Surgical Planning Research Articles

Use of Three-Dimensional (3D) Airway Modeling and Virtual Reality for Diagnosis, Communication, and Surgical Planning of Complex Airway Stenosis.

We hypothesized that a method to segment human airways from clinical cases and import them into a case presentation environment in Virtual Reality (VR)could be developed to model and visualize complex airway stenosis for efficient surgical planning. One normal and two pathological airways modeled from CT scans at a slice thickness of 0.625 mm were processed. A multidisciplinary team composed of airway surgeons, VR engineers, educators, and radiologists collaborated to create a clinically relevant VR rendering and explanatory Narrations of the three clinical cases. Segmentation and postprocessing were completed in the Mimics Innovation Suite v24 from Materialize. Structures were segmented from the level of bifurcation of common carotid arteries to the level of bifurcation of the main bronchi, including cartilaginous and bony airway structures, vessels, and soft tissues. They were then postprocessed into 3D image volumes and imported into syGlass (IstoVisio Inc.), a VR software. Direct visualization and free manipulation of these 3D airway models within the VR environment provided improved geometrical and anatomical details compared to traditional two-dimensional (2D) CT. Then, specialized presentation and active learning tools developed for scientific communication using the VR environment permitted the creation of VR Narrations to explain pathological cases. The method to segment human airways from clinical cases used in this paper, combined with intuitive VR tools to overlay segmentation and image data in an active learning environment, shows potential in the use of 3D airway modeling and VR in clinical practice for the description and surgical planning of complex airways. Further work is needed to validate the use of these models in clinical practice and patient education. Level 4.

Predictors of mortality at 3 months in patients with skull base tumor resections in a low-income setting

ObjectiveGlobally, skull base tumors are among the most challenging tumors to treat and are known for their significant morbidity and mortality. Hence, this study aimed to identify robust associated factors that contribute to mortality of patients following surgical resection for a variety of skull base tumors at the 3-month follow-up period. This in turn helps devise an evidence-based meticulous treatment strategy and baseline input for quality improvement work.MethodologyA retrospective cohort study of patients undergoing skull base tumor resection was conducted at two large-volume neurosurgery centers in Ethiopia. The categorical variables were expressed in frequencies and percentages. Normal distribution of continuous data was checked by histogram and the Shapiro–Wilk test. Median with interquartile range (IQR) was calculated for skewed data, while mean with standard deviation (SD) was used for normally distributed data. Odds ratio and adjusted odds ratio (AOR) were used to express the result of univariate and multivariate binary logistic analyses, respectively. A p-value <0.005 was considered statistically significant at 95% confidence interval (CI).ResultThe study involved 266 patients. Of this, women accounted for 63.5% of patients. The median age of patients was 37 (±IQR = 17) years while the median size of the tumor in this study was 4.9 (±IQR 1.5) cm. The mean duration of symptoms at time of presentation was 17.3 (±SD = 11.1) months. Meningioma, pituitary adenoma, and craniopharyngioma contributed to 68.4%, 19.2%, and 9% of the skull-based tumors, respectively. Mortality following skull base tumor resection was 21.1%. On multivariable binary logistic regression analysis, intraoperative iatrogenic vascular insult (AOR = 28.76, 95% CI: 6.12–135.08, p = 0.000), intraventricular hemorrhage (AOR = 6.32, 95% CI: 1.19–33.63, p = 0.031), hospital-associated infection (AOR = 6.96, 95% CI: 2.04–23.67, p = 0.002), and extubation time exceeding 24 h (AOR = 12.89, 95% CI: 4.89–40.34, p = 0.000) were statistically significant with 3-month mortality.ConclusionMortality from skull base tumor resection remains high in our setting. Holistic pre-operative surgical planning, meticulous intraoperative execution of procedures, and post-operative dedicated follow-up of patients in a neurointensive care unit alongside quality improvement works on identified risks of mortality are strongly recommended to improve patient outcomes. The urgent need for setup improvement and further training of neurosurgeons is also underscored.

CBCT Analysis of the Hyoid and Pharyngeal Airway Changes in Class III Patients With Orthognathic Surgery.

