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Background: Ulnar nerve transposition is used for cubital tunnel syndrome (CuTS) with nerve instability. The aim is to report a modified technique for ulnar nerve transposition using medial intermuscular septum and Osborne's ligament as a double-strand helix sling to recreate a sliding channel for the ulnar nerve and the functional outcomes at follow-ups. Methods: Twenty-five patients with persistent CuTS underwent nerve release and subcutaneous transposition from January 2017 to January 2022 in our institute. Among them, 9 patients were excluded due to incomplete medical records, lack of follow-up history, or bilateral limb numbness. The medial intermuscular septum with one end attached was excised to rebuild a tension-free double-strand helix sling by anchoring at the residue of Osborne's ligament. The modified Mc-Gowan classification was applied to evaluate the disease severity preoperatively. The quick disability of arm and shoulder and hand (quickDASH) questionnaire and visual analogue scale (VAS) scores were used to evaluate pre- and postoperative symptoms. Ultrasound imaging was utilized for nerve structure evaluation before surgery and at follow-ups. Results: Sixteen out of twenty-five patients received follow-ups postoperatively (ranging from 9 to 69 months, 36 months in average). No findings indicated subluxation of ulnar nerve or recompression by ultrasound imaging examination. According to quickDASH and VAS scores and physical examination, 14 out of 16 patients showed postoperative improvement in symptoms and function at final follow-ups. Interpretation: In this modified technique, the medial intermuscular septum and Osborne's ligament can create tension-free helix sling for stable and smooth sliding and preventing subluxation after nerve transposition, which is highly effective and safe for CuTS treatment.

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PURPOSE: Despite various existing surgical techniques, treatment of facial nerve palsy remains difficult. The purpose of this report is to present the cerclage sling technique using temporalis fascia to manage paralytic lagophthalmos. METHODS: A series of six patients underwent a cerclage sling technique using temporalis muscle fascia to treat paralytic lagophthalmos. The technique is presented in detail. Symptoms, palpebral fissures, and lagophthalmos were assessed pre- and postoperatively. Data were submitted for statistical analysis. RESULTS: After surgery, all patients achieved a reduction in clinical symptoms. The upper eyelids had lowered, and the inferior eyelids had elevated, reducing ocular exposure even if mild residual lagophthalmos was present. CONCLUSION: Cerclage using the temporalis muscle fascia sling technique is a safe and effective procedure to treat facial nerve paralytic lagophthalmos. A reduction in ocular exposure and lagophthalmos provides improvement in clinical symptoms and eyelid function.

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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.

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Background: The biomedical glue sling technique is a convenient and effective method for vertebrobasilar artery-associated cranial nerve diseases but postoperative hemorrhage is poorly understood. Methods: We retrospectively reviewed 14 of 1157 patients associated with cranial nerve diseases who were subjected to the biomedical glue sling technique in microvascular decompression at our hospital from January 2015 to January 2020. Results: There were 14 patients with cranial nerve diseases included in this study. A clinical diagnosis of postoperative hemorrhage was made after an average of 41.75 h (ranging between 0.5 and 95 h). A cerebellopontine angle hemorrhage was presented in 5 patients, while basal ganglia hemorrhage was observed in 2 patients. Both a cerebellopontine angle and brainstem hemorrhage was seen in 1 patient. Distal supratentorial subdural hemorrhage was recorded in 6 patients. The correlation coefficient was -0.1601 (p = 0.7094) between the standard deviation of systolic blood pressure and the Hemphill Score, -0.2422 (p = 0.5633) between the coefficient of variation of systolic blood pressure and the Hemphill Score, and -0.0272 (p = 0.9489) between the range of systolic blood pressure and the Hemphill Score. Conclusions: The incidence of postoperative hemorrhage after MVD with the biomedical glue sling technique is higher than with traditional MVD and most cases have a favorable prognosis. Postoperative symptoms are the main area of concern and changes in symptoms usually suggest the occurrence of hemorrhage. Several factors, including surgical procedures, the release of CSF, and blood pressure might be associated with hemorrhaging. We still believe such a technique is an efficient approach to treating complicated cranial nerve diseases.

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Although the importance of the retrieval of an optional inferior vena cava filter (o-IVCF) has gained attention because of the awareness of a high complication rate with long indwelling time, the o-IVCF retrieval rate remains low. The advanced retrieval technique of o-IVCF may increase the retrieval rate, which in turn diminishes future adverse events. Through two cases, we describe how to perform the novel approach "bidirectional sling technique with biopsy forceps." This technique will improve the retrieval rate in patients following the failure by conventional retrieval technique.

