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.

Successful Repair of Esophageal Atresia with Tracheoesophageal Fistula and Interrupted Inferior Vena Cava: A Rare Case Report

【Abstract】Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a congenital anomaly that can present complex surgical challenges, especially when accompanied by rare vascular conditions like an interrupted inferior vena cava (IVC). The division of the azygos vein is a common part of TEF repair, but in the presence of an interrupted IVC, this can lead to life-threatening complications. We report the case of a newborn diagnosed with EA, TEF, and interrupted IVC, successfully treated through thoracotomy. This case underscores the importance of prenatal and postnatal imaging to diagnose vascular anomalies prior to TEF repair, ensuring the preservation of the azygos vein to prevent fatal outcomes. Raising awareness of this rare association is crucial to optimizing surgical planning and outcomes.

The Use of 3D Model Printing for Acute Planning in Oral and Maxillofacial Traumatology

Introduction Due to the complex anatomy of craniomaxillofacial structures, facial reconstruction following high-impact traumas is extremely challenging. Therefore, this study aimed to evaluate the use of biomodels in the surgical planning of complex fractures and the sequelae in the oromaxillofacial region. Materials and Methods This is a cross-sectional, exploratory, descriptive, and quantitative documentary study. It was conducted at the “Dom Luiz Gonzaga Fernandes” Emergency and Trauma Hospital, in the hinterland of the state of Paraíba, in Brazil, based on cases recorded between November 2021 and November 2022. The research instrument utilized was a self-developed questionnaire. Results No statistically significant correlation was observed between the biomodel acquisition time and the length of hospitalization, with a Spearman's correlation coefficient of r = -0.079. Although the need for adjustment of osteosynthesis material was 50% in cases where acrylonitrile butadiene styrene (ABS) models were used, with p (1) = 0.464, in order to be significantly more faithful, it would require a study with a higher sample size. The average length of surgery, in minutes, was 91.25 ± 28.00. The average cost of the materials used to manufacture the biomodels, in Brazilian reais (R$), was R$122.00 ± R$89.09. Conclusion The use of biomodels in the surgical planning of complex fractures and oromaxillofacial sequelae did not increase the length of hospitalization. The material used for the prototype manufacture suggests a potential influence on its faithfulness. The length of surgery was shorter in interventions that utilized biomodels in the planning phase. It was also noted that the average cost of manufacture varies according to the type of material chosen and the quantity required.

Integrating standard epilepsy protocol, ASL-perfusion, MP2RAGE/EDGE and the MELD-FCD classifier in the detection of subtle epileptogenic lesions: a 3 Tesla MRI pilot study.

Malformations of cortical development (MCDs) in children with focal epilepsy pose significant diagnostic challenges, and a precise radiological diagnosis is crucial for surgical planning. New MRI sequences and the use of artificial intelligence (AI) algorithms are considered very promising in this regard, yet studies evaluating the relative contribution of each diagnostic technique are lacking. The study was conducted using a dedicated "EPI-MCD MR protocol" with a 3 Tesla MRI scanner in patients with focal epilepsy and previously negative MRI. MRI sequences evaluated included 3D FLAIR, 3D T1 MPRAGE, T2 Turbo Spin Echo (TSE), 3D T1 MP2RAGE, and Arterial Spin Labelling (ASL). Two paediatric neuroradiologists scored each sequence for localisation and extension of the lesion. The MELD-FCD AI classifier's performance in identifying pathological findings was also assessed. We only included patients where a diagnosis of MCD was subsequently confirmed on histology and/or sEEG. The 3D FLAIR sequence showed the highest yield in detecting epileptogenic lesions, with 3D T1 MPRAGE, T2 TSE, and 3D T1 MP2RAGE sequences showing moderate to low yield. ASL was the least useful. The MELD-FCD classifier achieved a 69.2% true positive rate. In one case, MELD identified a subtle area of cortical dysplasia overlooked by the neuroradiologists, changing the management of the patient. The 3D FLAIR sequence is the most effective in the MRI-based diagnosis of subtle epileptogenic lesions, outperforming other sequences in localisation and extension. This pilot study emphasizes the importance of careful assessment of the value of additional sequences.

