Artificial intelligence for surgical safety during laparoscopic gastrectomy for gastric cancer: Indication of anatomical landmarks related to postoperative pancreatic fistula using deep learning.

BACKGROUND: Postoperative pancreatic fistula (POPF) is a critical complication of laparoscopic gastrectomy (LG). However, there are no widely recognized anatomical landmarks to prevent POPF during LG. This study aimed to identify anatomical landmarks related to POPF occurrence during LG for gastric cancer and to develop an artificial intelligence (AI) navigation system for indicating these landmarks. METHODS: Dimpling lines (DLs)-depressions formed between the pancreas and surrounding organs-were defined as anatomical landmarks related to POPF. The DLs for the mesogastrium, intestine, and transverse mesocolon were named DMP, DIP, and DTP, respectively. We included 50 LG cases to develop the AI system (45/50 were used for training and 5/50 for adjusting the hyperparameters of the employed system). Regarding the validation of the AI system, DLs were assessed by an external evaluation committee using a Likert scale, and the pancreas was assessed using the Dice coefficient, with 10 prospectively registered cases. RESULTS: Six expert surgeons confirmed the efficacy of DLs as anatomical landmarks related to POPF in LG. An AI system was developed using a semantic segmentation model that indicated DLs in real-time when this system was synchronized during surgery. Additionally, the distribution of scores for DMP was significantly higher than that of the other DLs (p < 0.001), indicating the relatively high accuracy of this landmark. In addition, the Dice coefficient of the pancreas was 0.70. CONCLUSIONS: The DLs may be used as anatomical landmarks related to POPF occurrence. The developed AI navigation system can help visualize the DLs in real-time during LG.

Clinical Outcomes and Treatment Strategy of Mirizzi's Syndrome Treated With Surgery.

BACKGROUND: There is currently no standardized treatment for Mirizzi's syndrome (MS). We aim to explore the surgical treatment strategy for MS by analyzing its clinical characteristics and treatment outcomes. METHODS: This retrospective study analyzed the clinical data of 130 patients with MS who underwent surgery at our hospital from April 2013 to April 2020. RESULTS: The study population comprised 130 patients with MS, with an approximately balanced sex ratio and a median age of 58.5 years. The preoperative diagnostic rate was 82.3%. The diagnostic accuracy of ERCP was 92.5%, higher than that of MRCP and ultrasound. All patients underwent surgical treatment, with 74 cases of laparoscopic surgery, 43 cases of laparotomy, and 13 cases of laparoscopic surgery converted to laparotomy. A total of 23 patients experienced short-term and long-term complications after surgery, with a complication rate of 17.7%. There was no statistical difference between laparoscopic surgery and open surgery in terms of intraoperative hemorrhage, operative time, and postoperative complication rate. However, the length of hospital stay was shorter in the laparoscopic surgery compared to the open surgery, which was statistically different from each other. CONCLUSION: ERCP is the gold standard for the diagnosis of MS, especially for identifying the type of MS. ERCP plays an important role in both the preoperative and postoperative phases of MS. Our study demonstrated that laparoscopic surgery was a safe and feasible option for MS treatment, even requires less hospitalization than open surgery.

Management of Complications in Crohn's Disease.

Complications of Crohn's disease reach far beyond postsurgical leak, infection, and enterocutaneous fistula. Malnutrition, intestinal failure, and recurrent disease all will require ongoing attentions. The management of these patients may further be complicated by the need for chronic immunosuppression. The underlying principles continue to include optimization of nutritional status, and preservation of bowel length when possible. However, there have been several recent advances in both the medical and surgical management of the disease. Understanding the contribution of the mesentery to inflammation, new surgical techniques such as the Kono-S anastomosis and extended mesenteric resection is decreasing the need for repeated resections.

Evaluation of multiple deep neural networks for detection of intracranial dural arteriovenous fistula on susceptibility weighted angiography imaging.

