This article reports a case of a female patient admitted with swelling and subcutaneous mass in the right forearm, initially suspected to be multiple nerve fibroma. However, through preoperative imaging and surgery, the final diagnosis confirmed superficial thrombophlebitis. This condition resulted in entrapment of the radial nerve branch, leading to noticeable nerve entrapment and radiating pain. The surgery involved the excision of inflammatory tissue and thrombus, ligation of the cephalic vein, and complete release of the radial nerve branch. Postoperative pathology confirmed the presence of Superficial Thrombophlebitis. Through this case, we emphasize the importance of comprehensive utilization of clinical, imaging, and surgical interventions for more accurate diagnosis and treatment. This is the first clinical report of radial nerve branch entrapment due to superficial thrombophlebitis.

OBJECTIVE: Microvascular decompression (MVD) is a widely used neurosurgical intervention for the treatment of cranial nerves compression. Segmentation of MVD-related structures, including the brainstem, nerves, arteries, and veins, is critical for preoperative planning and intraoperative decision-making. Automatically segmenting structures related to MVD is still challenging for current methods due to the limited information from a single modality and the complex topology of vessels and nerves.
METHODS: Considering that it is hard to distinguish MVD-related structures, especially for nerve and vessels with similar topology, we design a multimodal segmentation network with a shared encoder-dual decoder structure and propose a clinical knowledge-driven distillation scheme, allowing reliable knowledge transferred from each decoder to the other. Besides, we introduce a class-wise contrastive module to learn the discriminative representations by maximizing the distance among classes across modalities. Then, a projected topological loss based on persistent homology is proposed to constrain topological continuity.
RESULTS: We evaluate the performance of our method on in-house dataset consisting of 100 paired HR-T2WI and 3D TOF-MRA volumes. Experiments indicate that our model outperforms the SOTA in DSC by 1.9% for artery, 3.3% for vein and 0.5% for nerve. Visualization results show our method attains improved continuity and less breakage, which is also consistent with intraoperative images.
CONCLUSIONS: Our method can comprehensively extract the distinct features from multimodal data to segment the MVD-related key structures and preserve the topological continuity, allowing surgeons precisely perceiving the patient-specific target anatomy and substantially reducing the workload of surgeons in the preoperative planning stage. Our resources will be publicly available at https://github.com/JaronTu/Multimodal_MVD_Seg .

BACKGROUND: An unintended dural tear (DT) is the most common intraoperative complication of lumbar spine surgery. The unilateral biportal endoscopic technique (UBE) has become increasingly popular for treating various degenerative diseases of the lumbar spine; however, the DT incidence and risk factors specific to UBE remain undetermined. Therefore, this study aimed to evaluate the incidence and risk factors of DTs in UBE.
METHODS: Data from all patients who underwent UBE for degenerative lumbar spinal diseases from November 2018 to December 2021 at our institution were used to assess the effects of demographics, diagnosis, and type of surgery on unintended DT risk.
RESULTS: Overall, 24/608 patients (3.95%) experienced DTs and were treated with primary suture repair or bed rest. Although several patients experienced mild symptoms of cerebrospinal fluid (CSF) leaks, no serious postoperative sequelae such as nerve root entrapment, meningitis, or intracranial hemorrhage occurred. Additionally, no significant correlations were identified between DT and sex (P = 0.882), body mass index (BMI) (P = 0.758), smoking status (P = 0.506), diabetes (P = 0.672), hypertension (P = 0.187), or surgeon experience (P = 0.442). However, older patients were more likely to experience DT than younger patients (P = 0.034), and patients with lumbar spinal stenosis (LSS) were more likely to experience DT than patients with lumbar disc herniation (LDH) (P = 0.035). Additionally, DT was more common in revision versus primary surgery (P < 0.0001) and in unilateral laminotomy with bilateral decompression (ULBD) versus unilateral decompression (P = 0.031). Univariate logistic regression analysis revealed that age, LSS, ULBD, and revision surgery were significant risk factors for DT.
CONCLUSIONS: In this UBE cohort, we found that the incidence of DT was 3.95%. Additionally, older age, LSS, ULBD, and revision surgery significantly increased the risk of DT in UBE surgery.

