Citations

Abstract Globe-sparing surgery for orbit-involving sinonasal neoplasms (OISNs) is increasingly an option since the introduction of effective neoadjuvant treatments. Even if vision is preserved, loss of orbital support structures can cause major ocular sequelae. This study analyzed long-term ophthalmic outcomes following globe-sparing maxillectomy (GSM). We retrospectively reviewed all cases of GSM for OISNs with at least 1 year of ophthalmology follow-up at a tertiary care multisite institution from 2005 to 2024. Patient demographics, surgical details, ophthalmic findings, and final oncologic status were recorded. Orbital involvement was graded based on preoperative computed tomography imaging, and outcomes were compared across orbital involvement grades. Thirty-three patients (39% female) were included, with a mean age of 56 ± 18 years and a median follow-up of 2 years (range 1–12 years). Eleven patients (33%) had Grade I, 19 (58%) had Grade II, and 3 (9%) had Grade III involvement. With higher grades of orbital involvement, patients had a higher likelihood of receiving a preoperative ophthalmic exam (p < 0.001) and experiencing preoperative globe malposition (p = 0.015). Patients with higher-grade orbital involvement had a greater frequency of most ophthalmic symptoms postoperatively. Final best visual acuity was 20/40 or better in 82% of Grade I patients and 71% of Grade II/III patients (p = 0.681). GSM for OISNs offers a favorable visual prognosis. Ocular structural and functional impairment were observed at high frequency after surgery, even with lower-grade orbital involvement. Establishing ophthalmic care for all OISN patients is critical to adequately manage ocular sequelae.

Abstract To quantify lateral extension over the optic canal (OC) through endoscopic endonasal approaches (EEAs) and present techniques to maximize lateral extension. On 20 sides of 10 specimens, transplanum EEAs were performed. The OC roof was drilled maximally laterally. The lateral anterior cranial fossa (ACF) dura accessed was marked; its distance from lateral OC was measured at the proximal and distal OC. To enhance lateral drilling, we performed a posteromedial orbital decompression (POD)—removal of the posteromedial lamina papyracea and orbital apex bone—and continued lateral drilling. New lateral limits were marked and measured. At proximal OC, the transplanum approach accessed the full width of ACF dura overlying OC in 55% of sides; POD addition provided access in 100% of sides (p < 0.01). At proximal OC, the transplanum approach provided access to ACF dura an average of 0.7 mm lateral to OC; POD addition provided an average access of 6.0 mm lateral to OC (p < 0.01). At distal OC, the transplanum approach accessed the full width of ACF dura overlying OC in 30% of sides dissected; POD addition afforded access in 100% of sides (p < 0.01). At distal OC, the transplanum approach provided access to ACF dura an average of 1.1 mm medial to OC; adjunct POD provided an average access of 6.4 mm lateral to OC (p < 0.01). A transplanum approach affords inconsistent access to the full width of ACF dura overlying OC; adjunct POD consistently affords access to ACF dura lateral to OC and significantly increases lateral reach.

Background Microsurgery is a critical component of plastic and reconstructive surgery. However, the high cost of training and equipment pose significant barriers, particularly in resource-limited settings. To address this challenge, the Microsurgery and Regenerative Medicine Lab within the Division of Plastic Surgery at the University of Wisconsin developed a low-cost, 3D-printed surgical microscope. This study qualitatively appraised the use of this novel microscope for microsurgery training by surveying surgeons about their experiences using this tool relative to traditional magnification methods. Methods In this prospective, multi-institutional appraisal study, surgical residents, fellows, and attending surgeons with varying microsurgical experience performed a single end-to-end microsurgical anastomosis on chicken thigh femoral arteries using the 3D-printed microscope. Participants then completed a survey assessing ease of use, adequacy for microsurgical training, educational value, and perceived impact on teaching capacity in local and global settings. Results Over 80% of participants reported that performing an end-to-end anastomosis was easier or equivalent using the 3D-printed microscope compared to surgical loupes. All respondents expressed willingness to use the device for microsurgery teaching and practice. Additionally, 91.7% (33/36) believed access to the microscope would enhance microsurgical teaching at their home institutions, and 97.1% (34/35) felt it would improve teaching capacity in globally. Qualitative feedback was overwhelmingly positive, with suggestions primarily related to ergonomics and lighting. Conclusion This study supports that this low-cost, 3D-printed microscope is an effective microsurgical training tool. Ongoing design refinements informed by user feedback may further optimize its role in expanding access to microsurgery education worldwide.

