Holan, Cole

Objective: In order to streamline patient care and optimize outcomes, we have undertaken a protocol for patients with cranial/intracranial tumors whereby coordinated resection and reconstruction are performed in a single stage procedure using a virtually planned craniotomy, guides, and implants. This represents an advanced interdisciplinary approach offering operative efficiency while avoiding many clinical and technical challenges. We present our experience and a 9-patient series using this method. Methods: Patients with cranial/intracranial tumors which would create a defect from extirpation or with inadequate bone following repeated craniotomies were evaluated by neurosurgery and craniofacial surgery teams. A virtual surgical planning (VSP) webinar was attended by both services, where extirpation and reconstruction were simultaneously planned. For resection cases, cranial CT images were superimposed with MRI to register precise tumor location in relation to bone anatomy. The virtually planned craniotomy position was transferred to the operating room with a custom cutting guide registered to the patient’s cranial contours. Finally, immediate reconstruction was performed using a custom 3D polyether ether ketone (PEEK) implant designed to extend precisely to the edges of the guided craniotomy. Results: Nine patients age 29 to 79 years old (mean = 55) underwent coordinated tumor extirpation and cranial reconstruction via our workflow. They were followed for 28 to 65 months (mean = 42.2). There were no intraoperative complications. One patient developed transient blurry vision which resolved. One patient with history of repeated meningioma removal developed recurrence. All patients have healed without long-term complications, and there have been no explants from these procedures. Conclusion: Our single-stage protocol for cranial tumor extirpation and cranial reconstruction, which includes collaborative preoperative consultation and VSP, is versatile and effective. The use of computer-generated cutting guides and custom implants obviates intraoperative improvisation and minimizes reoperation. Ultimately, this interdisciplinary approach improves the esthetic and functional results for patients, representing an advancement in cranial defect reconstruction.

Purpose: To present our approach to zygomatic osteotomy and repositioning using technological aids: virtual surgical planning, custom guides, and implants. Background: The zygomatic complex is highly 3-dimensional, establishing cheek prominence, facial width, and orbital morphology. Functionally, the zygoma supports soft tissues and is vital to mastication. The zygoma may require reconstruction after a variety of congenital or acquired conditions; however, Zygomatic Osteotomy and Repositioning (ZyOaR) is a complex operation with many technical considerations. The advent of virtual surgical planning (VSP) has enhanced efficiency, accuracy, and reproducibility, while permitting utilization of custom-designed guides and implants. There remains a paucity of literature on ZyOaR and its unique challenges. Methods: This case series includes all patients older than 18 years old undergoing ZyOaR with VSP between 2010 and 2024. Demographics and clinical etiology were noted. Outcomes included fidelity to preoperative plan, facial symmetry, mastication defects, and globe malposition. Results: Eight patients age 18 to 60 years old (mean = 38) met inclusion criteria. Three patients had congenital deformities, and 5 were post-traumatic. Follow-up time ranged from 1 to 50 months (mean = 17 months). There were no intraoperative or postoperative complications. No patient had visual changes at latest follow-up. Preoperative VSP plans were compared to postoperative CT scans, showing a high degree of fidelity. All patients underwent secondary reconstructive and/or soft tissue procedures to achieve final results. Conclusions: Zygomatic Osteotomy and Repositioning (ZyOaR) is inherently difficult, and there is a current gap in the literature on its unique technical challenges. We present 8 cases of ZyOaR using VSP for patients with a range of disease etiologies. The procedures were well tolerated and maintained high surgical fidelity. In our experience, keys to optimize ZyOaR include comprehensive analysis of regional bony and soft tissue anatomy, virtual planning with production and use of surgical transfer guides, and custom 3D printed patient-specific implants.

