Evaluation and Treatment of Lumbar Spine Extradural Cysts: A Narrative Review.

The main objective was to describe the different types and characteristics of lumbar spine extradural cysts and their optimal treatment options with a focus on endoscopic technique. We searched Pubmed, EMBASE, Medline, and Google Scholar for articles published between 1967 and 2020 using the keywords "Spinal Cyst," "Extradural Cyst," and "Lumbar Cyst." The various anatomical and histological types of the extradural cysts with their presentations, etiologies, imaging, and optimal treatment with a focus on endoscopic techniques were reviewed from the articles. Lumbar spinal cysts are relatively rare pathologies that might cause radicular symptoms similar to lumbar disc herniation. Spinal extradural cysts are classified either histologically based on the cyst lining tissues (synovial cysts or non-synovial, ganglion cysts) or anatomically based on the structure of origin (epidural cysts, ligamentum flavum cysts, discal cysts, post-discectomy pseudocysts, posterior longitudinal ligament cysts, facet cysts). Surgical excision is the recommended treatment of symptomatic cysts with endoscopic techniques being a viable option. Extradural lumbar cysts can be identified based on their histological structure or depending on their structure of origin. Regardless of their classification, they could all give similar clinical findings, and the optimal treatment would be surgical excision with endoscopic technique being a viable option with a satisfactory outcome.

A new classification of left apicoposterior segmental bronchus and its clinical significance / 中国胸心血管外科临床杂志

@#Objective    To analyze a new classification of the left apicoposterior segmental bronchus and summarize its clinical significance. Methods     We accessed the computed tomography imaging data of the inpatients treated in the Department of Thoracic Surgery, Henan Provincial People's Hospital between January and November 2021. We observed and classified the branching pattern of the left apicoposterior segmental bronchus (B1+2) using three-dimensional computed tomography bronchography and angiography (3D-CTBA) technique. And we filtered out the patients who underwent thoracoscopic left apicoposterior segmentectomy and analyzed their clinical data retrospectively to summarize the instructing significance of different bronchial classification in the accurate and safe operation of left apicoposterior segmentectomy. Results     Finally 240 patients were collected, including 131 males and 109 females with a median age of 51.0 (19.0-77.0) years. The anatomical pattern of the left apicoposterior segmental bronchus was divided into four main types based on the branching pattern of the outer subsegmental bronchi (B1+2c): type Ⅰ 10% (24 patients), type Ⅱ 54% (130 patients) , type Ⅲ 17% (40 patients) , type Ⅳ 18% (43 patients) and other variations 1% (3 patients). Thirty-two patients smoothly underwent thoracoscopic left apicoposterior segmentectomy, including 23 patients of type Ⅰ and type Ⅱ receiving LS1+2 resection, the other 9 patients of type Ⅲ and type Ⅳ receiving LS1+2 resection (3 patients), LS1+2c resection (4 patients) and LS1+2(a+b) resection (2 patients). Conclusion     This new classification systematically and concisely elucidates the branching characteristics of the left apicoposterior bronchus. Different branching types are instructive to the left apicoposterior segmentectomy.

Clinical and Radiological Results after Endoscopic Treatment for Gluteal Tendon Injuries with a Minimum Follow-Up of 12 Months.

Objectives: The study aimed to evaluate the clinical and radiological results after endoscopic repair of gluteus medius muscle injuries and proposed an anatomical classification for the different injury classes. Methods: A retrospective case series, including patients who had undergone endoscopic repair of the hip abductor tendon. The surgical procedure was standardized. Magnetic resonance imaging (MRI) studies were analyzed, and the injuries were classified into three types: nontransfixing partial-extension (nTPE) tear, transfixing partial-extension (TPE) tear, and transfixing full-extension (TFE) tear. TPE and TFE were considered high-grade tears. The postoperative outcomes were as follows: duration of walking aid requirement, duration of physical therapy, time to return to daily activities, modified Harris Hip score (mHHS) and Nonarthritic Hip Score (NAHS) functional scores, pain visual analog scale (VAS), satisfaction, claudication, Trendelenburg test, and reoperation. Results: Sixteen patients were included (94% women; mean age 65 years), with a mean follow-up of 42 months (12-131, range). Out of the cases with preoperative exams available for analysis, four cases (31%) were nTPE, three (23%) TPE, and six (46%) TFE tears. Thus, 69% of the patients had high-grade injuries. These patients had a higher degree of fat infiltration (P = 0.034), but this was not correlated with inferior postoperative clinical or radiological results. One patient required reoperation due to a recurrent injury. Conclusion: Isolated extra-articular injuries to the tendons of the gluteus medius and minimus evolved satisfactorily after endoscopic repair. Due to the small number of cases, it was not possible to observe differences in outcomes between high-and low-grade injuries.