This study was designed to investigate the response of the respiratory structures to orthognathic surgery in patients with Class III malocclusion, with a specific emphasis on the vertical placement of the hyoid bone. The correlations of these changes were also analysed, followed by further subgroup analyses based on preoperative conditions. Dolphin software was used to obtain cephalometric landmarks, airway and hyoid bone measurements from pre- and postoperative CBCT scans of 31 patients. Statistical analyses included paired t-tests and Pearson's correlation analysis. Stomatological mandibular values and the nasopharynx height showed significant changes. Pearson's correlation identified significant correlations between changes in B and H horizontal coordinates (p < 0.05), as well as between changes in H longitudinal coordinates and specific airway dynamics (p < 0.05). Patients with a lower preoperative hyoid position experienced a more pronounced decrease in hypopharyngeal airway volume after surgery compared to those with a higher preoperative hyoid position, as evidenced by the significant mean differences and p values (p < 0.01). Class III patients experienced airway constriction following orthognathic surgery, particularly those with a lower preoperative hyoid bone position, who showed a more significant decrease in hypopharyngeal airway volume postsurgery compared to those with a higher preoperative hyoid position. These findings underscored the importance of individualised surgical planning and highlighted the need for further research with dynamic assessments to optimise respiratory outcomes.

Pleomorphic adenoma of palate, A case report

Pleomorphic adenoma is a benign and most common salivary gland tumor of both major and minor salivary glands. Majority of the minor salivary glands’ tumor are malignant. However, pleomorphic adenoma is still the most common neoplasm of palate. Large pleomorphic adenoma in palate may cause pressure erosion of palate mimicking malignant pathology. Imaging with Computed tomography or Magnetic Resonance Imaging is important for surgical planning of the tumors in the uncommon location like palate. Early diagnosis and management is important to reduce morbidity. Here, we present a case of histopathologically proven pleomorphic adenoma of palate which was evaluated with CT scan prior to excision. Keywords: CT, palate, pleomorphic adenoma

"Dangling choroid" with contralateral glomus displacement and ischemic torsion in congenital hydrocephalus: illustrative case.

"Dangling choroid" is a prenatal sonographic marker of ventriculomegaly that measures the angle of choroid plexus (ChP) displacement in the lateral ventricle. To the authors' knowledge, postnatal sequelae related to this pathology, besides hydrocephalus, have never been reported. A female fetus was diagnosed with bilateral ventriculomegaly. Postnatally, the patient was diagnosed with hydrocephalus and macrocephaly secondary to aqueductal stenosis and underwent endoscopic third ventriculostomy with ChP cauterization. Intraoperatively, the septum pellucidum was incomplete, and the right-sided ChP glomus was contralaterally displaced and entangled with the left, with evidence of ischemic torsion and hemorrhage. In this case of an ischemic ChP secondary to transventricular displacement of the glomus, at least two biomechanical events are relevant. First, the choroid fissure and velum interpositum can be thinned in the setting of ventriculomegaly. Second, stretching and perforation of the septum pellucidum can occur. Both changes can increase the mobility of a dangling choroid, occasionally leading to entanglement of the vascular pedicles. Preoperative recognition of this complication can help optimize surgical planning, e.g., using flexible endoscopy to facilitate complete ChP cauterization and changing the surgical approach if the ChP has been displaced. https://thejns.org/doi/10.3171/CASE24505.

Predictors of Post-Hepatectomy Liver Failure in Klatskin Tumors: The Role of Preoperative Glucose, Future Liver Remnant to Spleen Ratio, and Early Bilirubin Monitoring

Background: Post-hepatectomy liver failure (PHLF) is a serious complication following hepatic resection for Klatskin tumors, significantly affecting patient prognosis. Identifying reliable preoperative and early postoperative predictors of PHLF can help optimize patient outcomes and guide surgical planning. Method: We conducted a retrospective review of 34 patients who underwent hemi-hepatectomy for extrahepatic cholangiocarcinoma at Kosin University Gospel Hospital between April 2019 and April 2024, and at Chonnam National University Hwasun Hospital between September 2017 and April 2024. Demographics, laboratory data, and volumetric measurements including spleen volume, were analyzed to assess their roles in predicting PHLF. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the predictive value of these factors. Results: Elevated preoperative glucose levels and reduced future liver remnant to spleen ratio (FLR/SV) were significantly associated with an increased risk of PHLF. Additionally, elevated postoperative day 1 total bilirubin (POD 1 TB) was identified as a key postoperative predictor of PHLF. Multivariable analysis confirmed the significance of these factors, with FLR/SV, preoperative glucose, and POD 1 TB demonstrating good discriminative ability in ROC analysis, with AUC values of 0.779, 0.782, and 0.786 respectively. Conclusion: Preoperative glucose control, evaluation of FLR/SV, and early postoperative monitoring of TB are useful for improving outcomes in patients undergoing major hepatectomy for Klatskin tumors.

