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Introduction: Penetrating spinal cord injuries present unique clinical scenarios with high variability in presentation and management. These injuries are rare, accounting for 0.8% of annual penetrating spine injuries in the United States, with knives being the most common penetrating object. Retention of the knife blade further complicates management, with greater risk of infection and progressive neurologic injury. Given the rarity and variability of such injuries, preferred management for penetrating-knife spinal cord injuries (PKSCI), especially those with retained knife blades, remains contested. Furthermore, the management of PKSCI with concurrent lung injury is poorly described within the literature. Case Report: Here we discuss a unique case of a neurologically intact adult male who suffered a large lower thoracic PKSCI with complete dural transection and lung involvement. The patient arrived with the blade in situ while maintaining full neurologic function. Emergent imaging revealed the blade trajectory passing through the T8 lamina exiting the spinal canal at the costovertebral junction with involvement of the lung parenchyma and associated pneumorrhachis and pneumothorax. The patient was brought to the operating room where the blade was removed under direct visualization, the dura was repaired, and pneumothorax was stabilized. Conclusion: We describe in this case the choice of imaging, method of blade removal, cerebrospinal fluid leak management, dural repair, and concurrent lung injury management that afforded a favorable, ASIA class E outcome with complete preservation of neurologic function. [ABSTRACT FROM AUTHOR]

Background: Endoscopic‐assisted breast surgery (EABS) provides better cosmetic outcomes for breast cancer patients with small incisions in an inconspicuous area. However, an extended incision and heavy assistant retraction are usually required for an adequate exposure for conventional axillary lymph node dissection (ALND). Therefore, we propose an innovative single‐port three‐dimensional endoscopic‐assisted ALND (S‐P 3D E‐ALND) to facilitate better visualization, and report its preliminary outcomes herein. Methods: The surgical technique of the S‐P 3D E‐ALND, using either monopolar Endo Hook, LigaSure, or Sonicision, is described. A total of 11 breast cancer patients who received the S‐P 3D E‐ALND in a single institution from January 2023 to September 2023 were enrolled. The preliminary results of the S‐P 3D E‐ALND, including perioperative parameters, complication, and short‐term oncological outcomes, were retrospectively analyzed. Results: Endoscopic breast and axillary procedures were conducted via a single axillary incision. The primary success rate of the S‐P 3D E‐ALND was 100% without a conversion to open surgery. The median operative time for the S‐P 3D E‐ALND was 39 (IQR = 28, 49) minutes. Average blood loss during E‐ALND was 3 (IQR = 3, 5) mL. The median number of harvested LN was 10 (IQR = 8, 11) LNs. During the median follow‐up time of 7 months, there was no complication, lymphedema, shoulder stiffness, or chronic arm numbness found. None of the patients reported locoregional recurrence, distant metastasis, or mortality. Conclusion: The S‐P 3D E‐ALND can serve as an alternative approach for ALND in breast cancer patients undergoing EABS, as our findings indicate it results in only minor complications. [ABSTRACT FROM AUTHOR]

Objective: Carpal tunnel syndrome (CTS) is a common neuromuscular disorder with an incidence rate of 4.9%. Research on the impact of Kinesio taping (KT) on electroneurography in individuals with CTS is limited, highlighting a significant gap in the literature. This study aimed to evaluate the effects of KT on palm numbness, pain intensity, hand grip strength, and median nerve electroneuromyography in individuals with mild to moderate CTS. Method: This was a randomized, controlled, parallel design study. Twenty-seven participants diagnosed with CTS through hospital outpatient clinics were randomly assigned to either the control or KT group. The outcome measurements included hand grip strength, the Boston Carpal Tunnel Questionnaire (BCTQ), and electroneurography, assessed at baseline and after 6 weeks of intervention. The statistical method used was non-parametric analysis, comparing differences with the median and interquartile range (IQR). Results: Both the KT and control groups significantly improved the numbness grades, hand grip strength, and the BCTQ. The kinesio-taping group demonstrated an improvement in grip strength with a median increase of 2.21 kg (IQR: 0.65–3.79 kg), compared to the control group, which showed a median increase of only 0.70 kg (IQR: 0.22–1.45 kg). Statistical analysis revealed a significant difference between the two groups (p = 0.039), with an effect size of r = 0.33. Conclusion: This study suggested that KT can be a supplementary treatment to relieve pain intensity, enhance hand grip strength, and improve sensory conduction velocity, motor latency, and motor amplitude. Clinical Trial Registration: https://doi.org/10.1186/ISRCTN82192319 , ISRCTNregistry (No. ISRCTN82192319). [ABSTRACT FROM AUTHOR]

Background: Lateral lumbar interbody fusion (LLIF) via a retroperitoneum approach has gained popularity due to minimal invasiveness, which avoids resection of the spinous process and laminae. However, as challenges in grafting autogenous bone persist, artificial bone has been tested in Japan to fill the spinal cage. Platelet-rich plasma (PRP) contains growth factors and anti-inflammatory cytokines to promote cellular proliferation and repair damaged tissues. While the effects of PRP on tendon and ligament repair are widely known, any effects on bone healing are scarcely reported. However, PRP-loaded artificial bone carries potential to improve intervertebral bone fusion. Objective: This study assessed whether PRP enhances intervertebral bone fusion in LLIF surgery using β-tricalcium phosphate artificial bone. Methods: The current study was a prospective, randomized, controlled trial. We evaluated 13 consecutive patients undergoing LLIF surgery in our hospital. Patients received artificial bone impregnated with PRP or without PRP within the same fusion cage. The primary outcome was the intervertebral bone fusion rate at 6 and 12 months postoperatively, evaluated using CT imaging. The intervertebral bone fusion rates with and without PRP loading and with and without contact part between the endplate and the artificial bone were compared. Secondary outcomes included clinical evaluations using visual analog scale scores for low back pain, buttock-leg pain, and leg numbness from the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI), plus adverse events information. Results: Of the 13 patients (29 vertebral segments) included, bone fusion was observed in 43.4% of the PRP group and 26.1% of the non-PRP group at 6 months (p = 0.216). At 12 months, fusion rates were 60.9% with PRP and 34.8% without PRP (p = 0.074). The fusion rate was significantly higher in cases with good contact between the vertebral endplate and the artificial bone (p = 0.0004). Clinical scores improved postoperatively. Adverse events were in accordance with expectations from LLIF surgery and no PRP-specific events occurred. Conclusion: PRP did not significantly improve intervertebral bone fusion rates in LLIF surgeries, particularly in cases with poor contact between the vertebral endplate and artificial bone. While PRP may have a limited role in enhancing bone fusion, maintaining good contact between the vertebral endplate and artificial bone is crucial for successful outcomes. Further research is needed to explore optimal uses of PRP in spinal fusion surgeries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a significant side effect of some chemotherapeutic agents. Effective treatment is limited. OBJECTIVES: This single patient case details gua sha as an intervention to reduce CIPN. METHODS: A 38-year-old female patient received weekly treatment of gua sha in one-hour sessions for 10 weeks. The patient completed the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-NTX) subscale to describe her CIPN throughout and postintervention. A research assistant measured the extent of numbness or tingling along the limb from baseline to 18 months after gua sha. Descriptive data were used to summarize this case. FINDINGS: After gua sha, the total FACT/GOG-NTX subscale score increased from 13 to 36, indicating a sevenfold greater change than the minimum clinically important difference. The range of limb numbness and tingling decreased, and the symptoms remained stable during follow-up. Gua sha showed a positive clinical effect. [ABSTRACT FROM AUTHOR]

