BACKGROUND: Microvascular decompression (MVD), the standard surgical approach for hemifacial spasm (HFS), can be divided into the interposition and transposition methods. Although the risk of HFS recurrence following interposition has been reported, there is limited data comparing long-term outcomes between both methods performed by a single surgeon. This study aimed to investigate the efficacy of MVD techniques on HFS by comparing surgical outcomes performed by a single surgeon in a single-center setting.
METHODS: A total of 109 patients who underwent MVD were analyzed and divided into the transposition (86 patients) and interposition (23 patients) groups. Postoperative outcomes at 1 month and 1 year were assessed and compared, including rates of spasm relief, complications, and recurrence.
RESULTS: Outcome assessment revealed higher rates of early spasm relief in the interposition group (66.3% vs. 100%, transposition vs. interposition, respectively, p = 0.0004), although spasm relief at 1-year postoperatively was comparable between the two groups (84.9% vs. 95.7%, transposition vs. interposition, respectively, p = 0.2929). No significant differences were observed in complication and recurrence rates. Kaplan-Meier analysis demonstrated no significant differences in the duration of spasm resolution by MVD method (p = 0.4347, log-rank test).
CONCLUSIONS: This study shows that both the transposition (Surgicel® and fibrin glue) and interposition (sponge) methods were excellent surgical techniques. The interposition method may achieve earlier spasm resolution compared to the transposition method.

OBJECTIVE: Operative interposition of material between the trigeminal nerve and offending artery for surgical treatment of drug-resistant trigeminal neuralgia (TGN), following the Jannetta method, has been proven to be the most successful invasive treatment. Reexplorations of patients with recurrence of TGN have revealed nerve root irritations and scarring due to interposed material. To prevent these complications, modifications of microvascular decompression (MVD) aim at transposing the vessel away from the trigeminal nerve, without attachment of additional material to the nerve root. Given that both techniques (interposition and transposition) have been performed in the authors\' institution, they decided to analyze them for the short- and midterm outcomes.
METHODS: All patients who had undergone MVD for drug-resistant TGN in the authors\' institution between 2008 and 2022 were analyzed retrospectively. Outcome at discharge and follow-up was evaluated using the Barrow Neurological Institute pain intensity score. Additionally, complications and pain recurrence were assessed.
RESULTS: A total of 114 patients were operated on using transposition and 110 patients were treated using interposition. For transposition 102 patients were followed up for a median of 31.5 months, and for interposition 100 patients were followed up for a median of 95 months. At discharge 92.1% versus 94.5% of patients in the transposition and interposition groups, respectively, experienced a good outcome (Barrow Neurological Institute pain intensity scores I-III). At follow-up, 83.3% versus 85% of patients in the transposition and interposition groups, respectively, continued to demonstrate a good outcome. In 4.9% of patients in the transposition group and in 6% of patients in the interposition group, recurrence of pain occurred. Complications occurred in 24.6% of patients in the transposition and in 27.3% of those in the interposition group. The most frequent complications were facial hypesthesia (10.5% vs 11.8%, transposition vs interposition), followed by CSF leaks (2.6% vs 8.2%).
CONCLUSIONS: Transposition for MVD is an elegant way of solving vessel-nerve conflicts at the cerebellopontine angle. Similar to interposition, transposition shows positive short- and midterm outcomes for patients experiencing drug-resistant TGN. However, the main objective of transposition, which is improved prevention of recurrence and reduction of complications at the trigeminal nerve, could not be confirmed in this study.

OBJECTIVE: To explore the clinical application of orbital fat fascia flap in the correction of sunken upper eyelid in Asian blepharoplasty based on anatomical and histological research.
METHODS: Observe the histological structure of the orbital fat and its fascia vascularity through cadaver anatomy and histological sections of 10 cadavers. Based on the anatomical and histological characteristics of orbital fat, 36 patients with mild to moderate sunken upper eyelids were corrected by transposition of orbital fat fascia flap with preservation of fascia vascular pedicle. During the operation, the lateral part of the central cellulite of orbital fat was separated longitudinally and transferred to the sunken place to correct the sunken upper eyelid.
RESULTS: Anatomy and histology show that the orbital fat was located between the anterior layer of the levator aponeurosis and the posterior layer of the orbital septum and was separated into fat lobules by many fibrous septa. The blood vessels move forward from back to front along the orbital fat interlobular septum, and the blood vessels in the capsule below the orbital fat are abundant. Clinical results showed that the shape of the sunken upper eyelid was significantly improved in 35 cases after correction with this method during the postoperative follow-up from 9 months to 18 months. The mean sunken depth improved from 6.2mm (±1.0 mm) preoperatively to 2.2mm (±0.9 mm) at the last follow-up with a statistical significance. And only 1 case had partial depression in the unilateral eyelid and received autologous granular fat transplantation with satisfactory postoperative results.
CONCLUSIONS: The transposition of orbital fat fascia flap with longitudinal separation and preservation of fascia vascular pedicle can better correct the sunken upper eyelid during blepharoplasty, and the long-term effect is stable, which is worthy of clinical promotion.
METHODS: 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 .

