Search Results (669)

Background: Little is known about the rate of rib fracture healing after Surgical Stabilization of Rib Fractures (SSRFs). We sought to evaluate the radiographic evidence of rib healing and hypertrophic ossification (HO) in patients after SSRFs. Methods: A single-center retrospective cohort study was conducted on all patients who had undergone SSRFs from 1 January 2010 to 31 March 2023 and had a computed tomography (CT) of the chest performed greater than 6 months after SSRFs. The rib fracture locations were mapped on the initial trauma CT scan and evaluated on the follow-up CT scan for healing and HO formation. Results: A total of 254 SSRF cases were evaluated, 21 patients met the inclusion criteria; out of 208 fractures, 109 underwent SSRFs. The median time to follow-up CT scan was 17(7–88) months. Overall, 95% of the fractures healed completely. Seventy percent of the non-union fractures were in posterior or paraspinal locations on ribs 8–10. HO was noted in nine patients and seen as early as 8 months post-operatively. A significant association was identified between the fixation method used to perform SSRFs (89% vs. 11%, p = 0.024) and operative day (6(0–9) vs. 2(2–5), p = 0.023). Conclusions: Non-union of rib fractures is uncommon after SSRFs. Many of these fractures involve the posterior or paraspinal lower rib cage. HO between fractures is common after SSRFs. Full article

Surgery remains a healthcare intervention with significant risks for patients. Novel technologies can now enhance the peri-operative workflow, with artificial intelligence (AI) and extended reality (XR) to assist with pre-operative planning. This review focuses on innovation in AI, XR and imaging for hepato-biliary surgery planning. The clinical challenges in hepato-biliary surgery arise from heterogeneity of clinical presentations, the need for multiple imaging modalities and highly variable local anatomy. AI-based models have been developed for risk prediction and multi-disciplinary tumor (MDT) board meetings. The future could involve an on-demand and highly accurate AI-powered decision tool for hepato-biliary surgery, assisting the surgeon to make the most informed decision on the treatment plan, conferring the best possible outcome for individual patients. Advances in AI can also be used to automate image interpretation and 3D modelling, enabling fast and accurate 3D reconstructions of patient anatomy. Surgical navigation systems utilizing XR are already in development, showing an early signal towards improved patient outcomes when used for hepato-biliary surgery. Live visualization of hepato-biliary anatomy in the operating theatre is likely to improve operative safety and performance. The technological advances in AI and XR provide new applications in pre-operative planning with potential for patient benefit. Their use in surgical simulation could accelerate learning curves for surgeons in training. Future research must focus on standardization of AI and XR study reporting, robust databases that are ethically and data protection-compliant, and development of inter-disciplinary tools for various healthcare applications and systems. Full article

Background/Objectives: Posterior inferior cerebellar artery (PICA) aneurysms are one of the most difficult cerebrovascular lesions to treat and account for 0.5–3% of all intracranial aneurysms. They have deep anatomical locations, broad-neck configurations, high perforator density, and a close association with the brainstem, which creates considerable technical challenges for either microsurgical or endovascular treatment. Despite its acceptance as the standard of care for most posterior circulation aneurysms, PICA aneurysms are often associated with flow diversion using a coil or flow diversion due to incomplete occlusions, parent vessel compromise and high rate of recurrence. This case aims to describe the utility of microsurgical clipping as a durable and definitive option demonstrating the value of tailored surgical planning, preservation of anatomy and ancillary technologies for protecting a genuine outcome in ruptured PICA aneurysms. Methods: A 66-year-old male was evaluated for an acute subarachnoid hemorrhage from a ruptured and broad-necked fusiform left PICA aneurysm at the vertebra–PICA junction. Endovascular therapy was not an option due to morphology and the center of the recurrence; therefore, a microsurgical approach was essential. A far-lateral craniotomy with a partial C1 laminectomy was carried out for proximal vascular control, with careful dissection of the perforating arteries and precise clip application for the complete exclusion of the aneurysm whilst preserving distal PICA flow. Results: Post-operative imaging demonstrated the complete obliteration of the aneurysm with unchanged cerebrovascular flow dynamics. The patient had progressive neurological recovery with no new cranial nerve deficits or ischemic complications. Long-term follow-up demonstrated stable aneurysm exclusion and full functional independence emphasizing the sustainability of microsurgical intervention in challenging PICA aneurysms. Conclusions: This case intends to highlight the current and evolving role of microsurgical practice for treating posterior circulation aneurysms, particularly at a time when endovascular alternatives are limited by anatomy and hemodynamics. Advances in artificial intelligence cerebral aneurysm rupture prediction, high-resolution vessel wall imaging, robotic-assisted microsurgery and new generation flow-modifying implants have the potential to revolutionize treatment paradigms by embedding precision medicine principles into aneurysm management. While the discipline of cerebrovascular surgery is expanding, it can be combined together with microsurgery, endovascular technologies and computational knowledge to ensure individualized, durable, and minimally invasive treatment options for high-risk PICA aneurysms. Full article