Orthognathic Surgery in Syndromic Craniosynostosis: Incorporating Midface Morphometric Analysis and Dental Parameters in Surgical Planning

Orthognathic Surgery in Syndromic Craniosynostosis: Incorporating Midface Morphometric Analysis and Dental Parameters in Surgical Planning

Radiographic Accuracy of Identifying Anterolateral Tibial Plafond Involvement in Pronation Abduction Ankle Fractures.

To evaluate the incidence of anterolateral tibial plafond involvement in pronation-abduction (PAB) ankle fractures and analyze the accuracy of radiographs in detecting anterolateral tibial plafond involvement, impaction, and predicting the need for direct visualization and an articular reduction. Design: A multi-institutional retrospective chart review. Five level 1 trauma centers in the United States. Adult patients with PAB ankle fractures (OTA/AO 44B2.3, 44C2.2, 44C2.3) from 2020-2022 were reviewed by 7 fellowship-trained orthopedic trauma surgeons. They were queried about the presence of anterolateral tibial plafond involvement and impaction, and whether they would need direct visualization and an articular reduction using both radiographs and CT. The presence of anterolateral tibial plafond impaction was tabulated separately using radiographs and CT scans. The accuracy of radiographs and changes in surgical plan after CT review were calculated using CT as the gold standard. 61 fractures in 61 patients were evaluated with CT and/or plain radiographs. Using plain radiographs, anterolateral tibial plafond involvement and impaction were identified in 61% and 36% of cases, respectively. In the 38 fractures with both plain radiographs and CT scans, anterolateral tibial plafond involvement was identified in 66% of radiographs and 74% of CT scans (p = 0.4). Plafond impaction was identified in 42% of plain radiographs and 37% of CT scans (p = 0.62). There was no difference in the rate of involvement between radiographs and CT scan. The diagnosis of anterolateral tibial plafond impaction using plain radiographs was correct in 74% of fractures when compared to CT imaging, resulting in a sensitivity of 71%, a specificity of 75%, a positive predictive value (PPV) of 62%, and a negative predictive value (NPV) of 82%. Plain radiographs correctly predicted the need for direct visualization and an articular reduction in 74% of cases and had a PPV of 59% and a NPV of 86%. Anterolateral tibial plafond involvement and impaction was present on CT in 74% and 37% of pronation-abduction (PAB) ankle fractures, respectively. Plain radiographs had higher NPV for identifying impaction and the need for articular reduction than they did sensitivity, specificity or PPV. CT is an important tool for preoperative planning that should be considered when planning for operative fixation of PAB ankle fractures. Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.

Complicaciones estéticas de la cirugía de uretra anterior: revisión exploratoria y galería de imágenes

Introduction: Anterior urethroplasty is the gold standard for treating complex urethral strictures, primarily focusing on restoring urinary function. However, aesthetic complications, including penile curvature, scarring, and meatal deformities, can impact patient satisfaction, self-image, and quality of life. Despite their significance, cosmetic outcomes are underreported in the literature, affecting patient counseling and surgical planning.Objective: This scoping review aims to assess the prevalence, types, and contributing factors of cosmetic complications after anterior urethroplasty. A photographic collection of these complications is also presented to aid in clinical education.Materials and Methods: A systematic search of PubMed, Scopus, and Web of Science databases was performed, including studies from 2000 onward that report cosmetic outcomes in male adult patients post-urethroplasty. Following PRISMA guidelines, studies focusing on pediatric cases, case reports with fewer than 10 patients, and those lacking specific cosmetic data were excluded.Results: Of the 493 studies screened, 97 met the inclusion criteria, with only a minority (8 studies) explicitly discussing cosmetic complications. Reported issues varied widely, including penile curvature, skin tethering, hypertrophic scarring, meatal deformities, and penile shortening, underscoring the diversity of aesthetic challenges in urethral reconstruction.Conclusion: This review highlights the need for incorporating aesthetic considerations into surgical planning and patient counseling for anterior urethroplasty. Standardized metrics for evaluating cosmetic outcomes could improve patient satisfaction and the quality of care in urethral reconstruction.