Background: The surgical management of midline ventral hernias complicated by concomitant diastasis recti presents a significant clinical challenge. The Endoscopic Onlay Repair (ENDOR) offers a minimally invasive solution, effectively addressing both conditions. This study focuses on describing the adaptation of ENDOR to a robotic platform, termed R-ENDOR, aiming to report initial outcomes along with other established robotic surgical approaches. Methods: This retrospective case series study included consecutive adult patients who underwent R-ENDOR approach from October 2018 to April 2023, performed by a single surgeon. A comprehensive description of the surgical technique is included. Patient demographics, operative, and hernia-specific characteristics, as well as clinical outcomes are described. Results: A total of 15 patients undergoing R-ENDOR for ventral hernia repair with diastasis recti plication were included. The median age was 59 years (IQR 42–63), with 60% (n = 9) female patients. The majority (86%, n = 13) had an ASA score of ≤ 2, and the median BMI was 24 kg/m2, with 20% (n = 3) classified as obese. Median hernia size was 2 cm (IQR 2–2.25), with a median diastasis length of 19 cm (IQR 15–21.5) and width of 4 cm (IQR 3–6). The median operative time was 129 min (IQR 113–166). Most repairs (93%, n = 14) were reinforced with mesh, predominantly self-fixating (73.3%, n = 11). Eighty percent of patients (n = 12) were discharged on the same day, with a median follow-up of 153 days (IQR 55–309). Notable complications included clinically significant seromas in 20% of patients (n = 3), long-term hypoesthesia in 40% (n = 6), and readmission in one patient (6.6%) for surgical site infection (SSI) requiring IV antibiotic therapy. Conclusion: Midline ventral hernias associated to diastasis recti can be managed robotically by ENDOR with safe and consistent 90-day outcomes in a carefully selected group of patients. [ABSTRACT FROM AUTHOR]

Background: Trigeminal nerve injury following endodontic treatment, leading to unpleasant sensations or partial sensory loss in the face or oral mucosa, is uncommon but significant when it occurs. Objective: This study analysed the pharmacological management of trigeminal nerve injuries (TNI) in a university‐based hospital. Methods: We conducted a retrospective analysis of 47 patients who visited the Department of Orofacial Pain and Oral Medicine at Yonsei University Dental Hospital, Seoul, Korea, after TNI following endodontic procedures in primary clinics. Both objective tests and subjective evaluations, assessed the extent and duration of sensory injury during the initial visit. The patient's initial symptoms, presumed cause of TNI, referral delay (time interval between TNI and the first visit to our clinic), and medications were analysed to determine whether these factors affected the outcomes. Results: Most patients with TNI experienced dysesthesia with hypoesthesia (70.2%). The mandibular molars were predominantly affected (72.3%), with the inferior alveolar nerve (IAN), lingual nerve (LN), both IAN and LN, and maxillary nerve compromised in 83.0, 12.8, 2.1, and 2.1% of cases, respectively. Causes of TNI included local anaesthesia (29.8%), overfilling/over‐instrumentation (25.5%), endodontic surgery (17.0%), and unknown factors (27.7%). A shorter referral delay was associated with better outcomes, with an average delay of 8.6 weeks for symptom improvement compared with 44.1 weeks for no change. The medication regimens included steroids, NSAIDs, topical lidocaine, vitamin B complex, Adenosine Triphosphate (ATP), antiepileptics, antidepressants, and opioids administered alone or in combination, with a mean duration of 20.7 weeks. 53.2% of the patients reported improvement in their symptoms, 27.7% experienced no significant change, and 19.1% had unknown outcomes. Conclusions: Swift referral to an orofacial pain specialist is recommended for effective recovery in cases of TNI arising from endodontic treatment. [ABSTRACT FROM AUTHOR]

Background: The L5-S1 interlaminar access described in 2006 by Ruetten et al. represented a paradigm shift and a new perspective on endoscopic spinal approaches. Since then, the spinal community has shown that both the traditional ipsilateral and novel contralateral interlaminar approaches to the L5-S1 foramen are good alternatives to transforaminal access. This study aimed to provide a technical description and brief case series analysis of a new endoscopic foraminal and extraforaminal approach for pathologies at the lumbar L5-S1 level using a new ipsilateral interlaminar approach. Methods: Thirty patients with degenerative stenotic conditions at the L5-S1 disc level underwent the modified interlaminar approach. The surgical time, blood loss, occurrence of complications, and clinical outcomes were recorded. The data were compiled in Excel and analyzed using R software version 4.2. All continuous variables are presented as the mean, median, minimum, and maximal ranges. For categorical variables, data are described as counts and percentages. Results: Thirty patients were included in the study. The cohort showed significant improvements in all quality-of-life scores (ODI, visual analog scale of back pain, and visual analog scale of leg pain). Five cases of postoperative numbness and three cases of postoperative dysesthesia have been reported. No case of durotomy or leg weakness has been reported. Conclusions: The fundamental change proposed by this procedure, the new ipsilateral approach, presents potential advantages to surgeons by overcoming anatomical challenges at the L5-S1 level and by providing surgeon-friendly visualization and access. This approach allows for extensive foraminal and extraforaminal decompression, including the removal of hernias and osteophytosis, without causing neural retraction of the L5-S1 roots while maintaining the stability of the operated level. [ABSTRACT FROM AUTHOR]

As a simple and safe alternative intervention, percutaneous balloon compression (PBC) has been gradually adopted by a growing number of neurosurgeons to treat trigeminal neuralgia. A pear-shaped opacity observed fluoroscopically, which indicates full suffusion of Meckel's cave conducting sufficient pressure against Gasserian ganglion, is believed to be the key to its success. Sometimes, a bitten pear may appear due to bubbles in the balloon but is usually ignored. This study aims to investigate the effects of the bubbles on postoperative outcomes. Patient data were obtained from the consecutive cases undergoing PBCs in our department between 2019 and 2021. Among them, pain and numbness were used to assess the efficacy of PBC based on Barrow Neurology Institute (BNI) scoring system. It was defined as an effective outcome if the postoperative pain intensity grade was lower than II. And those with numbness grade > II were regarded as numb incidence. We eventually recruited 59 cases, including 42 in full pear and 17 in bitten pear groups with follow-up time up to 44 months. The early effective rates were 95.2% and 82.4%, respectively (p > 0.05), which turned to 88.1% and 52.9% during the last follow-up period (p < 0.01). This result indicated that the bitten pear gave rise to a significantly higher recurrence. In terms of numbness, there was no significant difference. Gas does not yield enough pressure as liquid, and cannot exert enough pressure to the semilunar ganglion. Therefore, air evacuation should not be ignored before injection. [ABSTRACT FROM AUTHOR]

We describe an exceptional instance of multiple sclerosis manifesting in a unilateral, superior visual field deficit accompanied by painful eye movements. A 16-year-old girl with no prior health issues presented with symptoms of blurred vision, ocular pain in eye movement, and a throbbing headache in her right eye. She experienced right-sided numbness for two weeks, which later affected her left limbs. Effective management of multiple sclerosis necessitates familiarity with its uncommon presentations due to the significance of early diagnosis and treatment. Unilateral superior altitudinal visual field defect, orbital pain upon eye movement, and left hemi-paresthesia may be an uncommon presenting symptom in MS patients. After completing treatment with methylprednisolone, visual acuity can improve completely. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 63-year-old man of iatrogenic spinal cord injury resulting in chronic neuropathic pain following a cervicothoracic epidural steroid injection (ESI). Topics include the development of symptoms and diagnostic imaging findings, multidisciplinary pain management efforts, and challenges associated with persistent neuropathic pain management after such spinal injuries.

Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal central nervous system (CNS) disease caused by the John Cunningham polyomavirus (JCV). Here, we present a case of PML that developed 12 years after kidney transplantation in a 36-year-old patient. The patient presented to the emergency department with weakness and numbness in the right arm, which resolved after treatment, restoring normal muscle strength. Treatment involved a gradual reduction of immunosuppressive therapy and plasmapheresis every other day for five days. PML can have an aggressive and fatal course, but our case was considered to have a favorable (atypical) onset of PML. Early diagnosis and treatment are believed to impact the prognosis of PML. [ABSTRACT FROM AUTHOR]

The occipital nerve block involves the injection of a local anesthetic and possibly a corticosteroid near the occipital nerves at the base of the skull and aims at providing relief from chronic headaches by temporarily numbing or reducing inflammation around the occipital nerves. It has proven to be efficacious in treating chronic headaches, especially those that are refractory to medication; it is both diagnostic and therapeutic with symptom abatement from weeks to months. Occipital nerve blocks can be utilized alone or with standard-of-care therapy for various other headache conditions, such as cluster headaches, episodic headaches or chronic migraines. This review aims to provide an analysis of the world literature on the role of occipital nerve block (ONBs) in the treatment of headaches, including the procedure, efficacy and safety of ONB, and to elucidate the current understanding of ONBs. ONBs demonstrate diagnostic and therapeutic benefits with symptom abatement for weeks to months. Outcomes are generally well tolerated, with minimal side effects associated mainly with the injection process, including numbness, tingling and local discomfort. Greater occipital nerve blocks are an efficacious procedure to treat chronic headache symptoms, and future research should include additional longitudinal follow-up results and interactions of ONBs with other headache treatments. [ABSTRACT FROM AUTHOR]