BACKGROUND: The natural history of intracranial dural arteriovenous fistula (DAVF) is variable and early diagnosis is crucial in order to positively impact the clinical course of aggressive DAVF. Artificial intelligence (AI) based techniques can be promising in this regard, and in this study, we used various deep neural network (DNN) architectures to determine whether DAVF could be reliably identified on susceptibility-weighted angiography images (SWAN). MATERIALS AND METHODS: A total of 3965 SWAN image slices from 30 digital subtraction angiographically proven DAVF patients and 4380 SWAN image slices from 40 age-matched patients with normal MRI findings as control group were included. The images were categorized as either DAVF or normal and the data was trained using various DNN such as VGG-16, EfficientNet-B0, and ResNet-50. RESULTS: Various DNN architectures showed the accuracy of 95.96% (VGG-16), 91.75% (EfficientNet-B0), and 86.23% (ResNet-50) on the SWAN image dataset. ROC analysis yielded an area under the curve of 0.796 (p < .001), best for VGG-16 model. Criterion of seven consecutive positive slices for DAVF diagnosis yielded a sensitivity of 74.68% with a specificity of 69.15%, while setting eight slices improved the sensitivity to above 80.38%, with a decrease of specificity up to 56.38%. Based on seven consecutive positive slices criteria, EfficientNet-B0 yielded a sensitivity of 73.21% with a specificity of 45.92% and ResNet-50 yielded a sensitivity of 72.39% with a specificity of 67.42%. CONCLUSION: This study shows that DNN can extract discriminative features of SWAN for the classification of DAVF from normal with good accuracy, reasonably good sensitivity and specificity.

The Value of Preoperative Rigid Tracheobronchoscopy for the Diagnosis of Tracheomalacia in Oesophageal Atresia Patients.

BACKGROUND: Oesophageal atresia (OA) is often accompanied by tracheomalacia (TM). The aim of this study was to evaluate its presence in OA patients during routine rigid tracheobronchoscopy (TBS) before primary correction and compare this to postoperative TBS and clinical signs of TM. METHODS: This retrospective cohort study included patients born with OA between June 2013 and December 2022 who had received a TBS before OA correction and had been followed for at least twelve months. Definite TM was postoperatively diagnosed through TBS, and probable TM was defined as having symptoms of TM. RESULTS: We analysed data from 79 patients, of whom 87% with OA type C. Preoperatively, TM was observed in 33 patients (42% of all patients), seven of whom had severe TM. Definite TM was observed in 21 patients (27%), of whom 15 had severe TM. Forty-one patients (52% of all patients) had developed symptoms of TM within twelve months, including harsh barking cough (n = 15), stridor and/or wheezing (n = 20), recurrent respiratory insufficiency (n = 11), or needing airway surgery (n = 7). The sensitivity of preoperative TBS for the presence of postoperative (definite and probable combined) TM is 50.0%, 95% CI [35.2-64.8], and the specificity 67.6%, 95% CI [51.7-81.1]. Clinical characteristics did not differ between the patients with or without postoperative TM. CONCLUSIONS: More than half of the studied patients with OA experienced symptoms of TM. While preoperative TBS is routinely performed prior to surgical OA correction, its predictive value for the presence of postoperative TM remains limited. LEVEL OF EVIDENCE: Level II. TYPE OF STUDY: Study of Diagnostics Test.

An arteriovenous fistula model: Carotid artery-posterior facial vein fistula in rats.

OBJECTIVE: To describe an alternative arteriovenous fistula (AVF) model involving anastomosis of the common carotid artery (CCA) with the posterior facial vein (PFV). METHODS: Twenty-two male Sprague-Dawley rats (age 6-8 weeks) were used to establish the AVF model involving end-to-side anastomosis of PFV and CCA. The peak velocity of the CCA and the diameter of the outflow vein were recorded at 7, 14, and 42 days after the operation using Doppler ultrasound. Pathological examination of the intimal lesions was performed at 14 and 42 days after operation. RESULTS: One rat died within 24 h after surgery related to anesthesia. The patency rates at days 7, 14, and 42 were 85.7%, 81%, and 81%, respectively. The diameter of the carotid artery in rats is approximately 0.8 mm. The diameter of the outflow vein was increased by 1.7-fold and 2.2-fold at 7 days (1.1 ± 0.118 mm) and 14 days (1.4 ± 0.073 mm). At 42 days (1.96 ± 0.101 mm) after operation, the diameter was 3-fold greater compared to the unoperated control rat. The peak systolic flow velocity of the carotid artery at 7 days (593 ± 17.36 mm/s) and 14 days (767 ± 13.64 mm/s) after surgery was significantly greater compared to the control rat (314 ± 15.13 mm/s). The rate of increase was fastest at 7 days and leveled off from 14 to 42 days (875 ± 26 mm/s) after surgery. At 14 days, the intima area showed a nearly 50-fold increase (230 ± 9.93 µm2 × 103) compared to control (area 5 ± 0.37 µm2 × 103). Comparing 6 weeks with 2 weeks (280 ± 10.54 µm2 × 103) after surgery, the intima area increased 1.2 times. CONCLUSION: The CCA-PFV fistula in rats is a viable alternative AVF model.