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Hemifacial spasm caused by an elongated, tortuous, or enlarged vertebral artery (VA) can be difficult to treat. Greater rates of incomplete cure also have been noted.1-6 In this video, we demonstrate the key steps of a simple and effective adjustable sling technique of an ectatic VA transposition for microvascular decompression. In this patient, an ectatic VA was stacked on the posterior inferior cerebellar artery, and together they compressed the root exit zone (REZ) of the facial nerve. We cut a suturable and unabsorbable artificial dural graft into a sling. The rougher side of the sling was used to wrap around the VA to obtain more friction and avoid sliding. Suitable width of the sling was determined to prevent prominent indentation on the VA. We wrapped the VA at a perforator-free zone and lifted the VA away from the REZ by pulling the sling in a lateral direction. At the same time, the anchor point for the aneurysm clip to hold the sling at the lateral skull base also was determined. We made a small dural incision at the anchor point, where an aneurysm clip was applied to hold the sling securely under tension but not to cause kinking of the VA/posterior inferior cerebellar artery. The patient had no hemifacial spasm immediately after the operation and thereafter. This adjustable sling technique provides an easy and strong hold to maintain an ectatic VA away from the REZ of the facial nerve (Video 1).

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BACKGROUND: It is recommended to remove retrievable inferior vena cava filters (r-IVCFs) when they are no longer needed because their presence may give rise to serious complications related to prolonged placement of the filter. An advanced filter retrieval technique may help improve the retrieval rate.Methods and Results:107 consecutive patients (mean age; 61±18 years, male 53%) in whom r-IVCF retrieval was attempted were prospectively enrolled between April 2012 and December 2018. The frequently used advanced techniques were sling technique and biopsy forceps dissection technique. Retrieval success was 75% with standard retrieval technique alone; however, the overall retrieval success rate improved to 98% with advanced techniques. We observed few serious complications related to the retrieval procedure. Logistic multivariate analysis identified prolonged indwelling time (P=0.0011) and embedded hook in the caval wall (P=0.0114) as independent predictors, and the cutoff value for the indwelling time for requirement of advanced technique was 80 days. CONCLUSIONS: Advanced retrieval techniques helped improve the retrieval rate without serious complications. We may need to consider the referral of patients to centers with expertise in advanced retrieval techniques when the indwelling time is >80 days, and pre-retrieval CT image shows a hook embedded in the vessel wall.

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Annually, approximately 65,000 inferior vena cava (IVC) filters are placed in the United States (Ahmed et al., J Am Coll Radiol 15:1553-1557, 2018). Approximately 35% of filters are eventually retrieved (Angel et al., J Vasc Interv Radiol 22: 1522-1530 e1523, 2011). Complications during filter retrieval depend heavily on technique and filter position. In this paper, we review risk factors and incidence of complications during IVC filter removal. We also discuss ways these complications could be avoided and the appropriate management if they occur.

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PURPOSE: When tendon allograft is not an option, knee posterolateral corner reconstruction by biceps femoris tenodesis gains increasing interest. This study investigated such question; "Does biceps femoris tenodesis result in clinical and functional outcomes comparable to Larsen fibular-based sling in concurrent posterolateral corner and anterior cruciate reconstruction? PATIENTS & METHODS: From October 2014 till December 2018, 19 patients of concurrent anterior cruciate and posterolateral corner injury were prospectively categorized according to posterolateral reconstruction technique into group-(A) of 10 patients managed by Larsen sling and group-(B) of 9 patients managed by biceps femoris tenodesis. Patients were evaluated for preoperative and 2-year postoperative knee range of motion, varus stress and prone dial tests, Lysholm and IKDC scores, return to work, and instability recurrence. RESULTS: Statistical analysis revealed matched demographics between groups. At mean of 29months postoperatively, average knee flexion was 146°; while extension loss didn't exceed 1° in both groups. There was no significant difference between groups in Lysholm and IKDC scores; (P-value= 0.710 and 0.210 respectively). CONCLUSION: Despite it is non-anatomic technique, biceps femoris tenodesis can achieve clinical and functional outcomes comparable to Larsen fibular-based sling in concurrent posterolateral corner and anterior cruciate reconstruction; while offering advantages of simplicity and quickness and overcoming tendon graft unavailability.

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Microvascular decompression is a well-established technique used to relieve abnormal vascular compression of cranial nerves and associated pain. Here the authors describe three cases in which a sling technique was used in the treatment of cranial nerve pain syndromes: trigeminal neuralgia with predominant V2 distribution, hemifacial spasm, and geniculate neuralgia and right-sided ear pain. In each case, the artery was mobilized from the nerve and tethered with a sling. All three patients had reduction of symptoms within 6 weeks. The video can be found here: https://youtu.be/iM7gukvPz6E.