Background/Objectives: This case study presents the first documented use of a low-cost, simulated, patient-specific three-dimensional (3D) printed model to support presurgical planning for an infant with Apert syndrome in a resource-limited setting. The primary objectives are to (1) demonstrate the value of 3D printing as a simulation tool for preoperative planning in low-resource environments and (2) identify opportunities for future AI-enhanced simulation models in craniofacial surgical planning. Methods: High-resolution CT data were segmented using InVesalius 3, with mesh refinement performed in ANSYS SpaceClaim (version 2021). The cranial model was fabricated using fused deposition modeling (FDM) on a Creality Ender-3 printer with Acrylonitrile Butadiene Styrene (ABS) filament. Results: The resulting 3D-printed simulated model enabled the surgical team to assess cranial anatomy, simulate incision placement, and rehearse osteotomies. These steps contributed to a reduction in operative time and fewer complications during surgery. Conclusions: This case demonstrates the value of accessible 3D printing as a simulation tool in surgical planning within low-resource settings. Building on this success, the study highlights potential points for AI integration, such as automated image segmentation and model reconstruction, to increase efficiency and scalability in future 3D-printed simulation models. Full article

Background/Objectives: The inferior thyroid artery (ITA) is an essential component of the thyroid gland’s vasculature, with significant clinical and surgical implications due to its anatomical variability. This systematic review aimed to describe the prevalence of ITA anatomical variants and their association with clinical conditions or surgical implications. Methods: A comprehensive search was conducted in MEDLINE, Web of Science, Google Scholar, CINAHL, Scopus, and EMBASE on 20 November 2025. Eligibility criteria included studies reporting on the presence of ITA variants and their correlation with pathologies. Two authors independently screened the literature, extracted data, and assessed methodological quality using the AQUA and JBI tools. Results: Of the 2647 articles identified, 19 studies involving 1118 subjects/cadavers were included. Variations in ITA origin, absence, and additional arteries were reported, with the most common variant being direct origin from the subclavian artery. Clinically, these variations were associated with increased risk of intraoperative hemorrhage, potential nerve damage, and challenges in preoperative planning, particularly during thyroidectomy and other neck procedures. Conclusions: Understanding the anatomical diversity of the ITA is crucial for reducing surgical risks and improving patient outcomes. The review highlighted the need for more standardized research protocols and comprehensive data reporting to enhance the quality of evidence in this domain. Preoperative imaging and thorough anatomical assessments tailored to individual patient profiles, considering ethnic and gender-related differences, are essential for safe surgical interventions in the thyroid region. Full article