Abstract Goals/Purpose This study aims to examine the sentiment and polarization of social media content regarding transgender care. We seek to quantitatively analyze social media posts related to transgender care using sentiment analysis, assessing the extent of positive or negative bias in online discussions about transgender healthcare. By establishing a baseline understanding of how online misinformation may impact public perceptions of transgender care, we highlight the importance of addressing online extremism in healthcare as a public health concern. This research represents the first large-scale natural language processing (NLP) analysis of online sentiment towards transgender care, utilizing sentiment analysis to minimize bias and provide quantitative insights into the impact of online rhetoric on public perception and patient care. Methods/Technique The lead author mined X for posts that mentioned transgender surgery (TG) and gender affirming surgery (GAS) from January 2018 to December 2023. Two different NLP models then analyzed the posts. The first was a binary model that characterized each post as positive or negative. The latter was an emotion-based model that scored each post about seven emotions – fear, sadness, anger, disgust, neutral, surprise, and joy. Posts were then classified by their highest-scoring emotion. An exponential regression analysis within the Python language was performed to study the trend in annual X post volume related to gender surgery. To determine whether there were statistically significant differences in sentiment between transgender (TG) and gender-affirming surgery (GAS) topics, independent two-sample t-tests were conducted for both positive and negative sentiments for each year within the study period. Results/Complications In total, there were 81,264 posts related to gender surgery included in our analysis. In 2018 there were 2,093 posts, compared to 2023 where there were 40,258 posts – a roughly 20-fold increase in annual post volume. In our exponential regression model, annual post volume demonstrated a strong positive trend R2 = 0.939, p = 0.001, Figure 1). Most of the posts were classified as ‘negative’ (63,192 posts, 78%). Mean scores for both GAS and TG posts trended towards more negative and less positive sentiments over the study period (Figure 2). When comparing annual TG to GAS posts, those that mentioned TG were significantly more negative and less positive in every year studied (p < 0.05). Conclusion Our analysis of social media posts related to gender-affirming surgery (GAS) and transgender (TG) care reveals a significant increase in online discourse over the past five years. The volume of posts grew exponentially from 2,093 in 2018 to 40,258 in 2023, representing a 20-fold increase. This rise in online discussion reflects the growing public interest and controversy surrounding transgender healthcare.The sentiment analysis revealed a trend toward increasingly negative rhetoric. A substantial majority (78%) of the posts were classified as negative, indicating a prevalence of critical or hostile attitudes towards GAS and TG care on social media platforms. The mean sentiment scores for both GAS and TG-related posts showed a consistent shift toward more negative and less positive sentiments over time. Notably, posts specifically mentioning transgender individuals or issues consistently displayed more negative and less positive sentiments compared to general GAS-related posts across all years studied. This finding suggests that transgender-specific topics are subject to particularly intense scrutiny and criticism online.These results highlight the urgent need for strategies to address misinformation and negative rhetoric surrounding transgender healthcare on social media platforms. The increasing volume and negativity of online discussions may contribute to a hostile environment for transgender individuals seeking care and for healthcare providers offering these services. Future research should focus on developing effective interventions to counter this trend and promote more balanced, informed discussions of transgender healthcare issues online.

Background: Nurtec, a versatile migraine medication, has gained popularity. However, the awareness of migraine surgery remains uncertain. Methods: Following a descriptive approach, this cross-sectional study used Google Trends data as of December 1, 2023, to analyze internet search patterns. Approval from Vanderbilt University’s institutional review board and adherence to Strengthening the Reporting of Observational Studies in Epidemiology guidelines were confirmed. Monthly relative search volume (RSV) data for “migraine surgery,” “Nurtec,” and “Rimegepant” were collected from January 1, 2004, to November 11, 2023, within the United States. Statistical analysis involved determining mean monthly RSV values and percentage changes for critical periods. Results: For “Nurtec,” a significant surge in RSV occurred from March 2020 to April 2020 (344%). Additional peaks were observed from June 2020 to July 2020 (66%), October 2020 to December 2020 (169%), May 2021 to June 2021 (33%), and May 2023 to June 2023 (14%). “Migraine surgery” exhibited a notable 400% increase in RSV, from March 2005 to May 2005. However, post-2006, RSV for “migraine surgery” consistently remained low without noticeable peaks. Conclusions: The analysis of RSV trends for “Nurtec” and “migraine surgery” from 2004 to 2023 reveals the impact of pivotal events and marketing strategies on public interest. The distinct peaks in “Nurtec” RSV align with Food & Drug Administration approvals and marketing campaigns, highlighting the medication’s accessibility. Conversely, the consistently low RSV for “migraine surgery” indicates limited awareness, emphasizing the need for enhanced promotion and education regarding surgical interventions.