Convexity dural arteriovenous fistula with Sylvian-Labbé collateral pattern: A case report.

Convexity dural arteriovenous fistula (dAVF) is associated with high-grade dAVF and is usually presented with aggressive clinical presentation. Precise diagnosis and understanding the pathogenesis are important to achieving successful treatment without complications. We report a case of dAVF with Sylvian-Labbé collateral pattern, concerning embryological development that was thought to be involved in the vascular architecture and pathogenesis of dural AVF. Thus, a 60-year-old man was presented with sudden onset of seizure with no history of trauma. Magnetic Resonance Imaging (MRI) showed cortical hemorrhage in the left precentral gyrus. Digital subtraction angiography (DSA) showed the convexity dural arteriovenous fistula (dAVF) involving a vein that appeared to be the vein of Labbé, the drainer was anastomosed with superior middle cerebral vein (SMCV) and formed the varix. With the successful treatment with trans-arterial embolization (TAE), obliteration of dAVF was achieved with no neurological deficits. This case highlights convexity dAVF with the complex relationship between embryological development and the arcade of venous drainage route, wherein the anomaly might be acquired and caused by elevated venous pressure in a vein that appeared to be the vein of Labbé. Gaining knowledge of the embryological basis may aid in a deeper understanding of acquired pathologies.

Selective bronchial occlusion for acquired bronchobiliary fistula caused by treatment of hepatocellular carcinoma: A case series.

Acquired bronchobiliary fistula (ABBF) is very rare among the complications that occur in patients with hepatocellular carcinoma (HCC) after treatment. Although surgery and drainage have been the main methods for treating ABBF for a long time, they are not entirely suitable for patients with refractory ABBF resulting from HCC therapy. In this study, we present four cases of ABBF caused by HCC treatment, who were treated using selective bronchial occlusion (SBO). Among the 4 patients with ABBF treated with SBO, 3 cases successfully blocked ABBF with SBO, and the treatment success rate was 75%. All successfully treated patients reported disappearance of symptoms of bilioptysis and cough was alleviated. No life-threatening adverse reactions were reported following SBO intervention, and no deaths occurred. We believe that the use of video bronchoscopy to place a self-made silicone plug in the bronchus to treat refractory ABBF is a feasible palliative treatment, which can significantly improve the condition of ABBF patients.

Nephrectomy as Salvage Treatment After an Unsuccessful Embolization of a Huge Incidental Renal Artery Aneurysm With an Arteriovenous Fistula.

Renal artery aneurysms (RAA) with a concomitant renal arteriovenous fistula (RAVF) are rare entities with a reported incidence of less than 1%. An 86-year-old man was admitted to the urology department after an incidental finding of a left RAA on an abdominal ultrasound. A computed tomography angiography (CTA) revealed a saccular aneurysm measuring 54x42mm in the distal part of the left renal artery, along with a huge arteriovenous fistula measuring 45mm. The patient was asymptomatic at admission. Given the radiologic findings, an unsuccessful attempt at transcatheter arterial embolization was conducted. Therefore, a radical nephrectomy was recommended for the patient, which was performed without major intraoperative or postoperative complications. Microscopic examination depicted arteriosclerotic lesions and arterionephrosclerosis with 30% sclerotic glomeruli. The patient at his last visit remained free of symptoms. This case highlights the role of nephrectomy as a feasible option in cases of endovascular treatment failure.

Perianal disease in inflammatory bowel disease: Broadening treatment and surveillance strategies for anal cancer.