Background and Objectives: Orbital floor fractures are challenging to treat, due to the complex orbital anatomy and limited surgical access. Emerging technologies—such as virtual surgical planning (VSP), 3D printing, patient-specific implants (PSIs), and intraoperative navigation—offer promising advancements to improve the surgical precision and clinical outcomes. This review systematically evaluates and synthesizes current technological modalities with respect to their accuracy, operative duration, cost-effectiveness, and postoperative functional outcomes. Materials and Methods: A systematic review was conducted according to the PRISMA 2020 guidelines. The PubMed, Scopus, and PRIMO databases were searched for clinical studies published between 2019 and September 2024. Out of 229 articles identified, 9 met the inclusion criteria and were analyzed using the PICO framework. Results: VSP and 3D printing enhanced diagnostics and presurgical planning, offering improved accuracy and reduced planning time. Pre-bent PSIs shaped on 3D models showed superior accuracy, lower operative times, and better cost efficiency compared to intraoperative mesh shaping. Custom-designed PSIs offered high precision and clinical benefit but required a longer production time. Intraoperative navigation improved implant positioning and reduced the complication rates, though a detailed cost analysis remains limited. Conclusions: VSP, 3D printing, and intraoperative navigation significantly improve surgical planning and outcomes in orbital floor reconstruction. Pre-bent PSIs provide a time- and cost-effective solution with strong clinical performance. While customized PSIs offer accuracy, they are less practical in time-sensitive settings. Navigation systems are promising tools that enhance outcomes and may serve as an alternative to custom implants when time or resources are limited. Full article

Osteosarcoma is one of the most common primary bone malignancies, typically occurring around the knee. However, the forearm is a rare site, with tumors in the proximal ulna being extremely uncommon. Primary sarcoma in this location presents a surgical challenge due to the complex anatomy and limited reconstructive options. We report a rare case of a 19-year-old female with non-metastatic, high-grade giant cell-rich osteosarcoma involving the right proximal ulna. To our knowledge, this is only the second reported adult case of this histological subtype in this location. The patient was treated at a specialized oncology center with neoadjuvant and adjuvant chemotherapy, along with wide intra-articular resection for local tumor control. Reconstruction was achieved using a novel, customized 3D-printed articulating cement spacer mold with plate osteosynthesis. Artificial elbow ligamentous reconstruction was performed using FiberTape and FiberWire sutures passed through drill holes, and the triceps tendon was reattached to the cement mold using an endobutton. This cost-effective and personalized surgical approach allowed successful joint reconstruction while maintaining elbow stability and function. Our case highlights a feasible reconstructive option for rare and anatomically challenging osteosarcoma presentations, contributing to the limited literature on proximal ulna giant cell-rich osteosarcoma. Full article

Background/Objectives: Currently, the transfemoral approach is recognized as the primary method for accessing transcatheter aortic valve implantation (TAVI). However, alternative techniques are needed when the transfemoral access is not suitable. We proposed that a modified transaxillary approach through the distal left axillary artery is both viable and safe for conducting TAVI, potentially offering benefits for patients. Methods: From December 2018 to February 2024, a total of 24 patients (7 women, average age 77.9 ± 8 years) received TAVI using transaxillary access via the left axillary artery. The participants suffered from symptomatic severe aortic stenosis and were deemed TAVI candidates with iliofemoral anatomy unsuitable for a transfemoral route. The patient group displayed a high perioperative risk profile, with significant peripheral artery disease or severe obstructive infrarenal aortic conditions. The implantation of the aortic prosthesis was carried out through the left distal axillary artery. A balloon-expandable valve was used in every instance. Results: In the examined cohort, the 30-day mortality rate was 4.2%. A new pacemaker was necessary for four patients (16.7%). One case exhibited a new moderate neurological dysfunction. Additionally, one patient required surgical revision of the access point due to ischemia. Conclusions: Our findings indicate that transaxillary TAVI via the distal left axillary artery has yielded encouraging outcomes. This approach is practicable and safe, does not prolong the procedure, minimizes surgical trauma, ensures excellent access regardless of chest anatomy, and is sparing for the brachial plexus. As a single-center pilot study, our findings require confirmation in larger, prospective cohorts with extended follow-up to fully validate the safety and long-term efficacy of this technique. Full article