Simple Summary: Intramedullary spinal cord melanocytomas are exceedingly rare. Here, we present a systematic review of the available literature and a case illustration from our surgical experience: a T1-weighted hyperintense lesion emerges with a focal contrast-enhancing nodule. Despite their benign histology, these tumors often present local aggressiveness with a high tendency towards local invasiveness, which is associated with frequent post-operative neurological deficits, and relapse, which eventually overwhelms adjuvant therapies, such as RT or salvage surgery. We present a case illustration of an intramedullary thoracic melanocytoma in a middle-aged woman. Despite the employment of complete intraoperative neuromonitoring and a frozen section, the adherence of the lesion to the surrounding spinal cord made it impossible to preserve neurological functioning. The current systematic review and case illustration highlight radiographic findings suspected of intramedullary melanocytoma, present the available surgical techniques, and address the importance of preserving neurological functions during the surgical treatment of intramedullary melanocytomas. Background: Intramedullary melanocytomas are exceedingly rare, with only twenty-four cases reported up to now. They present as local invasive tumors despite their benign biological behavior. Attempting a complete safe resection often results in severe post-operative neurological deficits, as in our case presented here. Methods: A systematic review was conducted across the PubMed and Scopus databases including studies published till February 2024. Results: A total of 19 studies were included, encompassing 24 cases. A similar distribution between sexes was noted (M:F 13:11), with ages ranging from 19 to 79 years. The thoracic segment was most affected, and intermediate-grade melanocytoma (19 cases) was the most common histotype. Radiographically, intramedullary melanocytomas usually appear as hyperintense hemorrhagic lesions peripheral to the central canal with focal nodular enhancement. Intraoperatively, they are black–reddish to tan and are tenaciously adherent lesions. In the sampled studies, IONM employment was uncommon, and post-operative new-onset neurological deficits were described in 16 cases. Adjuvant RT was used in four cases and its value is debatable. Recurrence is common (10 cases), and adjuvant therapies (RT or repeated surgery) seem to play a palliative role. Case presentation: A 68-year-old woman presented with a three-year history of worsening spastic paraparesis and loss of independence in daily activities (McCormick grade 4). An MRI revealed an intramedullary tumor from Th5 to Th7, characterized by T1-weighted hyperintensity and signs of recent intralesional hemorrhage. Multimodal neuromonitoring, comprising the D-Wave, guided the resection of a black–tan-colored tumor with hyper-vascularization and strong adherence to the white matter. During final dissection of the lesion to obtain gross total resection (GTR), a steep decline in MEPs and D-Wave signals was recorded. Post-operatively, the patient had severe hypoesthesia with Th9 level and segmental motor deficits, with some improvement during neurorehabilitation. Histopathology revealed an intermediate-grade melanocytoma (CNS WHO 2021 classification). A four-month follow-up documented the absence of relapse. Conclusions: This literature review highlights that intramedullary T1 hyperintense hemorrhagic thoracic lesions in an adult patient should raise the suspicion of intramedullary melanocytoma. They present as locally aggressive tumors, due to local invasiveness, which often lead to post-operative neurological deficits, and frequent relapses, which overwhelm therapeutic strategies leading to palliative care after several years. [ABSTRACT FROM AUTHOR]

Acute limb ischemia (ALI) is a medical emergency with a time-sensitive outcome. Acute upper limb ischemia (AULI) is less common than lower limb ischemia, and relatively few cases have been reported. It may cause significant disabilities and severe functional impairment even in the absence of overt tissue loss. Six hours window of presentation yielded a better outcome. However, diagnosing and treating within the time frame has always been a challenge. A high index of suspicion assisted with Doppler study in a limited-resources health centre is of sound importance as limb ischemia might be mimicked by other diseases. We illustrated a case of AULI with atypical presentation and successful revascularisation intervention. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is a prevalent condition characterized by hand pain, tingling, and numbness. The severity of symptoms and functional status in CTS patients may be influenced by perceived stress and how individuals cope with it. However, scarce knowledge exists about the role of coping strategies as moderators in this relationship. Unfolding the role of perceived stress and coping strategies for CTS management will help the nurse to provide comprehensive and tailored nursing care. This will ultimately improve patient comfort, functionality, and quality of life. Purposes: This study aimed to examine the role of coping strategies (adaptive and maladaptive) in the relationship between perceived stress and both symptoms severity and function status among those patients. Method: We employed a multisite, correlational study design with moderation analysis. The study included 215 patients with CTS from neurosurgery outpatient clinics at three hospitals in Egypt. After obtaining their consent to participate, eligible participants completed anonymous, self-reported measures of perceived stress, the brief COPE inventory, and the Boston Carpal Tunnel Questionnaire. Demographic and biomedical data were also collected. The questionnaire took about 20 min to be completed. The data was collected over six months, starting in February 2023. Results: The results showed that perceived stress, adaptive coping, and maladaptive coping were significant predictors of symptoms severity and functional status. Adaptive coping moderated the relationships between perceived stress and both symptoms severity and function status, while maladaptive coping did not. The interaction between perceived stress and adaptive coping explained a moderate effect on symptoms severity and function status after controlling for the main effects and the covariates. Conclusion: This study explored the relationship between perceived stress, coping strategies, and outcomes in patients with CTS. The results indicate that nurses play a vital role in assessing and assisting patients to adopt effective coping strategies to manage perceived stress and alleviate symptoms and functional impairment. Moreover, the findings support the need for psychological interventions that address both perceived stress and coping strategies as a way to enhance the functioning status and quality of life of patients with CTS. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive approaches to the hip joint for total hip arthroplasty such as the DAA ("Direct Anterior Approach with bikini incision") are increasingly utilized. According to the literature, this approach is more muscle-sparing, results in less postoperative pain, and achieves higher patient satisfaction. The existence of postoperative lymphedema after hip arthroplasty is hardly considered. The aim of this paper is to contribute to the evaluation of the different access methods related to postoperative lymphedema and their functional outcomes. Methods: This is a prospective non-randomized study at an orthopedic specialist clinic in Northern Europe. The surgeons that performed the arthroplasties are high-volume surgeons in private practice affiliated to the clinic. The study included 188 patients with primary hip arthroplasty in a 1:1 ratio (DAA: standard accesses (posterior, transgluteal, and anterolateral access)). Epidemiologic data, Harris Hip Score, Oxford Hip Score, European Quality of Life 5, and Visual Analog Scale were collected preoperatively on admission day, 3rd and 5th postoperative day, and follow-up after 1 year. Furthermore, the range of motion, gait, and ability to climb stairs, as well as the presence of hypesthesia were assessed. To evaluate the edema situation, both legs were measured on the 3rd and 5th postoperative day. The prescription of manual lymphatic drainage and remaining swelling conditions 1 year postoperatively were recorded. Results: For each group, 94 patients with a mean age of 61.7 years (DAA 60.7 and standard access 62.6) were included. All but one patient in the DAA group showed postoperative lymphedema (n: 93/94; 98.9%). In the standard surgery group, only n: 37/94 (39.4%) showed swelling symptoms requiring treatment. After 1 year, lymphedema persisted in 20 patients in the DAA group and 0 patients in the standard-OR group. Hypesthesia at the ventral thigh persisted in 16/94 (= 17%) patients of the DAA group versus 0/94 patients of the standard group after 12 months. Of these 16 cases, 10 had concomitant edema (62.5%). The DAA showed better results than the standard accesses in terms of Oxford Hip Score (p < 0.05) and ability to climb stairs (p < 0.05). In contrast, the Visual Analog Scale and patient quality of life results showed no significant difference (p > 0.05). Conclusion: The present study demonstrated the increased incidence of postoperative lymphedema in patients operated on via DAA access using a Bikini-type skin incision. In the follow-up, significantly more hypesthesia of the ventral thigh occurred in the DAA group. Otherwise, the DAA proved to be superior to the standard approaches from a functional point of view at short-term follow-up. Future research is needed to compare the horizontally oblique to the longitudinal oblique skin incision technique in direct anterior hip surgery regarding the above-mentioned adverse effects found in this study. [ABSTRACT FROM AUTHOR]

