy is an injury in newborn babies that is often associated with increased force on the neck during passage through the birth canal. This puts excessive strain on the brachial plexus and causes nerve injury. Obstetric brachial plexus palsy results from injury to the cervical roots C5–C8 and thoracic root T1. Although it has been known for patients to make a spontaneous recovery, there is a large subset who do not recover and require primary or secondary surgical intervention. This article discusses classification of the differing injuries within obstetric brachial plexus palsy, its prevalence and its aetiology. It also discusses the impact that the injury can have on individuals and the role of healthcare professionals involved in the diagnostic phases.