Residual microcalcifications after neoadjuvant systemic therapy for early breast cancer: Implications for surgical planning and long-term outcomes

Residual microcalcifications on mammograms after neoadjuvant chemotherapy (NACT) pose a challenge in surgical decision-making. This single-centre retrospective review of all patients who had NACT for breast cancer over five years, evaluated the relationship between pathological complete response and residual microcalcifications, controlling for tumour size, nodal stage, grade, and receptor status, as well as the impact of residual microcalcifications on recurrence and survival. There was no significant association between pathological complete response (pCR) and residual microcalcifications (p = 0.763). We computed hazard ratios (HR) for Time to recurrence (TTR) and overall survival (OS) which were both not significant, with HR = 2.599, [0.290, 23.264], p = 0.393 and HR = 1.362 [0.123, 15.062], p = 0.801 respectively. The predictive and prognostic significance of residual microcalcifications remains to be proven. The surgical excision of these lesions should be considered based on individual patient risk.

An Unusual Presentation of Chaput Tubercle Fracture with Coexisting Bimalleolar Component Involving Lateral and Posterior Malleoli: A Case Report

Background: Chaput tubercle fracture is a counterpart to adolescent Tillaux fracture, which occurs at the anterolateral part or the attachment site of the antero-inferior tibiofibular ligament on the distal tibia. It is rare, and its presentation may not be well appreciated in X-rays, which depicts the importance of a computed tomography (CT) scan of the ankle to reveal the same. Case Report: A 25-year-old gentleman presented to Chettinad Hospital, India, casualty with acute onset of pain, swelling, and restricted movements at the ankle joint following a road traffic accident. Ankle CT revealed a Chaput fracture along with a bimalleolar fracture (posterior and lateral malleoli). The complex displaced fracture was managed with open reduction internal fixation (ORIF) with plate osteosynthesis for the posterior malleoli and lateral malleoli, and tension band wiring was done for the Chaput tubercle fracture. At the end of two-year follow-up, the patient was able to mobilise without any support. Conclusion: Through this case report, we would like to enumerate the rarity of Chaput tubercle fracture associated with bimalleolar fracture of the ankle, which will be evaluated better with a CT evaluation in the first place. At the same time, it gives valuable information for the preoperative surgical plan.

Dentigerous cysts in horses: A retrospective study

SummaryBackgroundDentigerous cysts are well‐known congenital defects in horses, and the literature on this condition is extensive. Recently, a third type of dentigerous cyst, associated with an exostosis arising from the temporal bone, has been described. Today, computed tomography (CT) is often available and provides detailed information about the exact location and extent of dentigerous cysts, allowing for the description of new findings.Study designThis is a case series outlining the clinical, radiographic and computed tomographic features of dentigerous cysts in seven horses presented to the Equine Clinic at the Vetsuisse Faculty, University of Zurich, Switzerland.ObjectivesThe aim of this case series was to describe the radiographic and computed tomographic findings, and the occurrence of exostoses arising from the temporal bone, in horses with dentigerous cysts.MethodsThe medical records of the Equine Hospital at the University of Zurich were reviewed for horses admitted with dentigerous cysts between 2007 and 2023. Data collected and analysed included patient signalment, clinical history, clinical signs and their duration prior to referral, diagnostic imaging results, treatment and outcomes.ResultsThe most common location for the cysts was the base of the ear, although in one case, the maxillary sinus was involved. Of the seven cases, four were Icelandic horses. CT proved superior to standard radiography for determining the extent and precise location of the cysts, as well as for identifying dental material and exostoses in the temporal region. CT also facilitated detailed surgical planning. All cysts were surgically removed with good long‐term outcomes.Main limitationsOverall, the incidence of dentigerous cysts in horses was low. The relatively high occurrence of dentigerous cysts in Icelandic horses in this study is an interesting finding, though the small sample size calls for further research.ConclusionsTwo of the cases in this series were similar to a recently described variant of a ‘temporal dentigerous cyst associated with an exostosis in the temporal region’ and were closely connected to the bony structure and draining tract.