Introduction: CyberKnife stereotactic radiosurgery (CKSRS) is recognized as a highly efficient intervention for refractory trigeminal neuralgia (TN). Our study aims to evaluate the clinical outcomes of CKSRS in treating medically refractory TN. By assessing these results, we aim to understand CKSRS efficacy and its potential as an alternative for nonresponsive patients to traditional medical treatments. Methods: In a retrospective study carried out at my institution, 25 patients with refractory TN were treated between 2018 and 2020. Clinical outcomes, including pain control and hypoesthesia/numbness, were assessed at 6, 12, and 24 months after CKSRS. The study employed the Barrow Neurological Institute pain intensity and facial numbness scores acquired through a telephone questionnaire to assess pain relief and the onset of facial hypoesthesia, thus establishing the effectiveness of the treatment. Results: There were 14 male and 11 female patients. Among all the patients, 44% experienced relief from pain and were not on any medication for pain, whereas 52% reported occasional pain that did not require medication at the end of the study period. The adverse effect of CKSRS, facial numbness, was observed in 58% of patients as mild facial numbness and in 44% as bothersome facial numbness. Moreover, a higher dose of CKSRS administered to the trigeminal nerve was associated with statistically significant pain control (P < 0.05). Conclusion: The study concludes that CKSRS is a safe and effective treatment option for refractory TN. It is worth noting that the occurrence or progression of facial hypoesthesia posttreatment was identified as a predictor of prolonged pain relief. [ABSTRACT FROM AUTHOR]

Objectives: Fungal tissue invasion in the setting of sinonasal malignancy has been rarely described in the literature. Only a handful of studies have discussed cases of suspected chronic and acute IFS (CIFS and AIFS, respectively), having an underlying undifferentiated sinonasal carcinoma, sinonasal teratocarcinosarcoma, and NK/T-cell lymphoma. Methods: Here, we describe 3 cases of carcinoma mimicking IFS from a single institution. Results: Each of our patients presented with sinonasal complaints as an outpatient in the setting of immunosuppression. Intranasal biopsies consistently were predominated by necrotic debris, with and without fungal elements, ultimately leading to a delay of oncologic care. The final pathologies included NK/T-cell lymphoma and SNEC. All patients were followed by radiation and chemotherapy, with 1 case of mortality. Conclusions: We aim to emphasize the importance of obtaining viable tissue as pathology specimens as the presence of necrosis with fungal elements may limit the diagnosis and ultimately delay the care of an underlying sinonasal carcinoma. [ABSTRACT FROM AUTHOR]

Purpose: To compare outcomes of fluoroscopic-assisted supra-acetabular pin placement percutaneous technique versus the open technique in traumatic pelvic fractures. Methods: Prospective randomized controlled trial was performed at Maharat Nakhon ratchasima hospital from January 2020 to March 2021. Time, size of wound, and position of supra-acetabular pin were recorded intraoperatively. Pin positions were confirmed and measured by postoperative CT scan. Complications such as cortex penetration, infection, hip joint violation, and lateral thigh numbness were recorded at 2 weeks postoperatively. Results: Twenty patients (40 hemipelvis) were randomized to fluoroscopic-assisted and non-fluoroscopic groups. Time taken for supra-acetabular pin placement for fluoroscopic-assisted and non-fluoroscopic-assisted groups was 211 and 522 s, respectively (P value < 0.001). Average wound size was 2.81 cm in the fluoroscopic-assisted group and 6.01 cm in the non-fluoroscopic-assisted group (P value < 0.001). Overall complications were similar in both groups with higher infection rates in the fluoroscopic-assisted group (5 and 0%, respectively). Discussion: Pelvic fracture is a life-threatening condition, which requires emergency pelvic stabilization. This study examined operative times for supra-acetabular placement and complication rates. The results show shorter operative times for the non-fluoroscopic-assisted technique without significant differences in complication rates. Conclusion: Non-fluoroscopic technique greatly reduced operative times for supra-acetabular pin placement with comparable safety to the fluoroscopic-assisted technique. [ABSTRACT FROM AUTHOR]

Introduction: The efficiency of pain management depends on appropriate pain assessment. Postoperative pain assessment is done by acute pain service (APS) team; patients may also assess their pain scores with the help of a patient's pain assessment format. The present study has evaluated the efficacy of patient's pain assessment format by comparing it with pain assessment done by the APS team. Materials and Methods: Thirty-five patients undergoing abdominal surgery were enrolled in this study; postoperative pain assessment was done by patient's pain assessment format and APS team for a period of 3 days after surgery. The primary outcome measure was postoperative pain score and the secondary outcome measures were postoperative nausea and vomiting, abdominal distension, pruritus, numbness, paresthesia, or weakness in the legs. Results were analyzed by the Mann-Whitney U-test and Fisher's exact test. P <0.05 was considered as statistically significant. Results: Pain scores and incidence of side effects assessed by the patient's pain assessment format were comparable to those assessed by the APS team; however, the first reading of pain scores after surgery assessed by the patient's pain assessment format was significantly higher than that assessed by the APS team (P < 0.05). Conclusion: Pain scores assessed by the patient's pain assessment format were comparable to the pain scores assessed by the APS team. Hence, we recommend the use of patient's pain assessment format as a valid tool for the assessment of postoperative pain by the APS team. [ABSTRACT FROM AUTHOR]

Background: Controversy remains regarding predictors of surgical outcomes for patients with lumbar spinal stenosis (LSS). Pain sensitization may be an underlying mechanism contributing to LSS surgical outcomes. Further, obesity is associated with dissatisfaction and poorer outcomes after surgery for LSS. Therefore, this study aimed to examine the relationship between central sensitization (CS), visceral fat, and surgical outcomes in LSS. Methods: Patients with LSS were categorized based on their central sensitization inventory (CSI) scores into low- (CSI < 40) and high- (CSI ≥ 40) CSI subgroups. The participants completed clinical outcome assessments preoperatively and 12 months postoperatively. Results: Overall, 60 patients were enrolled in the study (28 men, 32 women; mean age: 62.1 ± 2.8 years). The high-CSI group had significantly higher mean low back pain (LBP), leg pain, and leg numbness visual analogue scale (VAS) scores than the low-CSI group (p < 0.01). The high-CSI group had a significantly higher mean visceral fat area than the low-CSI group (p < 0.01). Postoperatively, LBP VAS score was significantly worse in the high-CSI group. Relative to preoperatively, postoperative leg pain and leg numbness improved significantly in both groups. Conclusions: We believe that neuro decompression can be effective for LSS surgical outcomes in patients with CS; nonetheless, it should be approached with caution owing to the potential for worsening LBP. Additionally, visceral fat is an important indicator suggesting the involvement of CS. [ABSTRACT FROM AUTHOR]

Background: Current evidence supports favorable short-term clinical outcomes with few complications after surgical management of proximal hamstring injuries; however, the durability of clinical benefits beyond approximately 2 years after surgery is unknown. Purpose: To evaluate patient-reported clinical outcomes and complication rates associated with open and endoscopic repair of proximal hamstring tears at minimum 5-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A single-surgeon registry of patients was queried between October 1, 2014, and December 31, 2017, to identify patients who underwent open or endoscopic repair of a proximal hamstring tear. Patients who reported minimum 5-year follow-up data were included. Multiple patient-reported outcome measures, including the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, 12-Item International Hip Outcome Tool (iHOT-12), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain domains, along with surgical complications, were analyzed. Results: Among 35 eligible patients (65.7% female; mean age, 52.3 ± 8.4 years), 24 had full-thickness tears and 11 had partial-thickness tears. There were 23 open repairs and 12 endoscopic repairs. Mean duration from symptom onset to surgical intervention was 37.9 weeks (range, 1.3-306.9 weeks). At a mean follow-up of 69.0 months (range, 60.0-95.0 months), mean postoperative outcome scores were as follows: HOS-ADL, 86.8 ± 12.7; HOS-SS, 83.1 ± 19.5; iHOT-12, 86.3 ± 14.9; PROMIS-PF, 50.0 ± 11.8; and PROMIS–Pain, 50.2 ± 7.9. Regarding complications, 28.6% of patients had a complication including persistent peri-incisional numbness (11.4%), wound infection (11.4%), postoperative neuropathy (8.6%), and revision surgery (2.9%). Conclusion: Both open and endoscopic surgical techniques for repair of proximal hamstring injuries produced favorable patient-reported clinical outcomes at a minimum 5-year follow-up. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to examine the short-termeffectiveness of a prefabricated wrist orthosis compared with a custom-made wrist orthosis and its long-term effectiveness on alleviating carpal tunnel syndrome (CTS) symptoms. Materials and Methods: A total of 109 patients withmild and moderate CTS were prescribed with either a prefabricated wrist or a custom-made wrist orthosis, and the changes in their mean scores on the Carpal Tunnel Syndrome Symptom Severity Scale (CTSSSS) at baseline and the eighth week follow-up. The changes in CTSSSS scores of those prescribed with the prefabricated wrist orthosis were compared with the 32nd week postintervention. Results: Repeated-measures analysis of variance (ANOVA) showed significant effect at both mean CTSSSS and subscale scores ( P < 0.001). Both prefabricated wrist orthosis (n = 88) and custom-made wrist orthosis (n = 21) were shown to alleviate CTS symptoms at the first follow-up. Repeated-measures ANOVA showed significant differences after the long-term application of the prefabricated wrist orthosis (n = 62) in terms of CTSSSS score, daytime numbness, nighttime numbness, and nocturnal awakening ( P = 0.005--0.029). Clinical Relevance: Along with the conventional thermoplastic splint, the prefabricated soft wrist orthosis could serve as an appropriate alternative to alleviate neurological symptoms of CTS due to its better long-term compliance. [ABSTRACT FROM AUTHOR]