The perianal disease affects up to one-third of individuals with Crohn's disease (CD), causing disabling symptoms and significant impairment in quality of life, particularly for those with perianal fistulising CD (PFCD). The collaborative effort between gastroenterologists and surgeons is essential for addressing PFCD to achieve fistula closure and promote luminal healing. Limited fistula healing rates with conventional therapies have prompted the emergence of new biological agents, endoscopic procedures and surgical techniques that show promising results. Among these, mesenchymal stem cells injection is a particularly hopeful therapy. In addition to the burden of fistulas, individuals with perianal CD may face an increased risk of developing anal cancer. This underscores the importance of surveillance programmes and timely interventions to prevent late diagnoses and poor outcomes. Currently, there is no established formal anal screening programme. In this review, we provide an overview of the current state of the art in managing PFCD, including novel medical, endoscopic and surgical approaches. The discussion also focuses on the relevance of establishing an anal cancer screening programme in CD, intending to propose a risk-based surveillance algorithm. The validation of this surveillance programme would be a significant step forward in improving patient care and outcomes.

Apple Vision Pro Augmented Reality-Assisted Minimally Invasive Surgical Treatment of Spinal Dural Arteriovenous Fistula.

This report outlines the innovative use of augmented reality (AR) in the surgical planning and treatment of a spinal dural arteriovenous fistula (dAVF) via a minimally invasive technique. AR technology by way of an Apple Vision Pro headset was employed to enhance preoperative visualization and understanding of the pathology, leading to successful surgical ligation of the AVF. This case describes a 56-year-old male presenting with progressive weakness and thoracic myelopathy who showed marked improvement postoperatively, highlighting AR's potential to improve surgical approach and outcomes.

Double Trouble: Synchronous Hepatoduodenal and Hepatocolic Fistulisation in a Case of Untreated Liver Abscess.

A hepatic abscess is a potentially life-threatening condition that can lead to major complications if left untreated. One of the rarest complications of hepatic abscesses is rupture into adjacent organs like the duodenum, stomach, and colon. We report a case of an elderly male patient with a hepatic abscess that ruptured into the duodenum and colon, forming fistulous connections. To the best of our knowledge, this is the only reported case of hepatic abscess with simultaneous hepatoduodenal and hepatotoxic fistulas, confirmed radiologically and endoscopically. This report signifies the need for a high level of vigilance for extremely rare complications in relatively common conditions.

Treatment of anal fistulas with Obsidian RFT®: just another autologous compound platelet-rich fibrin foam?

BACKGROUND: Sphincter-preserving techniques like autologous compound platelet-rich fibrin foam have gained popularity, offering potential for better functional outcomes in anal fistula treatment. The present study aimed to evaluate the efficacy and safety of Obsidian RFT®. METHODS: The study conducted a retrospective analysis from January 2018 to December 2022 on patients who received anal fistula closure with Obsidian RTF® at the Department of General Surgery, Medical University of Vienna. Clinical diagnosis, complemented by radiographic imaging, was employed to confirm inconclusive cases. Demographic and fistula characteristics and postoperative data were collected from electronic records following STROCSS criteria. RESULTS: Fifteen patients received Obsidian RFT® treatment for anal fistulas. We found no intra- and postoperative complications. The median hospital stay was 3 days. After a median follow-up of 32 months, a closure rate of 53.3% was detected. Non-significant differences were observed in various variables, yet trends emerged, indicating associations between abscess presence and non-healing fistulas. A distinct age threshold (≥ 42.7 years) served as an indicator for an inability to achieve anal fistula cure. CONCLUSION: Obsidian RFT® represents a safe, minimally invasive operative procedure. Approximately half the patients experienced healing, with better outcome in a younger population. TRIAL REGISTRATION: Ethical Approval number Medical University of Vienna (#1258/2018). This study was registered retrospectively in ClinicalTrials.gov (NCT06136325).

Contrast-Enhanced Ultrasound: A Real-Time, Noninvasive, Radiation-Free Method for Intraoperative Male Urethral Fistula Assessment.