Ruptured Complex Aortoiliac Aneurysm in an Elderly Patient With a Kidney Transplant Presenting With Sciatica.

Background: Common iliac artery aneurysms are uncommon, with an estimated incidence of less than 0.01% in adults and accounting for only 1% of all intra-abdominal aneurysms. While the risk of rupture is approximately 5%, it increases significantly to 29% once the aneurysm reaches 4 cm. Similarly to abdominal aortic aneurysms, common iliac artery aneurysms often develop silently, remaining asymptomatic in about 70% of cases. This report describes the treatment of a patient with a kidney transplant who underwent endovascular repair of a ruptured left common iliac artery aneurysm with a concomitant abdominal aortic aneurysm and a focal aneurysm of the right renal artery origin. Case Description: A 78-year-old male patient with a kidney transplant presented with left sciatica symptoms and was found to have a contained rupture of a 10 x 7 cm left common iliac artery aneurysm with a concomitant 8 cm abdominal aortic aneurysm and a focal 1.8 cm aneurysm of the right renal artery origin. He underwent an endovascular aneurysm repair with an Aorto-Uni-iliac stent graft and a concomitant right-to-left femoral-femoral bypass using 8 mm ringed PTFE graft and ligation of left external iliac artery to prevent retrograde flow into the left common iliac artery aneurysm. At 3-year follow-up, patient remains stable with a functioning kidney transplant and excluded aneurysms with no evidence of endoleak. Conclusion: This report describes the endovascular repair of a ruptured left common iliac artery aneurysm conducted under local anesthesia in a patient with a renal transplant and complex aneurysm anatomy. The calcification pattern observed on a non-contrast CT scan was effectively used for surgical planning, leading to a successful aneurysm repair while preserving kidney transplant function.

Improving communication during damage control surgery: a survey of adult major trauma centres in England.

Deficiencies in non-technical skills can severely impede the functioning of teams in high-intensity scenarios, such as in damage control surgery for the critically injured trauma patient. Truncated preoperative checklists, modified from the standard World Health Organization preoperative checklist, and situational reporting at intervals during surgery are long-established practices in the military, and are recommended in the National Health Service guidelines on major incidents. These tools allow the multiprofessional team to create a shared mental model of the anaesthetic and operative plan, thereby improving team efficiency. Our aim was to establish whether adult major trauma centres in England are using truncated preoperative checklists and situational reporting for damage control surgery. An online survey was devised and distributed via the national programme of care for trauma in November 2020. Responses were received from all 23 adult major trauma centres in England. Nine centres (39.1%) reported using a truncated preoperative checklist for damage control surgery albeit in a variety of formats. Common components were blood products received and/or available, presence of allergies, tranexamic acid and antibiotic administration, availability of viscoelastic tests, equipment required, availability of cell saver, role allocation and reference to other personnel needed, and discussion of the plan. Twelve centres (52.2%) have formal policies in place for situational reporting. Again, these were in multiple formats but all focused on patient physiology to direct surgical planning. We have identified key components to advanced communication aids for damage control surgery, providing a foundation on which other major trauma centres can build their own versions of these potentially lifesaving tools.

