Tetralogy of Fallot is the most common cyanotic CHD and is ideally repaired during infancy. However, delayed diagnosis and limited access to congenital cardiac care may result in presentation during adolescence or adulthood. This study evaluated outcomes of tetralogy of Fallot repair in patients aged ≥ 13 years.

This retrospective cohort study included patients aged ≥ 13 years undergoing primary tetralogy of Fallot repair between June 2016 and June 2025. Demographic, operative, and post-operative data, including early mortality and reintervention, were analysed.

Ninety-four patients underwent repair at a median age of 15 years (interquartile range: 3) and weight of 36.5 kg (interquartile range: 12.2). Pre-operative coil embolisation of aortopulmonary collaterals was required in 26.6%. Mean cardiopulmonary bypass and aortic cross-clamp times were 114.8 ± 49.8 and 82.4 ± 35.6 minutes, respectively. Mean ventilation duration was 7.7 ± 7.1 hours, ICU stay 3.9 ± 1.0 days, and post-operative hospital stay 4.6 ± 1.3 days. Transannular patch repair was performed in 65 patients (69%), while 29 (31%) underwent pulmonary valve-preserving repair, with comparable early outcomes. Thirty-day mortality was 1.06%, and reintervention occurred in 2.1% during a mean follow-up of 38.4 months.

Primary repair of tetralogy of Fallot in late-presenting adolescents and adults can be performed with low early mortality and acceptable morbidity. Careful pre-operative assessment, including identification and management of significant aortopulmonary collaterals, and individualised right ventricular outflow tract reconstruction are important components of management. These findings support definitive repair in appropriately selected late-presenting patients.

Lung cancer patients have a higher risk of suicide, but the long-term patterns and how they differ by treatment type have not been fully characterized. To investigate longitudinal suicide risk among lung cancer patients who underwent surgery compared to matched controls and to examine variations over time by treatment modality and patient characteristics.

We identified 37,215 individuals newly diagnosed with lung cancer between 2010 and 2017 who underwent lung resection within 1 year of diagnosis, along with 1:3 age- and sex-matched controls. Subdistribution hazard ratios (sHRs) and 95% confidence intervals (CIs) for suicide were estimated using a competing risk analysis.

The cohort (mean age 64.0 years; 62.5% male) was followed for a mean of 7.6 years. There were 154 suicides among lung cancer patients (incidence rate 0.6 per 1,000 person-years). Suicide risk peaked during the first year after surgery (sHR 1.88, 95% CI 1.23–2.87) and declined in subsequent years. Patients who underwent surgery alone had a higher risk in the first year (sHR 1.66, 95% CI 1.02–2.69), which gradually decreased over time. In contrast, patients treated with adjuvant chemotherapy or radiotherapy experienced a substantially higher initial risk (e.g., sHR 7.00, 95% CI 3.00–16.37 for surgery + radiotherapy) and maintained a moderate increase in suicide risk even beyond 5 years. Subgroup analyses showed an especially elevated first-year suicide risk among younger adults aged 20–49 years, males, and never smokers.

Suicide risk for lung cancer patients is highest during the first postoperative year, particularly for those who receive multimodal therapy, or are younger adults, males, or never smokers. These findings emphasize the need to prioritize early, tailored psychosocial support in survivorship care to help mitigate long-term suicide risk.

To evaluate medications, surgical procedures, demographics and co-morbidities in Ménière’s disease using TriNetX.

Retrospective cohort analysis.

Among 117,059 Ménière’s disease patients, common medications were corticosteroids benzodiazepines, diuretics and antacids. Surgical procedures were rare: cochlear implantation (1 percent), endolymphatic sac surgery (1 percent), labyrinthectomy (0.3 percent) and vestibular nerve section (0.1 percent). Surgical patients were older (mean 68.4 vs 66 years, p < 0.001), more often male (44.3 percent vs 34.6 percent) and less likely to be Asian (1.6 percent vs 8.3 percent) or African American (2.0 percent vs 4.4 per cent). Co-morbidities included musculoskeletal diseases, metabolic disorders, hypertension, anxiety and/or depression, gastro-oesophageal reflux disease, thyroid disordersand migraine. Melanoma prevalence (6 percent) was 12–15 times higher than in the US population.

Ménière’s disease treatment is dominated by corticosteroids, benzodiazepines and diuretics, with rare surgical procedures. Surgical patients are older, more often male and less likely to be Asian or African American. Co-morbidities include musculoskeletal diseases, hypertension, gastroesophageal reflux disease, thyroid disorders, migraine and higher melanoma prevalence, warranting further research.

Adults with repaired tetralogy of Fallot represent a growing clinical population at risk for long-term cardiovascular complications. Characterising their postoperative course and late outcomes is essential to guide surveillance and management.

To describe the clinical characteristics and long-term outcomes of adult patients (≥18 years) with repaired tetralogy of Fallot who received care at a quaternary-care institution between January 2000 and December 2024.