Vieussens' Arterial Ring: Historical Background, Medical Review and Novel Anatomical Classification.

In coronary artery disease, the presence of Vieussens' arterial ring (VAR), a ring-shaped anastomosis between the conus branch of the right coronary artery with the left anterior descending artery (LAD), will allow blood flow to return to the obstructed coronary system. We have conducted a literature review, aiming to collect all the existing information about the documented VAR cases and any related pathological conditions. A total of 54 studies entered the review, including 56 patients. The mean age of the patients was 56.12 ± 16.2 years. Angina was present in 53.6% of the patients, with 7.2% of the cases being asymptomatic. Coronary artery disease outweighed (58.9%) as the patients' most frequent diagnosis. We propose a novel VAR anatomical classification, based on the sites of origin and termination of its course, with six distinct types, for a better understanding and surgical management of VAR. Type IA, originating from the conus branch and terminating in the proximal segment of the LAD was most frequently reported (51.8%). The recognition and the subsequent evaluation of the ring's anatomy and course are crucial for a customized clinical intervention. When right and left coronary angiographies fail to reveal any collateral circulation, selective conus artery catheterization should be in order. The proposed classification offers a manageable and comprehensive context for the assessment, evaluation and planning of therapeutic strategies of VAR and sets a new terminology frame for treatment guidelines.

Outcomes of surgery for coarctation of the aorta based on a new classification system.

OBJECTIVES: To evaluate early- and long-term outcomes of the surgical treatment for coarctation of the aorta based on a new classification system. METHODS: A retrospective clinical review of 111 patients with coarctation of the aorta who underwent surgery (March 2011 to August 2020) was performed. We categorised coarctation of the aorta into type I, with all three head vessels tightly packed; type II, with the left subclavian artery separated from the two other head vessels; and type III, with all three head vessels separated from one another. Each type included subtype a, with a short isthmic portion, and subtype b, with a long isthmic portion. RESULTS: The median patient age and weight at operation were 8 (range, 1-1490) days and 3.2 (range, 1.9-18.5) kg, respectively. Extended end-to-end anastomosis was performed via sternotomy in 54, via thoracotomy in 12, end-to-side anastomosis in 31, autologous main pulmonary artery patch augmentation in 12, and modified end-to-end anastomosis combined with subclavian artery flap aortoplasty in two patients. There was one (0.9%) case of early mortality and 12 (10.8%) cases of post-operative complications. Two (1.8%) late deaths occurred during follow-up. Five (4.5%) patients underwent balloon dilatation and three (2.7%) underwent reoperation for restenosis of coarctation of the aorta. All patients with type Ia (21 patients, 18.9%) underwent extended end-to-end anastomosis via sternotomy or thoracotomy. CONCLUSIONS: According to the early and late outcomes observed in this study, surgical treatment of coarctation of the aorta using the new classification system could be safe and low risk.

[Automatic anatomical site recognition of laryngoscopic images using convolutional neural network].

Objective:To explore the automatic recognition and classification of 20 anatomical sites in laryngoscopy by an artificial intelligence（AI） quality control system using convolutional neural network（CNN）. Methods: Laryngoscopic image data archived from laryngoscopy examinations at the Department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences from January to December 2018 were collected retrospectively, and a CNN model was constructed using Inception-ResNet-V2+SENet. Using 14000 electronic laryngoscope images as the training set, these images were classified into 20 specific anatomical sites including the whole head and neck, and their performance was tested by 2000 laryngoscope images and 10 laryngoscope videos. Results:The average time of the trained CNN model for recognition of each laryngoscopic image was（20.59 ± 1.55） ms, and the overall accuracy of recognition of 20 anatomical sites in laryngoscopic images was 97.75%（1955/2000）, with average sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 99.88%, 97.76%, and 99.88%, respectively. The model had an accuracy of ≥ 99% for the identification of 20 anatomical sites in laryngoscopic videos. Conclusion:This study confirms that the CNN-based AI system can perform accurate and fast classification and identification of anatomical sites in laryngoscopic pictures and videos, which can be used for quality control of photo documentation in laryngoscopy and shows potential application in monitoring the performance of laryngoscopy.