OBJECTIVES: To evaluate the feasibility of intraoperative transurethral contrast-enhanced ultrasound for the assessment of male urethral fistulas. METHODS: Patients in a prospective database who underwent intraoperative two-dimensional ultrasound, transurethral saline-enhanced ultrasound, and contrast-enhanced ultrasound between January 2017 and July 2022 were included. All patients were clinically diagnosed with urethral fistulae (UF) in the outpatient setting based on clinical presentations, traditional two-dimensional ultrasound, and/or other imaging modalities and confirmed during surgical repair. Dynamic videos of the scans were independently analyzed by two experienced ultrasonologists. RESULTS: Thirty-nine patients with an average age of 51 years were included. The UF were located in the anterior urethra in 22 (56.4%) patients and in the bulbar urethra in 14 (63.6%) patients. UF were located in the posterior urethra in 17 (436%) patients and in the prostatic urethra in 13 (76.5%) patients. Contrast-enhanced ultrasonography revealed UF in all patients. In patients with anterior UF, saline-enhanced ultrasound images did not show a UF in 15 (68.2%, 15/22) patients, 13 (86.7%, 13/15) of whom had fistulae with diameters <3 mm. Saline-enhanced ultrasound images did not reveal posterior UF in 13 (76.5%, 13/17) patients. The fistula diameters in eight (61.5%, 8/13) patients were <3 mm. The duration for contrast-enhanced ultrasonography was approximately 3 minutes. The duration for surgical repair was approximately 2 hours. CONCLUSIONS: Transurethral contrast-enhanced ultrasound is a real-time, noninvasive, and radiation-free method that allows intraoperative imaging and accurate assessment of male UF. Its sensitivity is higher than that of both two-dimensional ultrasound and transurethral saline-enhanced ultrasound. The location, size, and course of the fistulae can be clearly seen due to greater contrast during contrast-enhanced ultrasound.

Beyond Conventional: A Systematic Review of Non-Conventional Techniques for Radio-Cephalic Arteriovenous Fistula.

BACKGROUND: Radio-cephalic arteriovenous fistulas (RC-AVFs), the preferred vascular access for hemodialysis, have high failure rates. New techniques like the no-touch technique (NTT) and modified no-touch technique (MNTT) have shown promising results. Our objective is to highlight the effectiveness of non-conventional techniques, aiming to address the challenge of AVF failure. METHODS: We searched Medline, Google Scholar, and Clinicaltrials.gov until April 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five relevant articles were found, all involving human studies on NTT or MNTT for RC-AVF creation. We focused on primary and secondary patency rates, fistula maturation rates, and complications. RESULTS: We reviewed five studies: two pilot, two prospective, and one retrospective. Three used NTT, and two used MNTT. Among double-arm studies, three out of four showed a significantly improved primary patency with non-conventional techniques. However, one study found no significant difference between non-conventional and conventional methods (90.5% vs. 84.2%; p=0.225). In a single-arm study, non-conventional technique (NTT) displayed 54% primary patency at one year. Secondary patency rates were in three studies. One demonstrated significant secondary patency with non-conventional methods compared to conventional (90% vs. 67.5%; p=0.028), while another found no significant difference (90.5% vs. 84.2%; p=0.803). In the single-arm study, the non-conventional technique (NTT) revealed 80% secondary patency at one year. CONCLUSION: Non-conventional techniques (NTT and MNTT) show promise in improving patency rates, hinting at their potential as alternatives to the conventional technique for RC-AVF creation. Further studies are crucial to confirm their effectiveness and evaluate long-term outcomes.

Successful creation and long-term usage of radiocephalic fistula based on the recanalized completely occluded radial artery.

The total occlusion of radial artery is a contraindication for reintervention and further usage. In this study, we report successful revascularization with creation of radiocephalic fistula from post-procedural chronically-occluded radial artery. The completely occluded radial artery was recanalized through ultrasound guided balloon angioplasty. A traditional radiocephalic fistula was created subsequently by using the recanalized radial artery for hemodialysis therapy. Though the fistula was failed at the 6 weeks caused by the juxta anastomotic stenosis, the further ultrasound guided percutaneous transluminal angioplasty restored the blood, and the hemodialysis therapy lasts for more than 1 year so far. It's feasible to create radiocephalic fistula based on the recanalized radial artery and maintain long-term hemodialysis therapy.

Construction and validation of a scale to assess knowledge, attitude, and practice regarding vascular protection anticipatory to the creation of an arteriovenous fistula.