To compare the rates of ulnar nerve neuropathy following ulnar nerve subcutaneous anterior transposition versus no transposition during open reduction and internal fixation (ORIF) of distal humerus fractures.
This was a retrospective cohort study at an academic level I trauma centre. A total of 97 consecutive patients with distal humerus fractures underwent ORIF between 2011 and 2018. All included patients were treated with plates (isolated lateral plates excluded) and had no pre-operative ulnar neuropathy. Subcutaneous ulnar nerve anterior transposition was compared versus no transposition at the time of ORIF. The main outcome measure was the rate of ulnar nerve neuropathy. The secondary outcomes were the severity of the ulnar nerve neuropathy and the rate of ulnar nerve recovery.
Twenty-eight patients underwent subcutaneous ulnar nerve anterior transposition during ORIF, whereas 69 patients had no transposition. Transposition was associated with significantly higher rates of ulnar nerve neuropathy (10/28 versus 10/69; P = 0.027). An adjusted logistic regression model demonstrated an odds ratio of 4.8 (1.3, 17.5; 95% CI) when transposition was performed. Ulnar nerve neuropathy was classified as McGowan grades 1 and 2 in all neuropathy cases in both groups (P = 0.66). Three out of ten cases recovered in the transposition group, and five out of ten cases recovered in the no transposition group over a mean follow-up of 11.2 months (P = 1.00).
We do not recommend performing routine subcutaneous ulnar nerve anterior transposition during ORIF of distal humerus fracture as it was associated with a significant 5-fold increase in ulnar nerve neuropathy.

This study evaluated the functional role of behavioral patterns in relational behavior in humans. The participants were five children, 9-11 years-old. A modified transposition task (size) was used, requiring active comparison patterns in order to match two relational stimulus compounds with two sample stimulus compounds. Comparison patterns were analyzed in terms of the variety of sequences and exceeding movements, the choice of relevant stimuli, and their correspondence with the size relationship between stimulus instances. Results suggest that variation in sequences and movements as well as choice for relevant stimuli influenced the establishment of relational behavior. The neglect of active comparison patterns in accounting for relational behavior is discussed.

UNASSIGNED: To compare the effects of graded anterior transposition with myectomy in primary inferior oblique overaction (IOOA).
UNASSIGNED: In a randomized clinical trial study, patients entered into two groups: graded anterior transposition (Group 1) and myectomy (Group 2). In the myectomy method, 8 mm of the inferior oblique (lO) muscle was excised in the lower temporal side, and in the graded anterior transposition group, the IO muscle was recessed according to Wright\'s method. Patients were followed up for at least 1.5 months. IOOA was graded from 0 to +4. Surgical success was defined as reduced IOOA to a grade of +1 or less.
UNASSIGNED: In a randomized clinical trial study, a total of 30 patients (60 eyes) were included in the study (32 eyes in Group 1 and 28 eyes in Group 2). Pre-operation IOOA was 3.18 ± 0.78 and 3.25 ± 0.70 in Groups 1 and 2, respectively. Mean IOOA in Group 1 and 2 was 0.95 ± 0.24 and 0.40 ± 0.10 at 6 months after the surgery, which means the mean correction of the overaction was statistically significant in both methods (P < 0.001). The success rate in the myectomy procedure was higher than graded recession. The weakening effect was better in higher grades of overaction (P < 0.001). The overall success rate of Groups 1 and 2 was 75% and 96.4%, respectively (P = 0.029).
UNASSIGNED: In both groups, IOOA significantly decreased after the operation. The success rate of the myectomy procedure was found to be significantly higher than graded anterior transposition.

OBJECTIVE: Improved survival has led to interest in functional health status (FHS) as patients with dextro-transposition of the great arteries (d-TGA) transition to adulthood. Our primary objectives were (1) evaluation of The Medical Outcomes Study Short Form-36 Health Survey (SF-36) results; (2) comparison with results of patients who completed the Child Health Questionnaire-Child Form 87 (CHQ-CF87) previously, or the PedsQL Generic Core Scales (PedsQL) survey subsequently; and (3) determination of factors associated with SF-36 domains.
METHODS: Survivors from the d-TGA Congenital Heart Surgeons\' Society cohort (1985-1989) completed the SF-36 (2010) as a measure of FHS (n = 210; age 21-26 years). Patient characteristics, medical history, psychosocial factors, and previous adolescent CHQ-CF87 FHS assessment (2000) were explored for association with SF-36 domains, along with comparison with recent PedsQL data (2017).
RESULTS: Patients scored themselves the same/higher than published normative data in 10 of 10 SF-36 summary scores/domains and similar in 5 of 6 PedsQL summary scores/domains. Factors commonly associated with lower summary scores/domains of the SF-36 were presence of cardiac symptoms, heart condition impacting physical activity/overall health/quality of life, unemployment, and lack of postsecondary education. Less commonly associated factors were lower birth weight, greater total medication number, female sex, shorter procedure-free interval, poor health knowledge, lower family income, younger age at SF-36, living with parents, and being married. These factors accounted for 17% to 47% of the variation in FHS summary scores/domains. FHS was minimally related to d-TGA morphology and repair type.
CONCLUSIONS: Patients with d-TGA surviving into adulthood, regardless of morphology or repair type, can primarily expect normal FHS. Addressing the challenges of patients with d-TGA entering adulthood requires consideration of psychosocial factors and clinical management.