Poor inter-observer agreement in anatomical classifications of infrapopliteal arterial disease due to mandatory selection of only one target artery.

BACKGROUND: Established anatomical classifications of infrapopliteal arterial lesion severity are based on assessment of only one target artery, not including all infrapopliteal arteries although multivessel revascularization is common. PURPOSE: To investigate the reproducibility of one of these classifications and a new aggregated score. MATERIAL AND METHODS: A total of 68 patients undergoing endovascular infrapopliteal revascularization at Sahlgrenska University Hospital during 2008-2016 were included. Preoperative magnetic resonance angiographies (MRA) and digital subtraction angiographies (DSA) were evaluated by three blinded observers in random order, using the infrapopliteal TransAtlantic Inter-Society Consensus (TASC) II classification. An aggregated score, the Infrapopliteal Total Atherosclerotic Burden (I-TAB) score, including all infrapopliteal arteries, was constructed and used for comparison. RESULTS: Inter-observer agreement on lesion severity for each evaluated artery was good; Krippendorff's α for MRA 0.64-0.79 and DSA 0.66-0.84. Inter-observer agreement on TASC II grade, based on the selected target artery as stipulated, was poor; Krippendorff's α 0.14 (95% confidence interval [CI]=-0.05 to 0.30) for MRA and 0.48 (95% CI=0.33-0.61) for DSA. Inter-observer agreement for the new I-TAB score was good; Krippendorff's α 0.76 (95% CI=0.70-0.81) for MRA and 0.79 (95% CI=0.74-0.84) for DSA. CONCLUSION: Reproducible assessment of infrapopliteal lesion severity can be achieved for separate arteries with both MRA and DSA using the TASC II definitions. However, poor inter-observer agreement in selecting the target artery results in low reproducibility of the overall infrapopliteal TASC II grade. An aggregated score, such as I-TAB, results in less variability and may provide a more robust evaluation tool of atherosclerotic disease severity.

A Case of Thoraco-Omphalopagus Conjoined Twins: Clinical Imaging and Anatomical Classification.

Conjoined twins are a rare phenomenon estimated to occur in a range between 1 in 49,000 births and 1 in 189,000 births. As a product of monochorionic-monoamniotic pregnancies, they are currently believed to result from late, incomplete fission of the bilaminar embryonic disk at 13-15 days gestation. Conjoined twins are typically classified by the point at which their bodies are joined, with 15 recognized types, five of which account for more than 70% of cases. Fusion of the thorax and upper abdomen (thoraco-omphalopagus) accounts for 28% of all cases. Mortality and morbidity rates remain high irrespective of the point of fusion, with 40-60% of cases being lost to miscarriage and stillbirth, and only about 18% of live births surviving more than 24 hours. Given this prognosis, knowledge of underlying anatomy and clinical imaging is paramount to antenatal diagnosis, assessment of viability, and subsequent management of conjoined twins. A case of thoraco-omphalopagus twins with a single heart and single liver discovered on routine ultrasound at 12 weeks gestation is described.

Preliminary Exploration of a New Clitoral Hood Classification System and Treatment Strategy.