Surgical Anatomy of the Lateral Thoracic Artery and Its Perforators: A Computed Tomographic Angiography and Cadaveric Dissection Study

Objective: This study explores the anatomical variations and characteristics of the lateral thoracic artery (LTA) and its perforators through thoracic computed tomographic angiographies (CTA) and cadaveric dissection, aiming to enhance surgical planning and patient outcomes. Materials and Methods: Data were recorded for both thoracic CTA patients (n = 40) and soft cadavers (n = 13) for subsequent retrospective analyses of biological sex, age, body mass index (BMI), LTA characteristics (length, diameter, origin, number of perforators, number of lymph nodes), and locations (rib level and distance from the pectoralis major, latissimus dorsi, and acromioclavicular joint). Results: Average LTA parameters for thoracic CTAs were 89.6 millimeters in length from origin and 2.1 millimeters in diameter, while cadavers were 117.0 millimeters in length and 2.3 millimeters in diameter. At least 1-2 cutaneousperforators and 1 proximal lymph node were found across both thoracic CTAs and cadavers. No significant differences were observed between the left and right sides for both groups. On average, 73.8% and 66.4% of LTAs from thoracic CTAs and cadavers, respectively, originated from the axillary artery. Conclusion: This knowledge is crucial for surgical planning, both to minimize damage to the LTA and ensure the inclusion of its perforators and proximal lymph nodes in the lateral thoracic region. The researchers recommend lateral thoracic artery perforator flap harvest between the lateral border of the pectoralis major and the anterior border of the latissimus dorsi, specifically above the 3rd-6th ribs, which is correlated to the length of LTA at 89.6-117 millimeters from origins.

Circumflex left aortic arch: a new vascular ring anomaly in dogs.

To describe the circumflex left aortic arch as a new form of canine congenital vascular ring anomaly leading to esophageal constriction. 3 large-breed dogs of variable age: a 9-month-old entire male German Shepherd Dog-Rottweiler cross, a 17-week-old entire male German Shepherd Dog, and a 9-year-old neutered female Labrador Retriever, seen between April 2022 and May 2023. Dogs presented for chronic postprandial regurgitation and poor growth. One dog presented for a hard mass on the caudal mandibular region. Computed tomography revealed a normal leftward-oriented cranial half and an abnormal caudal half of the aortic arch crossing toward the right dorsal hemithorax leading to esophageal constriction in all dogs. In addition, 1 dog presented with a right patent ductus arteriosus and 1 with an aberrant right subclavian artery. Circumflex left aortic arch is a newly discovered rare type of congenital vascular ring anomaly in dogs, which presents a similar anatomical derangement to the human form. Clinical signs include postprandial regurgitation and poor growth. Circumflex left aortic arch vascular anomaly cannot be surgically corrected via the left thoracotomy that is commonly used for the more common vascular ring anomalies in dogs. Computed tomography is a useful diagnostic modality for the diagnosis of this condition, detection of concomitant congenital vascular malformations, evaluation of associated pathologies, and surgical planning.

The Effect of Reverse Shoulder Arthroplasty Design and Surgical Indications on Deltoid and Rotator Cuff Muscle Length