Background: Lumbar disk herniation (LDH) is one of the most common diseases of the spine, especially occurring in L4-5 and L5-S1 intervertebral disks, and surgery is a choice when conservative treatment is ineffective. The purpose of this study is to investigate the clinical efficacy and radiologic outcomes of one-hole split endoscopy (OSE) technique versus unilateral biportal endoscopy (UBE) technique in the treatment of L5-S1 lumbar disk herniation (LDH). Methods: A total of 133 patients of a single center surgically treated for L5-S1 LDH between 2019 and 2021 were retrospectively included in this study, of which 70 were treated by UBE technique and the rest were treated by OSE technique. Hospitalization time, operative time, intraoperative blood loss, fluoroscopy times, incision length and related complications were recorded. Bone resection area (BRA), articular process resection rate, range of motion (ROM), sagittal translation (ST), disk height (DH), Visual Analog Score (VAS), Oswestry Disability Index (ODI) and Macnab criteria were used to evaluated the clinical efficacy. Results: There was no statistically significant difference in hospitalization time or fluoroscopy times between the two groups. The operation time was shorter in the UBE group than that in the OSE group; however, the incision length was longer. Intraoperative blood loss and BRA were larger in the UBE group than in the OSE group. There was no significant difference in ROM, ST, DH, or postoperative facet resection rate between the two groups. There was no significant difference in ROM, ST, or postoperative facet resection rate compared with preoperative indicators in each group, but there was a significant difference in DH among distinct groups. At any time point, the lower back and leg VAS and ODI in each group were significantly improved compared to those before the operation, with no significant difference between the two groups. There was one case of dural tear in the UBE group. One case of transient hypoesthesia occurred in each of the two groups. The excellent–good rates of the UBE group and the OSE group were 88.6% and 90.5%, respectively. Conclusion: The OSE technique is an effective minimally invasive surgical option as well as the UBE technique in the treatment of L5-S1 LDH. [ABSTRACT FROM AUTHOR]

Background This study aims to systematically review the treatment outcomes of percutaneous balloon compression (PBC) and microvascular decompression (MVD) in patients with trigeminal neuralgia. Methods A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was performed using PubMed, Embase, and Cochrane Central Registry of Controlled Trials databases. Only those articles with more than 5 years' follow-up length were included in this investigation. To uniformly assess the postoperative outcome, we defined pain relief as totally pain free, while the postoperative hospitalization and last follow-up period were defined as early and long term , respectively. The facial numbness was quantified with Barrow Neurological Institute Pain Intensity Score (BNI). Results After database searching and screening, 7,797 cases were finally included according to the criteria. The early pain relief rates were 94.1% (1,551/1,649) and 89.9% (4,962/5,482) following PBC and MVD (odds ratio [OR] = 0.603; p < 0.05), while the long-term rates were 58.1% (921/1,566) and 74.9% (4,549/6,074; OR = 2.089; p < 0.05), respectively. Although a significant higher facial numbness occurred in the PBC group in the early stage, it was mostly diminished 5 years later compared with the MVD group. At long-term follow-up, hypoacusis and facial palsy occurred more often in the MVD group (p < 0.05). Conclusions Both MVD and PBC provide a satisfactory outcome for the patients in the long term. As a simple, safe, and reliable technique, PBC should be considered as a viable alternative. [ABSTRACT FROM AUTHOR]

Image-guided percutaneous biopsies are routine, safe procedures and complications are infrequent and usually directly related to the biopsy itself. This report describes a biopsy of a retroperitoneal mass with extension into the spinal canal, following which the patient developed paralysis unrelated to the biopsy itself but secondary to spinal cord ischemia during the procedure. Multiple factors contributed to the ischemia, including prone positioning, compression of spinal vasculature by the mass, low arterial pressures, and an extended duration of anesthesia. While the patient eventually recovered neurologic function, it is an important reminder to consider individual patient factors that may complicate typically routine procedures. In masses with intraspinal extension, patient positioning is critical to prevent positional ischemia, and maintaining elevated mean arterial pressures is crucial for ensuring adequate spinal perfusion throughout the procedure. [ABSTRACT FROM AUTHOR]

The presentation of symptomatic inferior vena cava (IVC) occlusion is variable, and no clear guidance exists on indications for invasive treatment. We describe the first documented case in the literature of IVC occlusion and venous congestion of the spine with associated neurological symptoms, successfully treated with endovascular IVC reconstruction. Case report: A 31 year-old male presented with a long history of reduced sensation and motor function in his lower limbs upon waking every morning, lasting 30-50 minutes during which he was unable to ambulate. He was involved in a severe road traffic accident as a child, and was born prematurely requiring prolonged neonatal hospitalisation. Both duplex ultrasonography and magnetic resonance venography identified an occlusion of the IVC, with patent common femoral and iliac veins draining into large spinal collaterals. No other cause was identified for his symptoms. After appropriate multidisciplinary team discussion and patient counselling, the patient proceeded to have endovenous recanalization of his IVC and common iliac veins with dedicated venous stents. Post-operatively, the patient reported an immediate resolution of neurological symptoms, with an improvement in quality of life questionnaire scores and with stent patency at 9-month follow up. Conclusion: IVC occlusion with symptomatic spinal venous congestion is a rare condition which may be successfully treated with endovascular iliocaval recanalization, although long-term outcomes of this treatment are still unknown. [ABSTRACT FROM AUTHOR]

Background: De qi, the needling sensation, is important in acupuncture treatment. Almost all studies believe that deep needling and manipulation could achieve a significant de qi sensation. However, relatively few studies have examined the effect of psychological factors on de qi, and those that did often reached different conclusions. Objectives: To explore the influence of psychologic factors on de qi in patients with primary dysmenorrhea (PD). Methods: Sixty-eight PD patients with cold and dampness stagnation were randomly allocated to de qi (deep insertion using thick needles, with manipulation, n=17) and non-de qi groups (shallow insertion using thin needles, without manipulation, n=51). Both groups received bilateral needling at Sanyinjiao (SP6) for 30 min. De qi was assessed using the Acupuncture De qi Clinical Assessment Scale (ADCAS). The patients' acupuncturerelated anxiety and their expectations of the relationship between needle sensation and curative effect were evaluated using a five-point and four-point scale, respectively. Results: Within the de qi group, all patients experienced the de qi sensation, although anxiety levels were unrelated to de qi. Patients' expectations correlated negatively with de qi timing, and positively with electric sensation. Within the non-de qi group, 59.5% of patients experienced de qi. Between those who experienced it and those who did not, no significant differences were found in anxiety levels, although patients' expectations differed significantly. Among patients who experienced de qi sensations in the non-de qi group, anxiety and throbbing were positively correlated. Additionally, patients' expectations correlated positively with de qi intensity, as well as coldness, and numbness. Conclusion: Psychological factors should be considered when studying de qi since PD patients' expectations could influence the de qi sensation at SP6. [ABSTRACT FROM AUTHOR]