Background: The transapical off-pump NeoChord procedure is a recognized minimally invasive surgical approach for the treatment of severe degenerative mitral regurgitation. This study aims to report the initial Greek experience with the NeoChord procedure, presenting mid-term clinical and echocardiographic outcomes from a single cardiothoracic surgical center, with a median follow-up duration of 20 months. Methods: In this study, 42 symptomatic patients with moderate to severe and severe primary mitral regurgitation underwent mitral valve repair with the Neochord procedure between March 2018 and December 2024. All patients were evaluated clinically and echocardiographically by the Heart team preoperatively, after 1 month, and at the last follow-up (end of 2024). The primary endpoint was established as the presence of a major clinical event (all-cause mortality, reintervention due to deterioration of MR, and cardiac-related rehospitalization). Results: The median age of patients was 69 [61.75–79.25] years, and 69% of patients were men. The median EuroScore II was 1.79 [1.32–2.48], and the STS-PROM MV repair score was 3.18 [2.28–4.66]. Regarding the preprocedural mitral valve anatomical evaluation, 35 patients had type A (83.3%),4 had type B(9.5%), whereas only two patients had type C and 1 with type D anatomy. The median of LAI was 1.2 [1.15–1.25], whereas the CI was 4 [2.15–5]. More than two neochordae were implanted in 34 patients (81%). MR severity improved at 1-month (<moderate:92.85%) and at the last follow-up (<moderate:92.1%). NYHA class decreased within 1 month (I + II: 95.23%) after the procedure and was maintained at the last follow-up (I + II: 94.73%). The median left ventricular ejection fraction (LVEF) before the procedure was 63 [58–67]%, which significantly decreased to 57 [53–61]% at the 1-month follow-up (2-sided p < 0.001). At the final follow-up, LVEF increased to 65 [60–68]%, however, this change was not statistically significant compared to the preprocedural value. During the follow-up period, four deaths were documented—three due to non-cardiac and one attributable to a cardiac cause. Two cases proceeded to reoperation for surgical valve implantation due to recurrent mitral valve regurgitation 6 months and 8 months after the NeoChord procedure. Conclusions: Transapical off-pump NeoChord implantation offers a minimally invasive alternative to conventional surgery for symptomatic patients with moderate-to-severe or severe primary mitral regurgitation. Among patients with suitable mitral valve anatomy, the procedure has demonstrated a favorable safety profile and promising mid-term outcomes, in terms of cardiac mortality, as well as freedom from reoperation and rehospitalization. Full article

The increasing interest in tricuspid regurgitation (TR) is due to the deep link between mortality and the severity of TR, as well as the limited application of surgical solutions in a setting marked by high in-hospital mortality, attributed to the late presentation of the disease. This delay in intervention is likely associated with a limited understanding of valvular and ventricular anatomy as well as the pathophysiology of the disease, leading to an underestimation of TR severity. With the rapid development of transcatheter solutions showing early safety and efficacy, there is a growing necessity to accurately understand and diagnose the valvular disease process to determine suitable management strategies. This review will outline the normal and pathological anatomy of the tricuspid valve, classify the anatomical substrates of TR, and present new risk stratification methods to determine the appropriate timing for both medical and surgical treatment. Full article

Background: Minimally invasive surgery (MIS) is increasingly adopted in pediatric surgical practice, yet it demands specific technical skills that require structured training. Simulation-based education offers a safe and effective environment for skill acquisition, especially in complex procedures such as thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA-TEF). Objective: This study aimed to evaluate the effectiveness of a 3D-printed simulator for training pediatric surgeons in thoracoscopic EA-TEF repair, assessing improvements in operative time and technical performance. Methods: A high-fidelity, 3D-printed simulator replicating neonatal thoracic anatomy was developed. Six pediatric surgeons at different training levels performed eight simulation sessions, including fistula ligation and esophageal anastomosis. Operative time and technical skill were assessed using the Stanford Microsurgery and Resident Training (SMaRT) Scale. Results: All participants showed significant improvements. The average operative time decreased from 115.6 ± 3.51 to 90 ± 6.55 min for junior trainees and from 100.5 ± 3.55 to 77.5 ± 4.94 min for senior trainees. The mean SMaRT score increased from 23.8 ± 3.18 to 38.3 ± 3.93. These results demonstrate a clear learning curve and enhanced technical performance after repeated sessions. Conclusions: Such 3D-printed simulation models represent an effective tool for pediatric MIS training. Even within a short time frame, repeated practice significantly improves surgical proficiency, supporting their integration into pediatric surgical curricula as an ethical, safe, and efficient educational strategy. Full article

