Surgical Techniques Development

Background: inferior mesenteric arteriovenous malformations and fistulas (IMAVMs/IMAVFs) are rare but clinically significant vascular anomalies characterized by abnormal communications between arterial and venous systems, leading to major hemodynamic disturbances. These lesions may be silent or cause disabling and difficult-to-diagnose symptoms such as colonic ischemia, portal hypertension, or even high-output cardiomyopathy. Methods: this narrative review aims to summarize current evidence on the pathophysiology, clinical features, diagnostic methods, and therapeutic management of these rare pathologies, supported by two our clinical cases. Conclusions: due to their rarity, multidisciplinary management and anatomical guided therapy are required for safe and lasting outcomes in patients with IMAVMs and IMAVFs.

Background: Obesity and its accompanying complications have an influence on diurnal rhythm, potentially causing cardiometabolic disease. This study explores how weight loss due to bariatric surgery affects circadian rhythm disruptions measurable through wearable heart rate monitors. Methods: A single-center observational study was performed, in which patients who had undergone primary bariatric surgery 3 years ago with telemonitoring of vital parameters using a wireless accelerometer were eligible to participate. A Wilcoxon signed-rank test was conducted to evaluate the delta of, or amount of change in, circadian patterns between the baseline (before) and post-weight-loss peak, nadir, and peak–nadir heart rates. Results: In this cohort of 69 patients, 70% were female, with a median total weight loss of 31.4% towards a median BMI of 28.4 kg/m². Analysis revealed significant changes in peak–nadir excursions post-weight loss. Peak, nadir, and peak–nadir differences showed a significant reduction in values in the post-weight-loss group. No significant correlations between other clinical endpoints and change in peak–nadir excursion were found in the multivariable regression models. Conclusions: In conclusion, this study reveals significant changes in circadian heart rate patterns before and after weight loss due to metabolic surgery. The results could add to the health benefits of bariatric surgery, as it could lower the incidence of diseases associated with changes in diurnal rhythm due to obesity. However, a clear clinical explanation is lacking, as no correlation with total weight loss nor other variables was substantiated.

Background: Pediatric craniocervical junction (CCJ) anomalies consist of a unique subset of anatomically complex spine conditions. The aims of intervention are to achieve long-term stability, correct existing deformity, and prevent neurological compromise. However, surgery is challenging due to critical neurovascular and musculoskeletal structures in the limited operative space of a young child. Recently, the use of three-dimensional (3D) printed models has been demonstrated to be valuable neurosurgical adjuncts. We therein report the application of a 3D-printed model for a pediatric case with a complex CCJ condition. A systematic review of the related literature is concurrently performed. Case description: A 10-year-old male presented with torticollis associated with neck pain and progressive thoracic kyphosis. Neuroimaging reported an unfused os odontoideum inferior to the basion and anterior half of the C2 vertebral body and anteriorly angulated with the C1 anterior arch. Of note, there was a large vertebral vein coursing over the left C2 lamina that was predominantly draining into the CCJ venous plexus. A radiologically derived 3D model of the patient’s CCJ was printed and used for pre-operative planning, multi-disciplinary team discussion, and detailed counseling with the patient and caregivers. The patient underwent an uneventful C1–C2 posterior screw fixation and has recovered well since. Separately, we observed there is a paucity of publications specific to this topic. Conclusions: As demonstrated, a custom-made 3D model was useful for clinicians work through technical difficulties and improve the perioperative discussion process in an otherwise difficult case.