BACKGROUND: Increasing attention has been given to clitoral hoods in recent years, but few studies have been conducted on the classification and treatment strategies of clitoral hood hypertrophy. The purpose of this article is to introduce a new system of clitoral hood classification based on relevant anatomy and make recommendations for clitoral hood reduction. METHODS: The clitoral hood region is divided into the central zone (zone C) and the lateral zone (zone L). According to the anatomical characteristics of each zone, patients can be divided into 5 types: standard form, central hypertrophy, lateral hypertrophy, composite hypertrophy and special type. Central hypertrophy is further divided into wide and long clitoral hoods, and horizontal and vertical redundancy are addressed using bilateral clitoral hood triangular skin resection and inverted horizontal V-shaped skin resection, respectively. Lateral hypertrophy can be treated with vertically oriented excision. Composite hypertrophy is corrected by combining these methods to remove redundant tissue depending on the situation. RESULTS: 1135 patients were classified according to the new classification system and 789 participants were given corresponding treatment measures. Thirty-four patients (4.3%) experienced complications, and 15 (1.9%) underwent revision surgery. Six months after the procedure, clitoral hood images improved significantly without paresthesia, and the overall satisfaction rate of the patients regarding clitoral hood reduction was 95.7%. CONCLUSIONS: The clitoral prepuce is an important part of the aesthetic unit of female vulva. The new clitoral hood classification strategy systematically summarizes the anatomical characteristics of the clitoral hood and clearly makes recommendations for surgical options. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Improving classification of the external branch of the superior laryngeal nerve with neural monitoring: a research appraisal and narrative review.

OBJECTIVE: To review the published literature on external branch of superior laryngeal nerve (EBSLN) neural monitoring and propose a new EBSLN classification system using intraoperative neural monitoring (IONM). BACKGROUND: The injury rate of the external branch of the superior laryngeal nerve (EBSLN) in thyroid surgery is 0-58%. Symptoms of EBSLN injury are not consistent, and patients often complain of modification of the voice timbre with the preservation of vocal cord function. Standards for the diagnosis of EBSLN injury are lacking. METHODS: The PubMed database was searched using the terms 'External branch of the superior laryngeal nerve' and 'Intraoperative neuromonitoring' from 2010 through March 2020. CONCLUSIONS: This paper reviewed the anatomy of the EBSLN, the diagnosis and treatment of injury, and the application of IONM in the EBSLN. The traditional EBSLN classification method was analyzed and compared with our new classification method. The diagnosis of EBSLN injury is a problem that still needs to be resolved. For anatomic classifications of the EBSLN, we found that the conventional classification systems may not accurately reflect the real status of the EBSLN and the surgical risks that may occur intraoperatively. Using IONM, we developed an EBSLN classification method that was consistent with conventional diagnosis and treatments and can be widely and easily utilized during surgery.

Pediatric multicompartmental trigeminal schwannoma: illustrative case.

BACKGROUND: Trigeminal schwannoma (TS) is an uncommon and histologically benign intracranial lesion that can involve any segment of the fifth cranial nerve. Given its often impressive size at diagnosis and frequent involvement of critical neurovascular structures of the skull base, it represents a challenging entity to treat. Pediatric TS is particularly rare and presents unique challenges. Similarly, tumors with extension into multiple compartments (e.g., middle cranial fossa, posterior cranial fossa, extracranial spaces) are notoriously difficult to treat surgically. Combined or staged surgical approaches are typically required to address them, with radiosurgical treatment as an adjunct. OBSERVATIONS: The authors presented the unusual case of a 9-year-old boy with a large, recurrent multicompartmental TS involving Meckel's cave, the cerebellopontine angle, and the infratemporal fossa. Near-total resection was achieved using a frontotemporal-orbitozygomatic craniotomy with a combined interdural and extradural approach. LESSONS: The case report adds to the current literature on multicompartmental TSs in children and their management. The authors also provided a simplified classification of TS that can be generalized to other skull base tumors. Given a lack of precedent, the authors intended to add to the discussion regarding surgical management of these rare and challenging skull base lesions.

Anatomical classification of upper gastrointestinal organs under various image capture conditions using AlexNet.

BACKGROUND: Machine learning has led to several endoscopic studies about the automated localization of digestive lesions and prediction of cancer invasion depth. Training and validation dataset collection are required for a disease in each digestive organ under a similar image capture condition; this is the first step in system development. This data cleansing task in data collection causes a great burden among experienced endoscopists. Thus, this study classified upper gastrointestinal (GI) organ images obtained via routine esophagogastroduodenoscopy (EGD) into precise anatomical categories using AlexNet. METHOD: In total, 85,246 raw upper GI endoscopic images from 441 patients with gastric cancer were collected retrospectively. The images were manually classified into 14 categories: 0) white-light (WL) stomach with indigo carmine (IC); 1) WL esophagus with iodine; 2) narrow-band (NB) esophagus; 3) NB stomach with IC; 4) NB stomach; 5) WL duodenum; 6) WL esophagus; 7) WL stomach; 8) NB oral-pharynx-larynx; 9) WL oral-pharynx-larynx; 10) WL scaling paper; 11) specimens; 12) WL muscle fibers during endoscopic submucosal dissection (ESD); and 13) others. AlexNet is a deep learning framework and was trained using 49,174 datasets and validated using 36,072 independent datasets. RESULTS: The accuracy rates of the training and validation dataset were 0.993 and 0.965, respectively. CONCLUSIONS: A simple anatomical organ classifier using AlexNet was developed and found to be effective in data cleansing task for collection of EGD images. Moreover, it could be useful to both expert and non-expert endoscopists as well as engineers in retrospectively assessing upper GI images.