Accuracy of robotic-assisted surgery for immediate implant placement in posterior teeth: a retrospective case series

BackgroundRobotic computer-assisted implant surgery (r-CAIS) is a revolutionary innovation in oral implantation; however, the clinical feasibility of r-CAIS for immediate implant placement (IIP) in posterior teeth has not been verified. Thus, this study aimed to evaluate the accuracy of r-CAIS for IIP in posterior tooth regions.MethodsPatients with posterior teeth to be extracted and indicated to undergo r-CAIS were evaluated. The patients had positioning markers installed in the oral cavity and underwent cone-beam computed tomography (CBCT). Subsequently, minimally invasive tooth extractions were performed, and an individualised surgical plan was generated in the robotic software. After marker registration, implantation surgery was performed by the robotic arm under the supervision and assistance of the surgeons. Finally, the deviations between the planned and placed implants were evaluated based on preoperative and postoperative CBCT data.ResultsA total of 12 patients were evaluated. No adverse events occurred during the surgery. The mean global coronal, global apical, and angular deviations were 0.46 ± 0.15 mm (95%CI:0.36 to 0.56 mm), 0.46 ± 0.14 mm (95%CI:0.37 to 0.54 mm), and 1.05 ± 0.55° (0.69 to 1.40°), respectively.ConclusionsUnder the limited conditions of this study, the r-CAIS exhibited high accuracy in posterior teeth IIP surgery. Further multicentre randomised controlled studies are required to confirm the feasibility of this technology.

Adult-onset intramedullary teratomas: systematic review with outcome analysis.

Intramedullary mature teratomas in adults are rare tumors that pose significant diagnostic and therapeutic challenges due to their diverse tissue composition and intramedullary location. This review, which includes an illustrative case, aims to provide a comprehensive overview of the clinical presentation, diagnosis, treatment, and outcomes of adult intramedullary mature teratomas through a systematic review of 89 cases. A systematic review was conducted following PRISMA guidelines, using keyword combinations in PubMed, MEDLINE, and Web of Science databases until June 2024. Inclusion criteria were adult patients (> 18 years) with histopathologically confirmed intramedullary mature teratomas. Statistical analyses examined relationships between the extent of resection (EoR), tumor location, and patient outcomes. Among the 89 cases, the mean age was 39.94 ± 13.52 years, with a male-to-female ratio of 1.39:1. Tumors were most commonly located in the conus region (51.2%). Surgical resection was the primary treatment, with 43 cases undergoing partial resection and 33 gross total resection. No statistically significant differences in outcomes were found between EoR, sex, associated anomalies, or specific outcomes. However, younger patients showed improved outcomes for lower limb weakness and sphincter dysfunction. Recurrence was noted in three cases, all located in the conus. Intramedullary mature teratomas require a nuanced approach that balances complete resection and neurological preservation. Early diagnosis and individualized surgical planning are crucial for optimizing outcomes. Despite the challenges, effective management is achievable, and ongoing research is essential to refining treatment strategies for this rare tumor.

SUCCESSFUL CONCEPTION AND FIRST PREGNANCY IN A 28-YEAR-OLD WOMAN WITH CERVICAL UTERINE MYOMA AND TOTAL PLACENTA PREVIA: A CASE REPORT

Background: Placenta previa is a major pregnancy complication associated with life-threatening hemorrhage. Cervical Uterine Myomas, benign smooth muscle tumors, increase the risk of placenta previa by two to three times, contributing to adverse pregnancy outcomes such as infection, urinary retention, preterm labor, and bleeding. Understanding the interaction between Cervical Uterine Myomas and placenta previa is crucial for optimizing care in high-risk pregnancies and improving maternal and fetal outcomes. Case Description: A 28-year-old primigravida (G1P0A0) patient was diagnosed with a breech presentation, Cervical Uterine Myoma, and total placenta previa at Klungkung Regional Hospital. The patient had a regular menstrual cycle and no history of comorbid conditions. The patient's management includes hospitalization with strict bed rest, followed by a scheduled elective cesarean section (CS). Fluid therapy will be administered using Ringer's lactate, and preoperative prophylactic antibiotics will be provided. Discussion: Cervical Uterine Myoma, particularly cervical myomas, can significantly impact pregnancy outcomes, with a prevalence of 1.6% to 10.7%. These fibroids, particularly large ones, increase the risk of placenta previa, a condition where the placenta partially or completely covers the cervix. The combination presents significant risks for both the obstetrician and the patient, including urinary retention, myoma degeneration, preterm labor, obstructed labor, and postpartum hemorrhage. Careful surgical planning and management strategies are crucial. Conclusion: A 28-year-old primigravida with breech presentation, Cervical Uterine Myoma, and total placenta previa was admitted after three days of abdominal pain and scheduled for an elective cesarean section at 36 weeks. The cesarean successfully delivered a healthy male infant, and a 10 x 10 cm cervical myoma was identified without complications. Postoperatively, the patient had a normal recovery with well-healing surgical wounds and was discharged in stable condition with appropriate medications.