MOG antibody disorder presenting as a combined central and peripheral demyelination (CCPD) is uncommon. CCPD has been associated with other primary demyelination syndromes such as multiple sclerosis, neuromyelitis optica or chronic inflammatory demyelinating polyneuropathy. Here, the authors describe the diagnosis and management of a 21‐year‐old female with historically sequential demyelinating plaques in her right thalamus, cervical cord, left optic nerve and electrophysiology suggestive of bilateral ulnar nerve demyelination. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to assess whether differences in duration of preoperative leg numbness lead to different surgical outcomes. Methods: This study included patients with lumbar spinal stenosis (LSS) who underwent lumbar fusion surgery in our hospital from January 2018 to September 2020. Patients were divided into three groups based on duration of preoperative leg numbness: no numbness (NN) group, short-term numbness (STN) group (leg numbness ≤ 3 months) and long-term numbness (LTN) group (leg numbness > 3 months). The Numerical Rating Scale of leg pain (NRS-LP) and leg numbness (NRS-LN), Oswestry Disability Index (ODI) and Short-Form Health Survey (SF-36) were collected before surgery and at 3, 6, 12 and 24 months postoperatively. Results: 178 patients were included in this study. At 24 months postoperatively, NRS-LP was significantly higher in LTN than in NN [NN vs. STN vs. LTN: 0 (0,1) vs. 0 (0,1) vs. 1 (0,1)] (p = 0.033). NRS-LN in STN [2 (1,3)] was significantly lower than in LTN [3 (2,3)] (p < 0.001). SF-36 was significantly lower in LTN than in other two groups (NN vs. STN vs. LTN: 86.10 ± 6.02 vs. 84.09 ± 5.59 vs. 78.93 ± 6.57) (p < 0.001). ODI was significantly higher in LTN than in other two groups [NN vs. STN vs. LTN: 18 (15,22) vs. 18 (16,20) vs. 21 (19,24)] (p = 0.001). Conclusions: Patients with LSS with long-term preoperative leg numbness have poorer outcomes at 2 years postoperatively. Surgical intervention should be performed before persistent leg numbness for more than 3 months to obtain a better prognosis. [ABSTRACT FROM AUTHOR]

MR-DTI parameters namely fractional anisotropy (FA) and apparent diffusion coefficient values (ADC) of diffusion imaging demonstrate the directional preference and speed of diffusion of water molecules. The purpose of this case report is to explore the effect of massage, passive neural mobilization and transcutaneous electrical nerve stimulation on MR-DTI of the tibial nerve in a patient with type 2 diabetes mellitus having chronic distal symmetrical sensorimotor neuropathy. A 63-year-old male with type 2 diabetes mellitus diagnosed with chronic symmetrical sensorimotor diabetic peripheral neuropathy on the basis of medical examination and electrophysiological testing. Altered mechanosensitivity of the tibial nerve was confirmed through neurodynamic testing. MR-DTI revealed severe damage of the tibial nerve as shown by chaotic diffusion of water molecules and damaged microstructural integrity. A total six sessions over 3 weeks including nerve massage in a longitudinal and transverse direction; passive neural mobilization consisting of sliders and tensioners of the tibial nerve; and followed by 15 minutes of continuous transcutaneous electrical nerve stimulation directed along the nerve course. FA and ADC values, pain,neuropathy quality of life and range of motion data were collected pre and post intervention. Analysis revealed clinical improvement in all the outcome measures. This case report identified improvement in radiological MR-DTI outcomes following rehabilitation in a patient with diabetic peripheral neuropathy. [ABSTRACT FROM AUTHOR]

Background: Trigeminal neuralgia is a severe facial pain disorder. Microvascular decompression is first choice surgical treatment of patients with classical TN. There exist few prospective studies with an independent evaluation of efficacy and complications after MVD. Objectives: We aimed to assess outcome and complications after microvascular decompression from our center. Methods: We prospectively recorded clinical characteristics, outcome, and complications from consecutive patients with either classical or idiopathic (only patients with a neurovascular contact) trigeminal neuralgia undergoing microvascular decompression. Neurovascular contact was evaluated by 3.0 Tesla MRI. Patients were assessed before and 3, 6, 12, and 24 months after surgery by independent assessors. Results: Of 115 included patients, 86% had a clinically significant outcome (i.e., BNI I – BNI IIIb). There was a significant association between an excellent surgical outcome and the male sex (OR 4.9 (CI 1.9–12.8), p = 0.001) and neurovascular contact with morphological changes (OR 2.5 (CI 1.1–6.0), p = 0.036). Significantly more women (12/62 = 19%) than men (2/53 = 4%) had a failed outcome, p = 0.019. The most frequent major complications were permanent hearing impairment (10%), permanent severe hypoesthesia (7%), permanent ataxia (7%), and stroke (6%). Most patients (94%) recommend surgery to others. Conclusion: Microvascular decompression is an effective treatment for classical and idiopathic (only patients with a neurovascular contact) trigeminal neuralgia with a high chance of a long-lasting effect. The chance of an excellent outcome was highest in men and in patients with classical trigeminal neuralgia. Complications are relatively frequent warranting thorough patient evaluation and information preoperatively. Trial registration: Clinical.trials.gov registration no. NCT04445766. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to evaluate the change patterns of leg numbness (LN) after lumbar decompression surgery (LDS), and to find the predictive factors that affect the recovery of numbness.Methods: Patients who underwent LDS in our institution between August 2020 and July 2021 were prospectively enrolled in this study, and were followed by a 12-month follow-up. The degree of LN, leg pain (LP) and the disability were assessed using the visual analog scale (VAS) and oswestry disability index (ODI).Results: A total of 314 patients finished the 12-month follow-up. The preoperative mean VAS-LN score was 3.49 ± 2.44, which decreased to 1.91 ± 1.30 at 3 months, to 1.29 ± 0.97 at 6 months and to 1.26 ± 0.96 at 12 months after surgery. The preoperative mean VAS-LP score was 6.05 ± 1.30, which decreased to 2.00 ± 0.86 at 3 months, to 1.02 ± 0.80 at 6 months, and to 0.49 ± 0.71 at 12 months after surgery. The preoperative mean ODI score was 27.90 ± 7.08, which decreased to 9.73 ± 3.09 at 3 months, to 6.72 ± 2.98 at 6 months, and to 4.57 ± 2.76 at 12 months after surgery. Via multivariate logistic regression analysis, only preoperative VAS-LN score (p < 0.001*) was identified as a significantly independent predictive factor for residual LN after operation.Conclusion: Clinically significant improvement in LN was observed in the majority of patients within 6 months after LDS, and the improvement of VAS-LN was slower than the VAS-LP. High pre-operative VAS-LN score can independently predict the presence of residual LN after surgery at 12-month follow up. [ABSTRACT FROM AUTHOR]

Background: Whether lumbar decompression with fusion surgery is effective against Meyerding grade 2 degenerative spondylolisthesis (DS) is unknown. Therefore, the current study aimed to compare the surgical outcomes between posterior decompression alone and posterior decompression with fusion surgery among patients with grade 2 DS with central canal stenosis.Methods: This retrospective cohort study included prospectively registered patients (n = 3863) who underwent surgery for degenerative lumbar spinal canal stenosis at nine high-volume spine centers from April 2017 to July 2019. Patients with grade 2 DS and central canal stenosis were included in the analysis. Patients with radiculopathy, including foraminal stenosis, degenerative scoliosis, and concomitant anterior spinal fusion, and those with a previous history of lumbar surgery were excluded. The participants were divided into the decompression alone group (group D) and decompression with fusion surgery group (group F). Data about patient-reported outcomes, including Numeric Rating Scale (low back pain, leg pain, leg numbness, and foot numbness), Oswestry Disability Index, EuroQol Five-Dimensional questionnaire, and 12-Item Short-Form Health Survey scores, were obtained preoperatively and 2 years postoperatively.Results: In total, 2354 (61%) patients, including 42 (1.8%) with grade 2 DS (n = 18 in group D and n = 24 in group F), completed the 2-year follow-up. Group D had a higher proportion of female patients than group F. However, the two groups did not significantly differ in terms of other baseline demographic characteristics. Group D had a significantly shorter surgical time and lower volume of intraoperative blood loss than group F. Postoperative patient-reported outcomes did not significantly differ between the two groups, although the preoperative degree of low back pain was higher in group F than in group D. The slip degree of group D did not worsen during the follow-up period.Conclusion: The surgical outcomes were similar regardless of the addition of fusion surgery among patients with grade 2 DS. Decompression alone was superior to decompression with fusion surgery as it was associated with a lower volume of intraoperative blood loss and shorter surgical time. [ABSTRACT FROM AUTHOR]