[Malignant tumors of the skull base]. / Maligne Tumoren der Schädelbasis.

Malignant skull base tumors consist of a heterogeneous group of malignancies that can be divided into primary and secondary (metastatic) skull base tumors. In addition, according their anatomical location, they can be further divided into tumors of the anterior, middle, or posterior cranial fossa. Although malignant skull base tumors do not rigorously respect anatomical borders, their anatomical occurrence can potentially be helpful for possible differential diagnosis. This article is focused on the most common malignant tumors of the skull base and their imaging and clinical presentations.

A Radiological Study Assessing the Prevalence of Frontal Recess Cells and the Most Common Frontal Sinus Drainage Pathways.

BACKGROUND: To date, there are numerous studies documenting the prevalence of frontal recess cells, but only 1 study using the newly developed International Frontal Sinus Anatomical Classification (IFAC) system. The identification of the frontal cells and their influence on the frontal drainage pathway plays an important role in endoscopic frontal sinus surgery. OBJECTIVE: The aim of this study is to document the radiological prevalence of various types of frontal cells, as classified by IFAC and the most common frontal sinus drainage pathways based on its anatomic relationships with these cells. METHODS: Using a novel preoperative virtual planning software (Scopis Building Blocks), consecutive computerized tomography scans of the sinuses of patients were analyzed for the prevalence of frontal cells, as classified by the by IFAC, and the frontal sinus drainage pathways at the Ear Nose Throat Hospital of Ho Chi Minh City, Vietnam. RESULTS: In this study, 208 computed tomography scans of consecutively selected frontal sinuses of 114 patients were included for analysis. The agger nasi cell was present in 95.7% of reviewed scans. The frontal cells prevalence was as follows: supra agger cell (SAC): 16.3%, supra agger frontal cell (SAFC): 13%, supra bulla cell (SBC): 46.2%, supra bulla frontal cell (SBFC): 4.3%, supra orbital ethmoid cell: 17.3%, and frontal septal cell: 10.6%. The most common frontal sinus pathway type in relation to frontal cells was medial to SAC (70.6%), medial to SAFC (81.5%), anterior to SBC (88.5%), and anterior to SBFC (100%). In cases that had 2 frontal cells group, the drainage pathway was medial to SAC/SAFC and anterior to SBC/SBFC in most cases. CONCLUSION: This study documents the prevalence of frontal cells (classified by IFAC) using a novel preoperative virtual planning software in the Vietnamese population. It demonstrates predominantly medial anteromedial frontal drainage pathways as related to these frontal cells.

Automatic Normalization of Anatomical Phrases in Radiology Reports Using Unsupervised Learning.

In today's radiology workflow, free-text reporting is established as the most common medium to capture, store, and communicate clinical information. Radiologists routinely refer to prior radiology reports of a patient to recall critical information for new diagnosis, which is quite tedious, time consuming, and prone to human error. Automatic structuring of report content is desired to facilitate such inquiry of information. In this work, we propose an unsupervised machine learning approach to automatically structure radiology reports by detecting and normalizing anatomical phrases based on the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) ontology. The proposed approach combines word embedding-based semantic learning with ontology-based concept mapping to derive the desired concept normalization. The word embedding model was trained using a large corpus of unlabeled radiology reports. Fifty-six anatomical labels were extracted from SNOMED CT as class labels of the whole human anatomy. The proposed framework was compared against a number of state-of-the-art supervised and unsupervised approaches. Radiology reports from three different clinical sites were manually labeled for testing. The proposed approach outperformed other techniques yielding an average precision of 82.6%. The proposed framework boosts the coverage and performance of conventional approaches for concept normalization, by applying word embedding techniques in semantic learning, while avoiding the challenge of having access to a large amount of annotated data, which is typically required for training classifiers.