The utilisation of fMRI for pre-operative mapping in the paediatric population with central nervous system tumours: a systematic review.

Functional MRI (fMRI) is a well-established tool for pre-operative planning, providing neurosurgeons with a roadmap of critical functional areas to preserve during surgery. Despite its increasing use, there is a need to compare task-based (tb-fMRI) and resting-state fMRI (rs-fMRI) in the peadiatric population to comprehensively evaluate the existing literature on the use of fMRI for pre-operative mapping in pediatric patients, comparing tb-fMRI and rs-fMRI. Two databases were searched for relevant studies published before July 2024 following the PRISMA guidelines. Eleven studies were selected and comprised 431 participants: 377 patients with different types and locations of brain tumours, and 54 healthy controls (HC). Results indicate that tb-fMRI could reliably locate the eloquent cortex with more than an 80% success rate. Furthermore, results were comparable with intraoperative mapping. Two studies reported that 68-81% of patients did not develop deficits in the postoperative period. Results also found that rs-fMRI can fill the gap in the situation of paediatric patients when other techniques do not apply to younger patients. This study suggests that tb-fMRI is more effective for pre-operative mapping in pediatric patients, offering precise localisation of critical brain functions and enhancing surgical planning. Although rs-fMRI is less demanding and compatible with light sedation, it lacks the specificity needed for accurate identification of language, sensory, and motor areas, which limits its clinical relevance. rs-fMRI can aid in function-preserving treatments for brain tumour patients and reduce the need for invasive procedures. Combining tb-fMRI with intraoperative mapping optimizes precision and safety in pediatric-neurosurgery.

Allograft Prosthetic Composite (APC) for Proximal Humeral Bone Deficiency in Revision Reverse Shoulder Arthroplasty: A Technical Note and Systematic Review.

Background: Proximal humeral bone deficiency in revision shoulder arthroplasty is an emerging and challenging problem as the use of reverse shoulder arthroplasty (RSA) increases. This paper presents a technical note discussing our detailed preoperative planning steps, surgical techniques, and their rationale in carrying out the use of an allograft prosthetic composite (APC) to address proximal humeral bone deficiency in revision RSA. The outcomes of this technique are also presented. This paper also presents a systematic review to further discuss the existing literature on RSA with APCs. Methods: The preoperative surgical planning and the surgical technique employed to execute proximal humeral reconstruction using APC during revision arthroplasty are discussed in the technical note. The preliminary clinical and radiological results of five patients who underwent revision shoulder arthroplasty with proximal humeral reconstruction using APCs are presented. The PRISMA guidelines were followed to perform the systematic review. A systematic search using PubMed, Embase, and Cochrane databases was conducted. All studies involving RSA and APCs were pooled, and the data were extracted and analyzed. Results: A total of 14 studies were eligible for inclusion in the systematic review, with a total of 255 patients and a mean follow-up of 57 months. All studies in the systematic review and the patients included in the author's case series showed improvements in the level of pain, range of motion, function, and satisfaction. Graft incorporation in the systematic review was 84%. Conclusions: Based on the available literature and the results of our case series, the use of an APC construct is a viable option for proximal humeral bone deficiency in revision shoulder arthroplasty.