Objective: This paper describes the content and multi‐method evaluation of a compassion‐focused cognitive behavioural psychotherapy (CBT) group for people who self‐harm/injure. Method: Quantitative questionnaires and a qualitative focus group were used for the three participants. Reflective diary contents were analysed. Results: Descriptive statistics were used to analyse the questionnaires. These demonstrated positive reductions in the GAD‐7 and PHQ‐9 scores but no significant change in self‐compassion scores. The Cognitions of Self‐Injurious Behaviour Scale demonstrated some positive belief changes. Participants reported improved self‐awareness, alternative coping and improved emotional regulation. All participants reported anger, anxiety and sadness in their diaries; one reported self‐hatred, and another reported feeling dead and numb. Distraction was considered a useful strategy to avoid or delay self‐harm. Interpretative Phenomenological Analysis (IPA) was used and identified six superordinate themes: 'The secret's out! Openness & Honesty', 'Care without fear: calm acceptance', 'Skills not Spills', 'We're all in it together', 'Compassion, not competition nor comparison' and 'Fear of flying solo'. Conclusion: Despite the small number of participants, the combination of compassion‐focused therapy and CBT appears to hold future promise for further research on effectiveness. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cervical radiculopathy is characterized by pain, numbness, tingling, and weakness, mostly in an affected extremity, reflecting compression of a nerve in the neck is compressed or irritated where it emerges from the spinal cord. Diagnosis requires a detailed anamnesis, physical examination, and imaging. Physical therapy, exercise, medical therapy, and injections are the preferred treatments, but injections into the cervical region are only indicated if conservative treatment is ineffective. OBJECTIVE: This study explored the utility of selective cervical nerve root blocks (SNRBs) performed at various levels under ultrasound guidance (USG). METHODS: We evaluated patients diagnosed with cervical radiculopathy via physical examination and magnetic resonance imaging from November 2019 to March 2020. We included those who did not respond to conservative treatment and therefore received SNRBs at various levels. Sixty-three patients were evaluated over 6 months in terms of pain, functional status, and complications. RESULTS: We retrospectively evaluated patients with cervical herniated discs who received SNRBs at various levels between C4–7 under USG. Pain and functional status improved in month 1 and was maintained until at least month 6. CONCLUSION: SNRB injections performed under USG effectively treated pain and poor functional status in selected patients. The procedure is safe (especially) for patients who do not respond to conservative treatment. [ABSTRACT FROM AUTHOR]

Background: Microvascular decompression (MVD) of the trigeminal nerve is a well-accepted nondestructive procedure for trigeminal neuralgia. Usually, Teflon (PTFE) puff or felt graft techniques, which are most commonly used, are associated with arachnoiditis and recurrence among other complications. We use the "sleeve graft" technique using PTFE to separate the neurovascular conflict and here we describe our experience with the same in 376 cases.Objectives: To study the outcomes in 376 patients treated with sleeve graft technique for trigeminal neuralgia.Materials and Methods: For a period of 18 years, from 2002 to 2020, all cases of medically refractory trigeminal neuralgia were subjected to the "sleeve graft" technique for MVD. Pre- and post-operatively, pain score was given according to Barrow Neurological Institute pain intensity score. Cases were observed for any complications and pain relief in short and long-term follow-up.Results: In total, 376 cases of refractory primary trigeminal neuralgia cases, among which 198 patients underwent MVD with no prior intervention, 158 underwent MVD following percutaneous ablative procedure, 13 were "Revision MVD" previously done at other centers, and four were post gamma knife failure. There was no incidence of arachnoiditis or recurrence of symptoms. Further, 368 (97.8%) patients had complete recovery from symptoms while eight (2.2%) had partial recovery after 5 years of follow-up. Complications included hearing loss (n = 1), temporary hypoesthesia (n = 45), and permanent hypoesthesia (n = 7).Conclusion: "PTFE Sleeve Graft" technique to remove the neurovascular conflict in micro vascular decompression (MVD) for trigeminal neuralgia is a safe and effective technique that yields better results. [ABSTRACT FROM AUTHOR]

May-Thurner syndrome (MTS) is a known structural risk factor for deep vein thrombosis (DVT) and embolism. In patients with a patent foramen ovale (PFO), emboli originating from the deep veins are able to paradoxically reach the systemic circulation via the PFO, consequently resulting in transient ischemic attacks (TIA) or stroke. We report the case of a 31-year-old pregnant woman, with a recent history of TIA, who presented with chronic bilateral numbness, pain, and swelling in the lower extremities. On imaging, she was found to have a PFO and MTS. Her pregnancy was subsequently terminated. This decision was made independently by the patient. Her care team did not advise her to terminate her pregnancy as there was no specific medical reason to do so. However, the patient was in significant physical pain and distress and ultimately was not comfortable continuing with the pregnancy. This highlights the complex, multifactorial decision-making process that pregnant patients with comorbid health conditions undertake. The patient then underwent transcatheter PFO closure and stents were placed bilaterally in the left and right common iliac veins. Following the stent procedure, lower extremity symptoms swiftly resolved, allowing the patient to significantly improve her ability to ambulate. There have been no signs of TIA since her procedures, and her venous symptoms have been stable. In patients with TIA or stroke from a paradoxical embolism, MTS should be considered as a potential etiology. Endovascular intervention to treat the underlying MTS should also be considered to decrease the risk of recurrent DVT and embolism. [ABSTRACT FROM AUTHOR]

Purpose: Controversies regarding venous compression and trigeminal neuralgia (TN) still exist. The study demonstrates our experience for microvascular decompression (MVD) in TN caused by purely venous compression. The goal was to identify prognostic anatomical or surgical factors that may influence the outcome. Methods: Between 2004 and 2020, 49 patients were operated with purely venous compression. Average age was 58.4 years. Mean history of TN was 7.8 years. Microsurgical procedures included transposition or separation of the vein, coagulation, and division. Several features have been analyzed with respect to BNI scores. Results: Evaluation on discharge revealed a complete pain relief in 39 (80%), partial improvement in 7 (14%), and no benefit in 3 (6%) patients. Facial hypesthesia was reported by 14 (28.6%) patients. Mean follow-up (FU) was 42.1 months. BNI pain intensity score on FU revealed 71.4% excellent to very good scores (score 1: 32 (65.3%); 2: 3 (6.1%)). BNI facial numbness score 2 could be detected in 13 patients (26.5%) during FU. There was no statistical relationship between immediate pain improvement or BNI pain intensity score on FU with respect to surgical procedure, size of trigeminal cistern, type of venous compression, venous caliber, trigeminal nerve indentation, or neurovascular adherence. BNI facial numbness score was dependent on type of venous compression (p < 0.05). Conclusion: We did not find typical anatomical features that could either predict or influence the outcome regarding pain improvement or resolution in any form. Neither classic microvascular decompression (interposition/transposition) nor sacrificing the offending vein made any difference in outcome. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive adrenalectomy is the standard of care for small adrenal tumours. Both the transperitoneal lateral approach and posterior retroperitoneal approach are widely used and have been proven to be safe and effective. However, the prevalence of chronic postsurgical pain has not been specifically investigated in previous studies. The primary goal of this study was to identify the prevalence of chronic postsurgical pain after minimally invasive adrenalectomy. Methods: A cross-sectional study was performed among all consecutive patients who had undergone minimally invasive adrenalectomy in a single university medical centre. The primary outcome was the prevalence of chronic postsurgical pain. Secondary outcomes were the prevalence of localized hypoesthesia, risk factors for the development of chronic postsurgical pain, and the Health-Related Quality of Life. Three questionnaires were used to measure the prevalence and severity of chronic postsurgical pain, hypoesthesia, and Health-Related Quality of Life. Logistic regression analysis was performed to determine risk factors for development of chronic postsurgical pain. Results: Six hundred two patients underwent minimally invasive adrenalectomy between January 2007 and September 2019, of whom 328 signed informed consent. The prevalence of chronic postsurgical pain was 14.9%. In the group of patients with chronic postsurgical pain, 33% reported hypoesthesia as well. Young age was a significant predictor for developing chronic postsurgical pain. The prevalence of localized hypoesthesia was 15.2%. In patients with chronic postsurgical pain, Health-Related Quality of Life was significantly lower, compared to patients without pain. Conclusions: The prevalence of chronic postsurgical pain following minimally invasive adrenalectomy is considerable. Furthermore, the presence of chronic postsurgical pain was correlated with a significant and clinically relevant lower Health-Related Quality of Life. These findings should be included in the preoperative counselling of the patient. In the absence of evidence for effective treatment in established chronic pain, prevention should be the key strategy and topic of future research. [ABSTRACT FROM AUTHOR]