ABSTRACT Background and Aims Autoimmune hepatitis is an immune‐mediated liver disease characterized by chronic inflammation and progressive fibrosis. Tissue‐resident memory T cells mediate organ‐specific immunity, but their role in autoimmune hepatitis remains poorly understood. We characterized tissue‐residency‐associated T‐cell populations and their cytokine profiles, assessed associations with disease severity and determined whether these signatures were reflected in peripheral blood. Methods Paired blood and liver samples were obtained from 19 patients with autoimmune hepatitis. Comparator cohorts included 20 patients with metabolic dysfunction‐associated steatotic liver disease and 20 surgical patients providing non‐inflamed adjacent non‐tumorous liver tissue. Multiparameter flow cytometry assessed tissue‐residency markers, T‐cell differentiation and cytokine production after polyclonal stimulation. Immune phenotypes were correlated with histological and clinical parameters. Results Autoimmune hepatitis was associated with compartment‐specific remodelling of T‐cell differentiation states and intrahepatic enrichment of CD8 + T cells expressing CD69, CD103 and CXCR6 relative to paired blood and comparator liver tissues. Intrahepatic CD8 + T cells exhibited an interferon‐γ‐dominant cytokine profile, whereas CD4 + T cells showed broader interferon‐γ‐, interleukin‐17A‐ and interleukin‐4‐associated responses. Despite the enrichment of tissue‐residency‐associated CD8 + T cells, cytokine‐producing CD8 + T‐cell populations with and without a tissue‐resident memory phenotype contributed comparably to the hepatic T‐cell compartment. Tissue‐residency‐associated phenotypes correlated positively with Ishak fibrosis stage, whereas the frequency of interferon‐γ‐positive intrahepatic CD8 + T cells correlated inversely with fibrosis. Conclusions Autoimmune hepatitis was characterized by intrahepatic accumulation of phenotypically distinct and functionally active CD8 + tissue‐resident memory T cells associated with fibrosis. This immune profile was not reflected in paired blood, indicating compartmentalized hepatic immune remodelling.

Objectives: To characterize the anatomic distribution, surgical management, perioperative outcomes, and early oncologic results of sinonasal glomangiopericytoma (SN-GPC) within a large single-institution cohort. Design: Multi-site, single-institution retrospective cohort study. Setting: Three tertiary care sites of a single academic medical center (Rochester, MN; Phoenix/Scottsdale, AZ; Jacksonville, FL). Participants: Twenty adults (≥18 years) with pathologically confirmed SN-GPC identified between September 2018 and August 2025. Main Outcome Measures: Tumor anatomic subsite, surgical approach, estimated blood loss, margin status, perioperative complications, and recurrence at follow-up. Results: Mean patient age was 66.4 ± 11 years (65% male). Tumors arose predominantly from the nasal cavity (95%), with 65% originating from the posterior-superior nasal septum near the olfactory cleft and 25% from the anterior-superior septum. Hypertension was the most common comorbidity (85%). All 18 definitively treated patients underwent endoscopic endonasal resection without preoperative embolization or conversion to open surgery. Mean estimated blood loss was 72.6 mL. Negative margins were achieved in 83% of cases. One intraoperative cerebrospinal fluid leak occurred and was repaired primarily. At mean follow-up of 18 months, no recurrences were observed regardless of margin status. No patient received adjuvant therapy. Conclusions: SN-GPC demonstrates a strong predilection for the septal olfactory cleft region. Endoscopic resection without preoperative embolization is safe and effective. The indolent behavior of this tumor supports observation as an acceptable strategy for select patients with positive margins at high-risk skull base locations. Keywords: glomangiopericytoma, sinonasal tumor, hemangiopericytoma, endoscopic resection, nasal cavity, skull base, olfactory cleft, mesenchymal tumor, nasal septum

Abstract Gallbladder (GB) cancer is an aggressive biliary malignancy with a silent clinical course, leading to delayed diagnosis and poor outcomes. Early detection and accurate staging are pivotal for guiding management, yet diagnosis remains challenging due to overlapping imaging features with benign pathologies. This review synthesizes the current state-of-the-art imaging modalities, including ultrasound (USG), multiphase computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, and PET/MRI, highlighting their roles in diagnosis, staging, and treatment planning. A systematic USG-based triaging helps in management decision. Algorithmic approach to GB masses and incidental GB polyps is also covered with future directives on artificial intelligence and radiomics.