BackgroundAdvancements in surgical planning, technique, and prosthesis design have improved adaptation to patient anatomy in reverse total shoulder arthroplasty (rTSA). Postoperative changes in deltoid and rotator cuff muscle length are important and may vary based on preoperative indications and prosthesis selection. The purpose of this study is to demonstrate the changes in deltoid and rotator cuff muscle length for planned rTSA using the spectrum of prosthesis configurations in both GHOA and RCA. MethodsTen shoulder arthroplasty surgeons used preoperative planning software to plan rTSA cases for 20 subjects (10 GHOA, 10 RCA) following surgical guidelines. Each surgeon planned each case using three prosthesis configurations: (1) 8-mm lateralized glenosphere and 135° neck-shaft angle (135+8), (2) 4-mm lateralized glenosphere and 145° neck-shaft angle (145+4), and (3) 0-mm lateralized glenosphere and 155° neck-shaft angle (155+0). Pre- and postoperative deltoid and rotator cuff muscle lengths and percentage-change were calculated and compared between prosthesis configurations within each indication. Different muscle lines of action were included representing the deltoid, subscapularis, infraspinatus, and teres minor. ResultsPreoperatively, the RCA cohort had significantly shorter muscle lines of action in the posterior, lateral, and anterior deltoid (P<0.001), a longer inferior subscapularis (P=0.022), and a longer teres minor (P=0.001) than the GHOA cohort. ANOVA and post-hoc analysis showed that post-planning lengths of each deltoid action line were greater in the 155+0 configuration compared to the 135+8 configuration in the RCA cohort (P<0.001, P=0.003, P=0.032, respectively), and post-planning lengths of the anterior and middle deltoid action lines were also greater for the same comparison in the GHOA cohort (P=0.004 and P=0.017, respectively). There were no significant differences in post-planning deltoid lengths between the 135+8 and 145+4 configurations in either diagnosis cohort (P>0.05). All post-planning rotator cuff muscle lengths (subscapularis, infraspinatus, and teres minor) differed significantly (P<0.001) between all prosthesis configurations in both diagnosis cohorts, with the 135+8 configuration resulting in the longest lengths and the 155+0 configuration resulting in the shortest lengths. ConclusionAutomated preoperative planning software calculates the lengths of muscle action lines, which vary between GHOA and RCA diagnoses. Varying rTSA implant geometries result in predictable differences in deltoid lengthening and rotator cuff shortening. Shoulder prostheses with a more lateralized center of rotation show greater rotator cuff muscle length and similar deltoid muscle length when compared to medialized designs with similar deltoid lengthening. Surgeons can use this software to understand the impact of implant geometry on muscle length.

The value of non-enhanced CT 3D visualization in differentiating stage Ⅰ invasive lung adenocarcinoma between LPA and non-LPA

ObjectiveThis study aims to analyze the quantitative parameters and morphological indices of three-dimensional (3D) visualization to differentiate lepidic predominant adenocarcinoma (LPA) from non-LPA subtypes, which include acinar predominant adenocarcinoma (APA), papillary predominant adenocarcinoma (PPA), micropapillary predominant adenocarcinoma (MPA), and solid predominant adenocarcinoma (SPA). MethodsA group of 178 individuals diagnosed with lung adenocarcinoma were chosen and categorized into two groups: the LPA group and the non-LPA group, according to their pathological results. Quantitative parameters and morphological indexes such as 3D volume, solid proportion, and vascular cluster sign were obtained using 3D visualization and reconstruction techniques. ResultsSignificant differences were observed in the vascular cluster sign, spiculation, shape, air bronchogram, bubble-like lucency, margin, pleural indentation, lobulation, maximum tumor diameter, 3D mean CT value, 3D volume, 3D mass, 3D density, and solid proportion between two groups (P<0.05). The optimal cut-off values for diagnosing non-LPA were a 3D mean CT value of -445.45 HU, a 3D density of 0.56mg·mm-3, and a solid proportion reaching 27.95%. Multivariate logistic regression analysis revealed that 3D mean CT value, lobulation, and margin characteristics independently predicted stageⅠinvasive lung adenocarcinoma. The combination of three indicators significantly improved prediction accuracy (AUC=0.881). ConclusionThe utilization of 3D visualization technology in a systematic approach enables the acquisition of 3D quantitative parameters and morphological indicators of thin-slice CT lesions. These efforts significantly contribute to the identification of histopathological subtypes for stageⅠinvasive lung adenocarcinoma. When integrated with pertinent clinical data, this offers essential guidance for developing various surgical techniques and treatment plans.

Digital technology-assisted minimally invasive removal of odontoma with high impacted maxillary canine by double-fenestration technique: a case report.