Utility of intraoperative Delphian lymph node sampling in pediatric thyroid surgery

ObjectivesThe Delphian lymph node (DLN) is the first lymph node receiving drainage from the thyroid. We aim to determine whether routine DLN sampling with frozen section analysis during pediatric thyroidectomy can alter intraoperative surgical decision making. Additionally, we aim to measure whether DLNs can predict a requirement for central neck dissection (CND) in the clinically node negative (CNN) pediatric population. MethodsRetrospective chart review for pediatric patients who underwent thyroidectomy between 2014 and 2022. Patients were included if they had prior FNA with a result of: benign nodule, atypia or follicular neoplasm of undetermined significance (AUS/FNUS), follicular neoplasm (FN), or papillary thyroid carcinoma (PTC). All patients had intraoperative DLN analysis via frozen section histopathology. Results27 patients were included, 9 males (33 %) and 18 females (67 %). On final pathology 19 patients (70.4 %) had PTC. The DLN was negative for carcinoma in all (n = 8, 100 %) patients with benign pathology. In 10 patients (100 %) with positive DLN on frozen section, postoperative pathology demonstrated central neck metastasis. Nine (90 %) of these patients were CNN and had alterations in the surgical plan based on the DLN. The tenth patient's surgical plan did not change given preoperative clinical disease. Three patients with negative DLNs had central neck metastasis. ConclusionThe DLN serves a role in guiding treatment for the pediatric population. Positive DLN altered surgical plans in 60 % of CNN PTC patients, allowing for CND to be performed and reducing need for additional surgical resection. The positive predictive value for DLN status was 100 % in this study, and the negative predictive value was 62.5 %. However, negative DLNs do not rule out central neck disease.

Exploring Hemophilic Pseudotumors: A Comprehensive Case Series

Introduction: This case series investigates four hemophilic pseudotumors, which are rare but significant complications of hemophilia. All patients presented with localized swelling and pain, with imaging revealing mass-like lesions that mimicked tumors. Treatment involved a combination of surgical intervention and factor replacement therapy. The findings underscore the importance of diagnostic vigilance and highlight the necessity of a multimodal approach to manage these challenging cases effectively. Aim(s): The major aim of this study is to highlight the prevalence of hemophilic complications like pseudotumors in India. Along with this, this series also aims to shed some light on the multi-disciplinary approach required to manage these complications of Hemophilia. Study Design: Case series. Methods and Materials: 4 cases were followed at a tertiary care centre who presented with various complaints but were each linked by hemophilic pseudotumor. It takes into account the management approach in each case. Conclusion: Early detection of compressive symptoms in hemophilic pseudotumors is crucial for accurate surgical planning. Recent hemorrhages should be managed conservatively, while chronic cases with pain and pressure symptoms often require surgery. Surgical intervention, though complex, is essential and should involve a multidisciplinary approach to prevent morbidity and mortality.

Which is the best imaging modality to diagnose a manica flexoria tear?

SummaryThe manica flexoria (MF) is an extension of the medial and lateral borders of the superficial digital flexor tendon (SDFT) that forms a sleeve around the deep digital flexor tendon (DDFT), within the digital flexor tendon sheath (DFTS), just proximal to the metacarpo/metatarsophalangeal joint. Tears of the MF have been described associated with cases of nonseptic tenosynovitis presenting with lameness, with ponies and cobs being over‐represented. Ultrasonography and contrast tenography are the predominant imaging modalities used to diagnose tears of the MF, with tenoscopic evaluation still serving as the gold standard. However, the sensitivity and specificity of additional techniques such as contrast computed tomographic tenography and MRI are now being investigated as other modalities that could be of value to identify MF tears. Additional techniques have been described to combine with traditional ultrasonography, with the aim to improve the sensitivity of identifying MF tears, such as dynamic extension/flexion techniques and saline injections of the DFTS. The overall aim of this paper was to review current evidence to determine the best noninvasive diagnostic imaging modality, with a high sensitivity and specificity, to more accurately diagnose MF tears and aid more thorough surgical planning.