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BACKGROUND: Accurate preoperative diagnosis of neurovascular compression (NVC) is crucial in the treatment of trigeminal neuralgia (TN) or hemifacial spasm (HFS). At present, there are many magnetic resonance imaging (MRI)-based methods for diagnosing NVC in clinical practice. This network meta-analysis (NMA) aimed to evaluate the diagnostic performance of different MRI-based imaging methods for NVC in patients with TN and HFS.
METHODS: Related studies based on a search of PubMed, Embase, Web of Science and the Cochrane Library were retrieved. A two-way analysis of variance model was constructed for the Bayesian NMA to compare the performance of different diagnostic imaging methods.
RESULTS: Our search identified 595 articles, of which 26 studies (including 2085 patients) related to 4 diagnostic imaging methods (3D time-of-flight magnetic resonance angiography (3D TOF MRA), high resolution T2-weighted imaging (HR T2WI), 3D TOF MRA combined with HR T2WI, and 3D multimodal image fusion (MIF) based on 3D TOF MRA combined with HR T2WI) were included in this NMA. The results showed that 3D MIF based on 3D TOF MRA combined with HR T2WI had the highest related sensitivity, the highest superiority index and the largest area under the receiver operating characteristic curve among all the methods.
CONCLUSIONS: 3D MIF based on 3D TOF MRA combined with HR T2WI had better diagnostic performance for detecting NVC in patients with TN or HSF than other MRI-based imaging methods. This method can be used as an effective tool for preoperative evaluation of MVD.

Neurovascular compression syndrome is caused by vessels touching a cranial nerve, resulting in clinical manifestations of abnormal sensory or motor symptoms. The most common manifestations are trigeminal neuralgia and hemifacial spasm. However, neurovascular compression of the vestibular nerve or glossopharyngeal nerve are rare. In this article, we describe four typical cases of neurovascular compression syndrome. In addition, we analyze the main features of the etiology, neuroimaging, and treatment of this disease.

To investigate the clinical value of electrophysiological tests in indicating pathogenic vascular contact of the 8th nerve in definite vestibular paroxysmia (VP) cases to provide a reference for decompression surgery.
We retrospectively analyzed patients who had vertigo, unilateral tinnitus, or hearing loss and exhibited vascular contact of the 8th cranial nerve by MRI. Participants were classified into the VP or non-VP group according to the criteria of the Bárány Society in 2016. The demographic characteristics and audiological and electrophysiological test results of the two groups were compared. Receiver operating characteristic (ROC) curves were calculated for ABR to determine the best parameters and cutoff values to predict the existence of pathological neurovascular contact in VP.
Thirteen patients in the VP group and 66 patients in the non-VP group were included. VP patients had longer interpeak latency (IPL) I-III and wave III latency compared to non-VP patients (p < 0.001; p < 0.001). According to the ROC analyses, IPL I-III and wave III latency were the best indicators for the diagnosis of VP. The optimal cutoff for IPL I-III was 2.3 ms (sensitivity 84.6%, specificity 95.5%), and that for wave III latency was 4.0 ms (sensitivity 92.3%, specificity 77.3%). There were no differences in the PTA, caloric test, o-VEMP, or c-VEMP results between the two groups.
Prolonged IPL I-III and the wave III latency of ABR strongly suggested that vascular contact of the 8th cranial nerve was pathological, which may provide some references for microvascular decompression surgery of VP.

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Sciatic nerve symptomatology may arise from both intra- and extra-neural pathology, at any point along descent from the sacral plexus to its bifurcation. The potential aetiology is broad, ranging from degenerative spinal disease to muscle, bony and vascular pathology. We present an extremely unusual case of position and exercise-induced nerve compression secondary to arteriovenous malformation and review the potential extraspinal causes, many of which may be ameliorated by surgical excision or decompression. We further discuss the usefulness of diagnostic imaging, specific clinical tests and histopathological tools that may aid in management.