Odontoma is a hamartoma or developmental malformation of dental tissues and often causes delayed or impacted permanent teeth. This paper reports a case of surgical removal of an odontoma that is closely attached to the labial bone plait and examines the extraction of accompanying high-impacted maxillary canine beside the nose and maxillary sinus. Digital technology was used in reconstructing a part of a patient's maxilla, odontoma, related teeth, and other adjacent anatomical structures, accurately determine the lesion boundary, and design an optimal surgical plan. The minimally invasive extraction of lesions and embedded teeth with a double-fenestration technique through the upper and lower paths not only preserved the continuity of the labial alveolar bone plate in the operative area and prevented postoperative bone collapse but also reduced the risk of maxillary sinus mucosal injury and perforation, improved surgical efficiency, and reduced the surgical trauma. These features were in line with the concept of minimally invasive alveolar surgery.

Promoting climate-resilient health systems through national surgical plans

Promoting climate-resilient health systems through national surgical plans

Foot kinematics and kinetics data for different static foot posture collected using a multi-segment foot model

This dataset presents human foot joints kinematics and kinetics data during walking, classified by static foot posture, filling a gap in existing lower limb databases that lack data on foot joints beyond the ankle or on static posture data, despite its link to foot and lower limb pathologies. Kinematics were recorded using a three-dimensional mocap system, and kinetics through a pressure platform, employing a multi-segment foot model including the ankle, midtarsal and first metatarsophalangeal joint. The dataset contains 350 recordings of right foot joint angles and moments and contact pressures from 70 healthy subjects with varying static posture (highly pronated, highly supinated and normal). Data were collected at 100 Hz, filtered and resampled to 100 frames throughout the stance phase. Descriptive data are also provided: age, weight, height, BMI and foot anthropometric data and foot posture index. Plots, tables and ANOVAs are included for validation. Presented in .xlsx and .mat formats, this database can assist professionals in corrective footwear design, insole customization, surgical planning, and evaluating interventions on foot dynamics.

CFD Analysis of the Choledynamic Flow Characteristics of a Patient with Gallbladder Carcinoma

Gallbladder carcinoma (GBC) is a rare malignancy with a low detection rate due to non-specific symptoms, complicating early diagnosis and treatment. This study aims to improve pre-operative and post-operative surgical analysis using patient-specific CFD analysis. CT scan images of a male patient with GBC were segmented using 3D Slicer software, and the biliary tree geometry was imported into ANSYS Workbench for fluid and solid meshing. The mechanical properties of the biliary tree and the rheological properties of bile were determined, with an LRN k-ω model used for simulating the gallbladder refilling stage. Results indicate that unhealthy bile flows slower than healthy bile, suggesting a link between obstructed bile flow and tumors or stones. Tumor-induced blockages cause pressure accumulation in the gallbladder neck, unlike the minimum pressure in healthy cases. These findings highlight the complex interplay between bile rheology, tumor development, and pressure dynamics, suggesting the model’s potential use in surgical planning.

Comparative Analysis of Large Language Models and Spine Surgeons in Surgical Decision-Making and Radiological Assessment for Spine Pathologies

AimThis study aimed to investigate the accuracy of large language models (LLMs), specifically ChatGPT and Claude, in surgical decision-making and radiological assessment for spine pathologies compared to experienced spine surgeons. MethodsThe study employed a comparative analysis between the LLMs and a panel of attending spine surgeons. Five written clinical scenarios encompassing various spine pathologies were presented to the LLMs and surgeons, who provided recommended surgical treatment plans. Additionally, MRI images depicting spine pathologies were analyzed by the LLMs and surgeons to assess their radiological interpretation abilities. Spino-pelvic parameters were estimated from a scoliosis radiograph by the LLMs. ResultsQualitative content analysis revealed limitations in the LLMs' consideration of patient-specific factors and the breadth of treatment options. Both ChatGPT and Claude provided detailed descriptions of MRI findings but differed from the surgeons in terms of specific levels and severity of pathologies. The LLMs acknowledged the limitations of accurately measuring spino-pelvic parameters without specialized tools. The accuracy of surgical decision-making for the LLMs (20%) was lower than that of the attending surgeons (100%). Statistical analysis showed no significant differences in accuracy between the groups. ConclusionThe study highlights the potential of LLMs in assisting with radiological interpretation and surgical decision-making in spine surgery. However, the current limitations, such as the lack of consideration for patient-specific factors and inaccuracies in treatment recommendations, emphasize the need for further refinement and validation of these AI models. Continued collaboration between AI researchers and clinical experts is crucial to address these challenges and realize the full potential of AI in spine surgery.