Non-surgical periodontal therapy (NSPT) represents the gold standard in the treatment of periodontitis, but deep periodontal pockets and complex anatomies may reduce its efficacy. Therefore, in order to enhance NSPT outcomes and reduce the need for surgical intervention, several adjunctive therapies have been proposed. Propolis, a natural substance with antimicrobial, anti-inflammatory, and healing properties, has shown promising results in controlling supragingival biofilm. This narrative review aims to assess the clinical efficacy of propolis as an adjunct to NSPT. A comprehensive search on scientific databases was conducted for randomised clinical trials (RCTs) comparing NSPT with and without propolis, or with other adjuncts or placebos. Probing depth (PD) was the primary outcome. Seven RCTs met the inclusion criteria, using different propolis formulations and application protocols. Statistically significant improvements in clinical outcomes were recorded in all analysed studies compared with NSPT alone or placebo, while benefits were less substantial compared with laser therapy and conflicting when compared with chlorhexidine. Thus propolis may be considered a promising adjunctive agent to NSPT, with the potential to improve clinical outcomes of NSPT. Nonetheless, further long-term clinical trials with larger sample size are needed to validate its clinical efficacy and to determine its adverse effects. Full article

Over the last ten years, transcatheter tricuspid valve interventions (TTVIs) have emerged as effective options for symptomatic patients with moderate-to-severe tricuspid regurgitation (TR) who are at prohibitive surgical risk. Successful application of these therapies depends on a patient-tailored, multimodal imaging workflow. Transthoracic and transesophageal echocardiography remain the first-line diagnostic tools, rapidly stratifying TR severity, mechanism, and right ventricular function, and identifying cases requiring further evaluation. Cardiac computed tomography (CT) then provides anatomical detail—quantifying tricuspid annular dimension, leaflet tethering, coronary artery course, and venous access anatomy—to refine candidacy and simulate optimal device sizing and implantation angles. In patients with suboptimal echocardiographic windows or equivocal functional data, cardiovascular magnetic resonance (CMR) offers gold-standard quantification of RV volumes, ejection fraction, regurgitant volume, and tissue characterization to detect fibrosis. Integration of echo-derived parameters, CT anatomical notes, and CMR functional assessment enables the heart team to better select patients, plan procedures, and determine the optimal timing, thereby maximizing procedural success and minimizing complications. This review describes the current strengths, limitations, and future directions of multimodality imaging in comprehensive evaluations of TTVI candidates. Full article

Aortic stenosis is the most prevalent valvular disease globally. Transcatheter aortic valve replacement (TAVR) has become a well-established treatment for aortic stenosis, offering outcomes comparable to surgical aortic valve replacement (SAVR). Its use has expanded to include younger, lower-risk patients and those with more complex anatomies. Recent advancements in TAVR include the increased adoption of transfemoral access, prosthesis designs optimized for challenging anatomies, enhanced delivery systems with repositioning capabilities, and outer skirts to minimize paravalvular leaks. Despite these innovations, several challenges remain. This review highlights recent updates in transcatheter heart valve (THV) systems, leaflet modification devices, and the current limitations of TAVR. Full article

Mitral regurgitation (MR) is a common valvular heart disease associated with significant morbidity and mortality. For patients at high or prohibitive surgical risk, mitral transcatheter edge-to-edge repair (M-TEER) offers a less invasive alternative to surgery. This review outlines key aspects of patient selection and procedural planning for M-TEER, with a focus on clinical and echocardiographic criteria essential for success. Comprehensive imaging—especially 2D and 3D transesophageal echocardiography—is critical to assess leaflet anatomy, coaptation geometry, and mitral valve area. Selection criteria differ between primary and secondary MR and are guided by trials such as COAPT and MITRA-FR. Optimal outcomes rely on careful screening, anatomical suitability, and multidisciplinary evaluation. With growing experience and advancing technology, M-TEER has become a transformative option for treating severe MR in non-surgical candidates. Full article