BACKGROUND: The possibility of creating an arteriovenous fistula (AVF) depends on the existence of an arterial-venous network that is in good condition, defined by the size and elasticity of the blood vessels. The knowledge, attitudes, and practices (KAP) toward vascular protection play a crucial role in preserving the vascular network for patients with end-stage renal disease (ESRD), it is observed that there is a significant lack of tools to measure these variables. Thus, the aim of this study is to develop and validate a scale to assess KAP regarding vascular protection anticipatory to the creation of an arteriovenous fistula (the KAP-VPAC-AVF Scale). METHODS: Initial item development was guided by a literature review and clinical experience, after which the items were improved and perfected through the Delphi process. The content of the scale was judged by an expert panel for content validity. In a convenience sample of 551 patients with ESRD, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to examine the instrument's factor structure. RESULTS: The KAP-VPAC-AVF Scale encompasses 11 items distributed over three factors: knowledge, attitude, and practice, demonstrated excellent internal consistency (Cronbach's alpha = 0.917) and construct validity, as confirmed by CFA with satisfactory fit indices (χ2/df = 2.394, RMSEA = 0.075, RMR = 0.049, CFI = 0.969, GFI = 0.936, AGFI = 0.892, TLI = 0.957, IFI = 0.970). CONCLUSION: The KAP-VPAC-AVF Scale is a scientific and effective assessment tool that can evaluate the KAP of ESRD patients regarding measures to preserve the vascular network.

Ultrasound-guided nitinol stent implantation to treat early restenosis of arteriovenous fistula: A 69-case study with 1-year outcome.

BACKGROUND: To investigate the feasibility, methods and effects of interventional ultrasound in nitinol stent implantation to treat early restenosis after percutaneous transluminal angioplasty (PTA) in autogenous arteriovenous fistula (AVF). METHODS: From April 2018 to December 2021, 69 patients with early restenosis of AVF received ultrasound-guided nitinol stent implantation (UNSI) and were followed-up. Imaging features of the stent and procedure by ultrasound were observed. The technical success rate, clinical success rate and incidence of complications were recorded and counted. Target lesion primary patency (TLPP), access circuit primary patency (ACPP) and access circuit secondary patency (ACSP) were estimated. RESULTS: Ultrasonography can show the structure of the stent and guide the stenting process clearly. Both the technical and clinical success rates were 100%. Thirty-one patients had in-stent restenosis (ISR), which was treated by plain balloon (PB) PTA or drug coated balloon (DCB) PTA. The TLPP at 3, 6, 12 and 24 months were 100.0%, 94.2%, 63.4% and 39.6%, respectively. The ACPP at 3, 6, 12 and 24 months were 98.6%, 91.6%, 60.2% and 35.2%, respectively. The ACSP at 3, 6, 12 and 24 months were 98.6%, 98.6%, 95.6% and 93.8%, respectively. The TLPP of ISR after DCB PTA at 3, 6 and 12 months were 100.0%, 100.0% and 93.6%, respectively. CONCLUSIONS: This pilot study indicates ultrasonography can accurately guide nitinol stent implantation in AVF and this technique is a feasible and minimally invasive treatment for early restenosis after PTA with good short- and medium-term patency. DCB PTA may be used to deal with the ISR and is a way to prolong the patency of nitinol stent.

Pubic bone osteomyelitis and fistulas after radiation therapy of the pelvic region: patient-reported outcomes and urological management of a rare but serious complication.

PURPOSE: This study investigated late urinary adverse events (UAEs) in patients who underwent pelvic radiation therapy, with a focus on occurrence, diagnostic characteristics and the impact of subsequent extirpative surgery with the need of urinary diversion on quality of life. METHODS: A retrospective analysis of 20 patients after pelvic radiotherapy (2016-2022) was conducted. Data included demographics, perioperative details, oncological parameters, and patient-reported outcomes. Imaging (CT, MRI) was examined for early manifestations of late UAEs. RESULTS: In the study cohort, prostate cancer was the primary malignancy in 85% with a mean radiation dose of 84 Gray over 35 days. Time to diagnosis of late UAEs was 4.0 years post-radiation. Radiological assessment demonstrated a progressive increase in typical CT and MRI features of pubic bone osteomyelitis over time. Surgical interventions, mainly cystectomy, were required with variable outcomes in patient-reported post-surgery quality of life. CONCLUSION: Diagnosing and managing late UAEs after pelvic radiation necessitate an understanding of their occurrence, diagnostic features and appropriate management strategies. Early imaging, particularly MRI, is crucial for timely diagnosis and treatment planning. Variable post-surgery quality of life underscores the importance of a multidisciplinary approach in managing late UAEs. The study contributes to understanding these complications and emphasizes their consideration in post-radiation follow-up care.