Incidental findings in preoperative computed tomography images of robotic-assisted total joint replacement: a multi-center retrospective study

BackgroundThe majority of robot-assisted total joint arthroplasties necessitate preoperative computed tomography (CT) scans. Incidental findings in these CT scans can introduce complexity into clinical treatment decisions. Consequently, this study sought to document the nature and frequency of incidental findings identified in preoperative CT imaging conducted for robot-assisted total joint arthroplasty, along with their impact on planned surgical procedures.MethodsThis investigation constitutes a retrospective review encompassing patients who underwent primary robot-assisted total hip arthroplasty between January 2020 and January 2022 at the Second Affiliated Hospital of Xi’an Jiaotong University, the First Affiliated Hospital of Peking University, and Nanfang Hospital. It also includes patients who underwent robot-assisted total knee arthroplasty during the same period at the Second Affiliated Hospital of Xi’an Jiaotong University, the Third Affiliated Hospital of Peking University, Nanfang Hospital, and the Second Affiliated Hospital of Zhejiang University. All CT examinations were initially interpreted by proficient musculoskeletal radiologists. Subsequently, the findings in the examination reports, whether significant or non-significant, were compiled and categorized.ResultsA total of 218 patients, median age 63, were evaluated; 90 had incidental findings (41.3%), with 56 (25.7%) significant. Males were more likely to have findings (P = 0.001). Nine needed additional imaging, and five required intervention.Our study highlights the impact of unexpected CT findings on surgical planning, which can delay or cancel surgeries and affect patient outcomes. It also urges surgeons to review medical histories and perform thorough examinations before surgery to prevent serious consequences.ConclusionsRadiologists often find incidental findings in preoperative CT scans for robot-assisted joint arthroplasty, with a 41.3% incidence rate. About 25.7% of these findings need physician follow-up, and under 5% require intervention, potentially causing delays or cancellations of procedures, while undetected findings could lead to fatal outcomes.Unexpected preoperative CT findings can enhance patient management and prevent complications, necessitating their inclusion in surgical protocols. Systematic assessment improves safety and outcomes, urging surgeons to review medical history and perform thorough examinations pre-surgery.Clinical trial registrationClinical trial registration time: 19/05/2022, clinical trial registration number: ChiCTR2200060115.

Implementation of high-definition fiber tractography for preoperative evaluation and surgical planning of brainstem cavernous malformation: long-term outcomes.

The aim of this study was to describe the role and long-term outcomes of high-definition fiber tractography (HDFT) in the surgical management of brainstem cavernomas. The authors performed a retrospective evaluation of their database at the HDFT laboratory in a single academic institution. The authors identified 11 patients with brainstem cavernomas who had HDFT for preoperative workup and underwent microsurgical resection. The mean patient age was 39 years (range 20-76 years), and the mean follow-up was 75.2 months (range 37-149 months). Four cavernomas were located anterolaterally in the pons (2 right and 2 left), 2 were left pontomesencephalic, 1 was thalamomesencephalic, 1 was in the posterior midbrain (right superior colliculus), and 3 were in the posterior pontine/floor of the fourth ventricle. Gross-total resection was achieved in 8 patients (72.7%) and subtotal resection in 3 patients (27.3%). Although 5 patients (45.5%) experienced transient worsening of preoperative symptoms or new deficits, all fully improved within 3 months. None of the patients developed new permanent neurological deficit. Preoperative symptoms improved partially in 8 patients (72.7%) and completely in 3 patients (27.3%). There was one asymptomatic new hemorrhage, and another patient had a symptomatic hemorrhage with a recurrence of his presenting symptoms 15 months after his initial surgery. This patient underwent a re-resection of his residual cavernoma, with no improvement in his preoperative symptoms. HDFT provides critical anatomical information guiding an optimal surgical corridor and more importantly defining eloquent perilesional boundaries. In this preliminary experience, preoperative planning with HDFT appeared to decrease morbidity in patients who underwent microsurgical resection of their brainstem cavernoma.