Anatomical classification of breast sentinel lymph nodes using computed tomography-lymphography.

To evaluate the anatomical classification and location of breast sentinel lymph nodes, preoperative computed tomography-lymphography examinations were retrospectively reviewed for sentinel lymph nodes in 464 cases clinically diagnosed with node-negative breast cancer between July 2007 and June 2016. Anatomical classification was performed based on the numbers of lymphatic routes and sentinel lymph nodes, the flow direction of lymphatic routes, and the location of sentinel lymph nodes. Of the 464 cases reviewed, anatomical classification could be performed in 434 (93.5 %). The largest number of cases showed single route/single sentinel lymph node (n = 296, 68.2 %), followed by multiple routes/multiple sentinel lymph nodes (n = 59, 13.6 %), single route/multiple sentinel lymph nodes (n = 53, 12.2 %), and multiple routes/single sentinel lymph node (n = 26, 6.0 %). Classification based on the flow direction of lymphatic routes showed that 429 cases (98.8 %) had outward flow on the superficial fascia toward axillary lymph nodes, whereas classification based on the height of sentinel lymph nodes showed that 323 cases (74.4 %) belonged to the upper pectoral group of axillary lymph nodes. There was wide variation in the number of lymphatic routes and their branching patterns and in the number, location, and direction of flow of sentinel lymph nodes. It is clinically very important to preoperatively understand the anatomical morphology of lymphatic routes and sentinel lymph nodes for optimal treatment of breast cancer, and computed tomography-lymphography is suitable for this purpose.

Novel Anatomic Classification of Spontaneous Thalamic Hemorrhage Classified by Vascular Territory of Thalamus.

BACKGROUND: Spontaneous thalamic hemorrhage has increased in incidence in recent years. Analysis of the characteristics of thalamic hemorrhage was based on the vascular territories of the thalamus. METHODS: Retrospective analysis included 303 consecutive patients with spontaneous thalamic hemorrhage. Thalamic hemorrhage was classified into 4 types: anterior type (supplied mainly by the tuberothalamic artery), medial (mainly paramedian thalamic-subthalamic artery), lateral (mainly thalamogeniculate artery), and posterior (mainly posterior choroidal artery). The baseline characteristics, complications, and functional outcomes were assessed. RESULTS: The anterior type was found in 10 patients (3.3%), the medial type in 47 (15.5%), the lateral type in 230 (75.9%), and the posterior type in 16 (5.3%). Intracerebral hemorrhage volume was smallest in the anterior type, and significantly smaller than in the medial (P = 0.002) and lateral types (P < 0.001). Intraventricular hemorrhage (IVH) or acute hydrocephalus was significantly associated with the medial type (P < 0.01 or P < 0.01, respectively). Non-IVH or non-acute hydrocephalus was significantly associated with the anterior (P < 0.05 or P < 0.05, respectively) and lateral (P < 0.05 or P < 0.05, respectively) types. Emergency surgery was correlated only with the medial type (P < 0.01). The independent predictors of poor outcome were age (odds ratio [OR], 1.07; P = 0.002), admission National Institutes of Health Stroke Scale score (OR, 1.32; P < 0.001), and type of thalamic hemorrhage (OR, 2.08; P = 0.038). CONCLUSIONS: The present study proposed a novel anatomic classification of thalamic hemorrhage according to the major thalamic vascular territories.

Retromaxillary Pneumatization of Posterior Ethmoid Air Cells: Novel Description and Surgical Implications.