Abstract Stroke thrombi are heterogeneous; their composition influences their mechanical properties, including stiffness, elasticity, and adhesiveness, which in turn affect their response to therapy. Systemic characterization of the thrombi components could help select therapeutic techniques and anticipate outcomes. We conducted a systematic review and meta-analysis to evaluate associations between thrombi composition and angiographic and functional outcomes in acute ischemic stroke (AIS). Up to May 2025, relevant studies were sourced from four databases: PubMed, Web of Science, Scopus, and Embase. We included cohort studies whose populations are patients with AIS in relation to thrombi composition. Thirty-six studies involving 5,462 patients matched our eligibility criteria. Angiographic success (Thrombolysis in Cerebral Infarction ≥ 2b/3) did not differ significantly between red blood cell (RBC)-rich and fibrin-rich thrombi (risk ratio [RR] 1.02, 95% confidence interval [CI] 0.85–1.22; p = 0.84; I 2 = 63.8%; very low certainty). However, thrombi from patients with good angiographic outcomes had a significantly higher RBC content compared to patients with poor outcomes (mean difference = 7.22%, 95% CI 3.31–11.13; p < 0.001; low certainty). No significant difference was observed between RBC-rich and fibrin-rich thrombi regarding functional independence at 90 days (modified Rankin Scale 0–2) (RR = 1.22, 95% CI 0.73–2.05; p = 0.31; low certainty). While RBC-rich thrombi are associated with more favorable angiographic performance, thrombus composition alone does not predict functional outcomes. Stroke outcomes remain multifactorial, dominated by time to reperfusion, collateral circulation, and baseline severity. Preinterventional assessment of clot composition via imaging or biomarkers may support individualized therapy but should complement, not replace, other prognostic determinants.

Abstract To review key concepts in facial nerve anatomy, physiology, injury mechanisms, and recovery patterns, and to summarize current approaches to classification, evaluation, and management of facial nerve dysfunction following skull base surgery. Narrative review of anatomical, clinical, and evaluative frameworks relevant to facial nerve dysfunction. Academic and clinical contexts involving the assessment and management of facial nerve injury, with emphasis on skull base surgery. Not applicable; this is a literature-based review. Descriptions of facial nerve anatomy and microanatomy; established classification systems for facial nerve injury; mechanisms of injury; patterns of recovery; common clinical presentations of post-surgical facial paralysis; and current grading scales and evaluation protocols. The review synthesizes foundational anatomical principles with contemporary understanding of facial nerve injury and recovery. It outlines the full spectrum of clinical outcomes observed after facial nerve injury, including typical post-surgical paralysis patterns and their natural course. Commonly used facial paralysis grading scales are compared, and standardized evaluation strategies are highlighted to promote consistent assessment across providers. Taken together, the findings provide a comprehensive framework for understanding and evaluating facial nerve dysfunction following skull base surgery. Understanding and treating facial nerve dysfunction requires nuanced knowledge of anatomy, injury mechanisms, recovery trajectories, and standardized evaluation methods. Consolidating these elements offers valuable guidance for skull base surgeons, facial plastic surgeons, and other clinicians caring for patients with facial paralysis, and supports more consistent and informed clinical decision-making.

Abstract The management of diverticular disease has undergone a major evolution over the past two decades, shifting away from episode-count triggers for surgery toward individualized strategies informed by patient-reported outcomes, recurrence risk, and high-quality randomized clinical trials. Pivotal decision analyses and randomized trials have reshaped the surgical treatment landscape, while parallel trials of antibiotic therapy have transformed the nonoperative management of uncomplicated disease. In this study, we provide a comprehensive synthesis of historical perspectives and modern evidence regarding the surgical and nonoperative management of diverticulitis, summarize key randomized trials across the disease spectrum, describe the evolution of operative techniques, and translate these findings into actionable guidance, including a patient-centered decision aid. A structured narrative review of pivotal trials, major guidelines, and multicenter randomized studies were performed, encompassing trials of antibiotic therapy for uncomplicated diverticulitis, laparoscopic lavage for perforated disease, operative strategy for complicated disease, elective resection versus conservative therapy for recurrent or persistent symptoms, and the evolution of minimally invasive and robotic surgical techniques. Trial design, eligibility, interventions, outcomes, and limitations were extracted and synthesized. The traditional “two-episode rule” has been supplanted by individualized, symptom- and quality of life (QoL)-driven decision-making. Routine antibiotic therapy for uncomplicated diverticulitis is not supported by randomized evidence and is now reserved for select patients. Laparoscopic lavage, initially promising for perforated diverticulitis, demonstrates variable outcomes and is now reserved for selected patients with Hinchey III disease; when resection is required, primary anastomosis with diverting ileostomy is increasingly favored over Hartmann's procedure because of markedly higher stoma reversal rates. Randomized trials of elective sigmoid resection show reduced recurrence and improved QoL for patients with persistent symptoms, though not universally across all patient groups, and minimally invasive-particularly robotic-surgical techniques continue to reduce perioperative morbidity. Contemporary management of diverticulitis requires individualized evaluation anchored in patient-reported outcomes, disease phenotype, comorbidity, and shared decision-making. This study synthesizes the current evidence and provides clinic-ready decision aid for patient discussions.