Stroke-related numbness and weakness (SRNW) are resultant symptoms of post-stroke sufferers. Existing research has supported the use of Huangqi Guizhi Wuwu Tang (HGWT) particularly for SRNW; however, their mechanisms of action have not been fully elucidated. Therefore, this study aimed to investigate the mechanisms of action of HGWT components targeting SRNW-related proteins through a computational molecular docking approach. Target proteins associated with SRNW were identified through DrugBank database and Open Targets database. Chemical compounds from each herb of HGWT were identified from the Traditional Chinese Medicine Systems Pharmacology and Analysis Platform (TCMSP). Autodock Vina was utilized and the cut-off criterion applied for protein-ligand complexes was a binding affinity score of ≤ -9.5 kcal/mol; selected protein-ligand complexes were identified using 3D and 2D structural analyses. The protein targets PDE5A and ESR1 have highlighted interactions with compounds (BS040, DZ006, DZ058, DZ118, and HQ066) which are the key molecules in the management of SRNW. PDE5A have bioactivity with the amino acid residues (Val230, Asn252, Gln133 and Thr166) throughout PDE5A-cGMP-PKG pathways which involved reduction in myofilament responsiveness. ESR1 were predicted to be critical active with site residue (Leu346, Glu419 and Leu387) and its proteoglycans pathway involving CD44v3/CD44 that activates rho-associated protein kinase 1 (ROCK1) and ankyrin increasing vascular smooth muscle. In conclusion, HGWT may provide therapeutic benefits through strong interactions between herbal compounds and target proteins of PDE5A and ESR1. Further experimental studies are needed to unequivocally support this result which can be valuable to increase the quality of life of post-stroke patients. Keywords Herbal medicine, Complementary and alternative medicine, Natural product, Post-stroke, Computational analysis [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical treatment options and postoperative complications and discuss this data with the current literature. Study design: One thousand five hundred and ninety-four patients with midface and orbital fractures treated at the Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery of the Goethe University Hospital in Frankfurt (Germany) between 2007 and 2017 were retrospectively reviewed. The patients were evaluated by age, gender, etiology, fracture pattern, defect size, surgical treatment and complications. Results: The average patient age was 46.2 (± 20.8). Most fractures (37.5%) occurred in the age between 16 and 35. Seventy-two percent of patients were male while 28% were female. The most common cause of injury was physical assault (32.0%) followed by falls (30.8%) and traffic accidents (17.0%). The average orbital wall defect size was 297.9 mm2 (± 190.8 mm2). For orbital floor reconstruction polydioxanone sheets (0.15 mm 38.3%, 0.25 mm 36.2%, 0.5 mm 2.8%) were mainly used, followed by titanium meshes (11.5%). Reconstructions with the 0.15 mm polydioxanone sheets showed the least complications (p < 0.01, r = 0.15). Eighteen percent of patients who showed persistent symptoms and post-operative complications: 12.9% suffered from persistent hypoesthesia, 4.4% suffered from post-operative diplopia and 3.9% showed intra-orbital hematoma. Conclusion: Results of the clinical outcome in our patients show that 0.15 mm resorbable polydioxanone sheets leads to significantly less post-operative complications for orbital floor defects even for defects beyond the recommended 200 mm2. [ABSTRACT FROM AUTHOR]

Background: Microvascular decompression (MVD) is the first choice in patients with classic trigeminal neuralgia (TGN) that could not be sufficiently controlled by pharmacological treatment. However, neurovascular conflict (NVC) could not be identified during MVD in all patients. To describe the efficacy and safety of treatment with aneurysm clips in these situations.Methods: A total of 205 patients underwent MVD for classic TGN at our center from January 1, 2015 to December 31, 2019. In patients without identifiable NVC upon dissection of the entire trigeminal nerve root, neurapraxia was performed using a Yasargil temporary titanium aneurysm clip (force: 90 g) for 40 s (or a total of 60 s if the process must be suspended temporarily due to bradycardia or hypertension).Results: A total of 26 patients (median age: 64 years; 15 women) underwent neurapraxia. Five out of the 26 patients received prior MVD but relapsed. Immediate complete pain relief was achieved in all 26 cases. Within a median follow-up of 3 years (range: 1.0-6.0), recurrence was noted in 3 cases (11.5%). Postoperative complications included hemifacial numbness, herpes labialis, masseter weakness; most were transient and dissipated within 3-6 months.Conclusions: Neurapraxia using aneurysm clip is safe and effective in patients with classic TGN but no identifiable NVC during MVD. Whether this method could be developed into a standardizable method needs further investigation. [ABSTRACT FROM AUTHOR]

Objectives To describe the method and clinical efficacy of awake computed tomography (CT)–guided percutaneous balloon compression (PBC) as a treatment for trigeminal neuralgia (TN). Design In this case series, patients with TN were treated with awake CT-guided PBC and followed up for treatment efficacy and complications for 12 months. Setting A single-center study. Subjects A total of 66 patients with medical treatment–refractory TN were recruited for the study. Methods The procedure was performed under moderate sedation. A balloon catheter was inserted through a trocar needle to reach Meckel's cavity under CT guidance. The position and optimal shape of the contrast-filled balloon were confirmed with CT three-dimensional reconstruction. Compression of the trigeminal ganglion was considered complete when the patient notified operators about facial hypoesthesia or the resolution of TN symptoms. All patients were followed up monthly for 12 months to monitor treatment efficacy and complications. Results The average trigeminal ganglion compression time was 272 ± 81 seconds, at which point the patients reported significant facial hypoesthesia compared with the contralateral side or resolution of triggered pain in the affected area. All patients had resolution of TN symptoms for 6 months, with a 1-year recurrence rate of 13%. The overall safety profile was improved with the technique described in this study. Side effects, such as hypoesthesia and mastication weakness, were overall mild and did not impact patients' quality of life. Some complications that historically have been associated with PBC, such as diplopia and keratitis, were not present. Conclusions This new awake CT-guided PBC technique produces better outcomes than the traditional PBC under fluoroscopy guidance and general anesthesia. [ABSTRACT FROM AUTHOR]

We present a novel case of acute invasive fungal rhinosinusitis (AIFRS) following a maxillary molar root canal in a 69-year-old diabetic female, who subsequently developed unilateral vision loss. The patient reported a 1-week history of progressive left facial pain, trismus, and numbness following the procedure. Initial evaluation was unremarkable, but her condition rapidly deteriorated, culminating in complete vision loss in the left eye. Imaging studies revealed opacification of the left-sided sinuses and a rim-enhancing collection in the left pterygopalatine fossa. Surgical debridement confirmed mucormycosis. The therapeutic approach included systemic and retrobulbar amphotericin B administration, along with multiple sinonasal debridements. The patient's poorly controlled diabetes mellitus significantly contributed to the rapid progression of the infection. Retrobulbar amphotericin B injections were effective in managing orbital involvement, thus avoiding the need for exenteration. Early diagnosis and aggressive treatment are paramount in improving outcomes for patients with AIFRS. [ABSTRACT FROM AUTHOR]

Lumbosacral region is the commonest location for a dermal sinus (DS). The DS provides a natural pathway for infections of the deeper tissues such as the meninges or spinal cord, depending on its termination. One of the rarest and serious complications of a DS is an intramedullary spinal cord abscess. One such case has been reported here. A 2-year boy presented with high-grade fever, acute onset flaccid paraplegia and urinary retention. A L5 level DS was noted. Imaging showed a D12-L5 heterogeneously enhancing intradural lesion suggestive of an abscess. Multi-level laminectomy and drainage of abscess with removal of an inclusion epidermoid was performed. Complete recovery of all neurological functions was achieved that remained stable at 60 months follow up. [ABSTRACT FROM AUTHOR]