Management of penetrating arrow injury of the maxillofacial region, case report

An arrow maxillofacial penetrating injury is an unusual traumatic injury sometimes encountered in developing countries. This rare injury has the potential to be dangerous because the arrow is deeply lodged in maxillofacial region crossed by major vessels, and because damage to one of these vessels should always be suspected. Furthermore, removal of a foreign body may result in complications such as massive bleeding or iatrogenic injury to adjacent structure and complications should always be considered in maxillofacial region. We describe a case of a patient who presented with maxillofacial penetrating arrow injury and analyze the problems faced in its management with emphasis on diagnostic imaging, on surgical planning and on careful surgery management.

Lesion and lesion network localization of dysnomia after epilepsy surgery.

Temporal lobe (TL) epilepsy surgery is an effective treatment option for patients with drug-resistant epilepsy. However, neurosurgery poses a risk for cognitive deficits - up to one third of patients have a decline in naming ability following TL surgery. In this study, we aimed to better understand the neural correlates associated with reduced naming performance after TL surgery, with the goal of informing surgical planning strategies to mitigate the risk of dysnomia. We retrospectively identified 85 patients who underwent temporal lobe (TL) resective surgery (49 left TL, 36 right TL) for whom naming ability was assessed before and >3 months post-surgery using the Boston Naming Test (BNT). We used multivariate lesion-symptom mapping to identify resection sites associated with naming decline, and we used lesion-network mapping to evaluate the broader functional and structural connectivity profiles of resection sites associated with naming decline. We validated our findings in an independent cohort of 59 individuals with left temporal lobectomy, along with repeating all analyses after combining the cohorts. Lesion laterality and location were important predictors of post-surgical naming performance. Naming performance significantly improved after right temporal lobectomy (P = 0.015) while a decrement in performance was observed following left temporal lobectomy (P = 0.002). Declines in naming performance were associated with surgical resection of the left anterior middle temporal gyrus (Brodmann area 21, r =0.41, P = <.001), along with a previously implicated basal temporal language area. Resection sites linked to naming decline showed a functional connectivity profile featuring a left-lateralized network closely resembling the extended semantic \ default mode network, and a structural connectivity profile featuring major temporo-frontal association white matter tracts coursing through the temporal stem. This extends prior work by implicating the left anterior middle temporal gyrus in naming decline and provides additional support for the role of the previously identified basal temporal language area in naming decline. Importantly, the structural and functional connectivity profiles of these regions suggest they are key nodes of a broader extended semantic network. Together these regional and network findings may help in surgical planning and discussions of prognosis.

Preoperative Imaging-Guided Surgical Planning in Complex Pelvic Fractures - Innovations in Traumatology and Radiology for Enhanced Clinical Outcomes: A Systematic Review

This systematic review will explore role of preoperative imaging-guided surgical planning for the management of complex pelvic fractures. Pelvic fractures occurs in high-energy trauma and cause challenges for intricate anatomy and have a high association with vascular, visceral injuries. Traditional imaging methods frequently fail to capture injury complexity while increasing surgical risks. Recent advancements of imaging technology CT, MRI, 3D reconstructions along with and AI-based predictive models offer enhanced precision in diagnosing and planning surgical interventions with detailed insights into fracture patterns, bone density, and soft tissue damage which enable accurate surgical planning to reduce intraoperative complications and shorten recovery times. We aim to systematically investigate effectiveness of modern imaging techniques with potencies in clinical outcomes, with an emphasis on improved surgical accuracy and patient safety. Analyzing range of studies, we have established evidence-based recommendations for integrating advanced imaging technologies into routine trauma care showing critical role these innovations play in improving both short-term recovery and long-term clinical outcomes for patients having complex pelvic fractures.