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Objective: To explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy. Methods: Between January 2016 and May 2017, 15 patients of severe breast hypertrophy had undergone breast reduction using inferior pedicle technique with inverted T pattern combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m 2, with an average of 30.8 kg/m 2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 g on average (range, 480-1 050 g). Results: The skin flap necrosis at the "T" trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shapes of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape and 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 13 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetric nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast shape in 4 cases, and unsatisfactory breast shape in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate of 93.3% (14/15). Conclusion: For severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.

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Objective: To explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy. Methods: Between January 2016 and May 2017, 15 patients of severe breast hypertrophy had undergone breast reduction using inferior pedicle technique with inverted T pattern combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m 2, with an average of 30.8 kg/m 2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 g on average (range, 480-1 050 g). Results: The skin flap necrosis at the "T" trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shapes of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape and 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 13 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetric nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast shape in 4 cases, and unsatisfactory breast shape in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate of 93.3% (14/15). Conclusion: For severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.

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BACKGROUND: Microvascular decompression is the most effective treatment for hemifacial spasm. However, when encountering hemifacial spasm associated with vertebral artery (VA), the procedure is more challenging and requires complicated operation techniques. The authors retrospectively analyzed the clinical characteristics of this group of cases and investigated reasonable transposition procedures for different anatomic classifications. METHODS: We retrospectively analyzed 117 cases that underwent their first microvascular decompression for hemifacial spasm between June 2010 and December 2016, which had all associated with vertebral artery compression diagnosed by preoperational radiology examination. The study first classified offending vessels into 3 types according to operative anatomy and designed personalized decompression management according to different forms of neurovascular conflict. Curative effects and complications were assessed. RESULTS: The offending vessels were artificially divided into 3 types according to both arterial pattern and compression direction: 1) ipsilateral VA plus anterior inferior cerebellar artery compressing the facial nerve from the ventrolateral direction in 72 (61.5%) cases; 2) ipsilateral VA plus posterior inferior cerebellar artery compressing the facial nerve from the caudal-medial direction in 31 (26.5%) cases; 3) bilateral VA compressing the facial nerve in 14 (12.0%) cases. We selected corridors to expose the neurovascular conflict site between the suprafloccular-transhorizontal fissure approach and subtonsillar-transcerebellomedullary fissure approach. The methods of decompression consist of anteromedial and posterolateral transposition by using biomedical glue-coated Teflon sling. Sufficient decompression of the offending vessels was safely performed in all cases. All cases had total relief of symptoms immediately after their operations. Follow-up periods ranged from 16-90 months, and total recovery occurred in 110 cases (94.0%). In 7 cases (6.0%), 90% recovery occurred. CONCLUSIONS: Accuracy and comprehensive recognition of anatomic features of the offending vessels are crucial for the management of hemifacial spasm associated with vertebral artery compression. Appropriate approaches combined with the biomedical glue-coated Teflon sling transposition technique can allow adequate mobilization of the vertebral artery and bring complete postoperative symptom relief for most cases.

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BACKGROUND: A 52-year-old woman had a 20-month history of progressive radiating pain in the left arm and numbness on C7 dermatome. CASE DESCRIPTION: On physical examination, left head rotation aggravated the radiculopathic pain. For an anatomic diagnosis of the vertebral artery and nerve root, magnetic resonance angiography was performed (computed tomography angiography was not possible because of her dye allergy history). Magnetic resonance angiography showed a left vertebral artery loop entering at the C6-7 intervertebral foramen. Surgical microvascular decompression was performed by an anterior cervical approach and the loop of the artery was fixed using a sling technique. Postoperative computed tomography angiography showed that the left vertebral artery was retracted anteriorly and the C7 nerve root was decompressed in the intervertebral foramen at the left C6-7 level. CONCLUSIONS: The patient's radiculopathic symptoms were improved and especially the aggravated pain by left head rotation subsided dramatically.

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OBJECTIVE: To explore a method of breast reduction which ensures well nipple and areola lactation function, adequate blood supply and good medial fullness and projection. At the same time, this study could evaluate the advantages of the combination of inferior pedicle method and dermal suspension sling technique for breast reduction. METHODS: From 2011.11 to 2013.8, 13 women have undergone breast reduction using utilizing inferior pedicle combined with the dermal suspension sling technique. The inferior pedicle was designed with medial and lateral triangular flaps in the areas where normally be excised. These triangular flaps were deepithelialized and defatted. The flaps were attached to the chest wall above the inferior pedicle to create a dermal "cage". RESULTS: After operation, Sensation of nipple and areola complex, breast projection and shape were sustained during follow-up, of which the median interval was 12 months. No patient had poor projection and bottoming out. CONCLUSION: Dermal suspension and horizontal dermal placation provides a structural foundation to the inferior pedicle. It is an effective method of treatment for breast reduction, in that the sensation and lactation function of nipple and areola complex get further guaranteed, have nice breast projection and shape, and can be applied to all cases of breast reduction.