OBJECTIVE: Posterior circulation strokes account for over one quarter of all ischemic strokes. The frequency of vertebral artery origin stenosis (VAOS) in patients with vertebrobasilar insufficiency (VBI) has been estimated to be as high 26%-32%, and VAOS is the direct cause of posterior circulation strokes in 9% of patients. This association could have a significant genetic component. This study examines the feasibility of the internal thoracic artery (ITA) as a donor vessel for revascularization in patients with VAOS.
METHODS: Ten sides from 5 fresh-frozen white cadaveric necks derived from 3 women and 2 men were used in this study. The mean age of the cadavers at death was 77.2 years (range, 68-88 years). The subclavian artery, vertebral artery, and ITA were dissected. The length and diameter (proximal and distal) of the V1 segment and the length and diameter of the ITA were recorded. Finally, the ITA was transposed to the V1 segment of the vertebral artery (VA1).
RESULTS: The mean length of the VA1 and its diameter at the proximal and distal parts were 35.51 and 3.69 mm, respectively. The mean length and diameter of the ITA were 26.53 and 3.27 mm, respectively. Rerouting the ITA to the VA1 was feasible without tension on all sides.
CONCLUSIONS: This study indicates that the ITA is anatomically and hemodynamically an excellent option for bypass surgery in a VAOS scenario. We present convincing and reproducible data to aid neurosurgeons in choosing the procedure best suited to their patients.

BACKGROUND: A few options of extracranial donor vessels exist for use in intracranial vascular bypass procedures. To our knowledge, the use of an internal thoracic artery for cerebral revascularization has not been studied previously. Hence, this cadaveric feasibility study was performed.
METHODS: The internal thoracic artery was dissected in 5 adult cadaveric specimens. The proximal diameter, distal diameter, and length of the vessel were measured and recorded. The artery was then transected distally at the seventh intercostal space and transposed cranially, through a pterional craniotomy opening to reach the middle cerebral artery at the skull base.
RESULTS: The mean diameter of the internal thoracic artery at its proximal end was 3.5 mm and at its distal end was 2 mm. The average length of the vessel was 31 cm. There was no statistical difference between the measurements recorded from different sides or sexes. In each specimen, an internal thoracic artery was dissected, rotated superiorly, and advanced subcutaneously behind the ear to reach the middle cerebral artery at the skull base without difficulty and remained tensionless at the site of anastomosis.
CONCLUSIONS: In this cadaveric study, we demonstrated the suitability of the internal thoracic artery in use as a donor vessel for a single site anastomosis in a high-flow cerebral bypass procedure.

Randomized controlled trials have not identified a superior surgical approach to cubital tunnel syndrome surgery. This study evaluates the early morbidity of open in situ decompression and transposition.
This prospective cohort study enrolled 125 adult patients indicated for cubital tunnel surgery at a tertiary institution. Exclusion criteria included preoperative use of narcotics and concurrent elbow procedures. In situ decompressions (n = 47) and ulnar nerve transpositions (n = 78) were performed. Data were collected by independent clinicians at 3 postoperative intervals: 1 to 3 weeks, 4 to 8 weeks, and longer than 8 weeks. Postoperative data quantified surgical morbidity: visual analog scale (0-10) surgical site pain, narcotic consumption, patient-reported disability (Levine-Katz, Patient-Reported Elbow Evaluation [PREE] scores). Olecranon paresthesia and wound complications (hematoma, drainage, infection) were recorded.
No preoperative differences in age, sex, or the presence of pain existed between the surgical groups. Surgical site pain was not significantly different at any time. Following transposition, a significantly greater percentage of patients were using narcotics at 4 to 8 weeks after surgery and the average total morphine equivalents consumed per patient was significantly greater. Both Levine-Katz and PREE scores indicated greater disability at 1 to 3 and 4 to 8 weeks after transposition, but this significant difference resolved by final follow-up. Olecranon paresthesias occurred after both procedures but were significantly less frequent at 4 to 8 weeks and longer than 8 weeks after decompression. Twelve hematomas occurred following transposition (15%) with 1 requiring operative debridement and 5 hematomas resolved with nonsurgical treatment after in situ decompression (11%).
Ulnar nerve transposition imparts greater surgical morbidity than decompression with greater narcotic consumption, more patient-reported disability up to 8 weeks after surgery, and more persistent olecranon paresthesia. However, most differences in surgical morbidity are transient with resolution after 8 weeks following surgery.
Therapeutic II.