OBJECTIVE: Retromaxillary pneumatization of posterior ethmoid (PE) air cells is an area that is yet to have appropriate description in rhinologic literature. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care hospital. SUBJECTS AND METHODS: First, 524 sides in 262 paranasal sinus computed tomography scans were analyzed: 350 normal sides were examined for PE pneumatization lateral to the sagittal plane of the medial wall of maxillary sinus posteriorly, and 174 diseased sides were similarly reviewed to check how pathology may affect identification and measurements. Following that, 153 operated sides in 84 cases prepared for revision endoscopic sinus surgery (ESS) were studied for residual diseased cells at different anatomic locations. RESULTS: Overall, retromaxillary PE pneumatization was identifiable in 416 of the 524 sides (79.4%). Lateral retromaxillary extension varied from 0.5 to 12.3 mm (mean ± SD, 4.8 ± 2.3 mm). This area of pneumatization is bounded anteroinferiorly by the junction between the posterior and superior walls of the maxillary sinus. Three cell types were described depending on the degree of lateral extension (type I, <3 mm; type II, 3-6 mm; type III, >6 mm). This cell, which we refer to as the Herzallah cell, was distinguishable from the anterior ethmoid Haller cell and was found to have residual disease in 50.3% of cases prepared for revision ESS. CONCLUSION: Retromaxillary extension of PE air cells varies considerably and requires attention during ESS. Residual undissected retromaxillary cell is a common finding in revision ESS and can contribute to inadequate disease clearance.

Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration.

With the advent of anti-vascular endothelial growth factor (VEGF) therapy, clinicians are now focused on various treatment strategies to better control neovascular age-related macular degeneration (NVAMD), a leading cause of irreversible blindness. Herein, we retrospectively reviewed consecutive patients with treatment-naïve NVAMD initially classified based on fluorescein angiography (FA) alone or with an anatomic classification utilizing both FA and optical coherence tomography (OCT) and correlated long-term visual outcomes of these patients treated with an anti-VEGF Treat-and-Extend Regimen (TER) with baseline characteristics including neovascular phenotype. Overall, 185 patients (210 eyes) were followed over an average of 3.5 years (range 1-6.6) with a retention rate of 62.9%, and visual acuity significantly improved with a TER that required a mean number of 8.3 (±1.6) (± standard deviation) intravitreal anti-VEGF injections/year (range 4-13). The number of injections and the anatomic classification were independent predictors of visual acuity at 6 months, 1, 2, 3 and 4 years. Patients with Type 1 neovascularization had better visual outcomes and received more injections than the other neovascular subtypes. There were no serious adverse events. A TER provided sustained long-term visual gains. Eyes with Type 1 neovascularization had better visual outcomes than those with other neovascular subtypes.

Renal tumour anatomical characteristics and functional outcome after partial nephrectomy.

OBJECTIVE: Anatomical features of renal tumours may be useful in predicting glomerular filtration rate (GFR) after partial nephrectomy. In this study, anatomical classification systems (ACSs) were compared to predict changes in renal function after surgery. MATERIALS AND METHODS: A group of 294 patients with T1 renal tumours receiving partial nephrectomy between January 2006 and June 2013 were identified from the institutional kidney tumour database. Preoperative images from computed tomography or magnetic resonance imaging were reviewed to assess diameter, PADUA (preoperative aspects and dimensions used for an anatomical) classification score, RENAL (radius, exophytic/endophytic properties of the tumour, nearness of tumour deepest portion to the collecting system or sinus, anterior/posterior descriptor and location relative to polar lines) nephrometry score, centrality index (C index) and renal tumour invasion index (RTII). GFR was estimated using the Modification of Diet in Renal Disease equation preoperatively and 3 months after operation. Linear and logistic regression were applied as statistical methods. RESULTS: Mean tumour diameter was 3.0 ± 2.2 cm (range 1.0-7.0 cm). GFR was 85 ± 22 ml/min/1.73 m² before the operation and 77 ± 21 ml/min/1.73 m² (-8% change) 3 months after the operation. In univariate linear regression, the percentage change in GFR was weakly but statistically significantly associated with surgical approach (p = 0.04), indication for nephron sparing (p = 0.02), preoperative GFR (p < 0.001), PADUA (p = 0.02), RENAL (p = 0.01) and RTII (p = 0.003). In multivariate logistic regression analysis among patients with tumours 3 cm or larger, PADUA (odds ratio 1.55, p = 0.021) and RTII (odds ratio 3.87, p = 0.037) predicted at least a 20% reduction in GFR. CONCLUSIONS: Renal tumour ACSs may be clinically useful in predicting changes in renal function after partial nephrectomy in patients with larger tumours. The performance of RTII is equal to that of other ACSs in predicting changes in GFR.