We performed a retrospective cohort study. Adult patients with a diagnosis of repaired tetralogy of Fallot who had undergone complete surgical repair either during the study period or before it were included. Clinical and sociodemographic data were obtained.Variables related to prior palliative procedures, type of surgical repair, reinterventions (surgical or catheter-based), and long-term outcomes were analysed.

A total of 56 patients were included; 31 (55.4%) were women. The median duration of follow-up after repair was 23 years; twenty patients (35.7%) had undergone a palliative or prior intervention before complete repair. The most common type of outflow tract reconstruction was a transannular patch (37.5%), followed by homograft implantation (25.0%). Reinterventions occurred in 29 patients (51.8%), most commonly pulmonary valve replacement (23 patients, 41.0%), mainly due to progressive pulmonary regurgitation and right ventricular dilation. Arrhythmic complications included premature ventricular contractions in 35.7% of patients. Long-term mortality was 3.6%.

Adults with repaired tetralogy of Fallot demonstrate high long-term survival; however, late complications are common and frequently require surgical or catheter-based reintervention. These findings underscore the need for lifelong specialised follow-up in adult CHD programmes.

Spinal CSF leaks are a known cause of spontaneous intracranial hypotension, often presenting with orthostatic headaches and other neurological symptoms. While epidural blood patches are commonly used as initial treatment, many patients require surgery due to persistent symptoms. This study integrates a retrospective institutional cohort and a systematic literature review to evaluate the safety and efficacy of surgical dural repair for spontaneous spinal CSF leaks.

A retrospective chart review included all patients who underwent surgery for spontaneous spinal CSF leak at a Canadian center between June 2017 and December 2023. Clinical presentation, imaging findings, surgical approach and postoperative outcomes were assessed. A PRISMA-compliant systematic review identified studies reporting surgical management and outcomes for spinal CSF leaks.

Forty patients (21 females, 19 males; mean age 50.48 ± 11.88 years) were included. Type 1 ventral dural CSF leaks predominated (72.5%), most commonly in the thoracic spine. Spinal longitudinal extradural collection and cranial stigmata were present in 70% and 75%, respectively. Microscopic direct dural repair led to clinical improvement in 82.5%, with headache resolution or improvement in 85.72%. The complication rate was 7.5% with all complications being transient. The systematic review included 20 studies (483 patients), reporting an 84.06% pooled surgical success rate, with transient complications most common in direct suturing techniques.

Surgical repair is a safe and effective treatment for spontaneous spinal CSF leaks, particularly in patients with failed conservative treatment. Favorable outcomes support early, anatomically guided surgical intervention.

Cerebrospinal fluid diversion via ventriculoperitoneal (VP) shunting is the mainstay treatment for hydrocephalus. Traditionally, neurosurgeons place the abdominal catheter through abdominal incision, which has become an efficient and standardized technique. This approach carries a 10–30% complication rate, including infection, catheter obstruction, misplacement, hemorrhage and post-operative pain. Laparoscopic assistance (LA) is an emerging alternative to mini-laparotomy, with potential benefits including reduced distal catheter malplacement and shorter operative times. Most investigations on LA are limited to single centers, with no data from Canada. This study aims to identify practice patterns in VP shunting within a Canadian context.

Practicing Canadian neurosurgeons were surveyed using a modified Delphi methodology. The survey was distributed to practicing neurosurgeons via the Canadian Neurosurgical Society and the Canadian Neurosurgery Research Collaborative.

Across two rounds, 36 neurosurgeons participated, representing all provinces with academic neurosurgical centers. Consensus was reached on five out of eight topics. Findings revealed that 65.5% of respondents had experience with LA, and 93% believed it reduced distal catheter malposition. Infection (77.8%), distal catheter obstruction (82.9%) and proximal obstruction (69.4%) were identified as the most common complications, each occurring in up to 10% of cases. In total, 71% anticipated eventual reduced operative times with increased LA experience.

Canadian neurosurgeons did not identify major barriers to LA beyond personal preference. LA is expected to improve distal catheter placement, though its broader benefits remain uncertain. Patient comorbidities were considered a greater risk factor for complications than surgical technique alone.

Contemporary management of aortic coarctation in adults is primarily by percutaneous intervention; however, this is not always possible. Intrapericardial ascending-to-descending aortic grafting is an alternative approach in adults with complex aortic coarctation. It can be performed off-pump and allows for a simultaneous treatment of concomitant cardiac lesions. Our aim was to examine the indications and the clinical long-term outcomes of intrapericardial ascending-to-descending aortic grafting in adults with aortic coarctation.

We retrospectively reviewed demographic, clinical, surgical, and follow-up data of patients who underwent intrapericardial ascending-to-descending aortic grafting at a single tertiary centre between September 1994 and November 2016.

Ten patients were identified. Indications were primary intervention (n = 4), re-coarctation (n = 5), and iatrogenic coarctation of aorta after stent grafting (n = 1). There were no peri-operative deaths. During a mean follow-up of 13.6 ± 9.4 years, one patient died 11 years after surgery, unrelated to intrapericardial ascending-to-descending aortic grafting. All grafts remained patent with no anastomotic pseudoaneurysms at latest follow-up.

The mean systolic blood pressure decreased from 154 ± 24 mmHg at baseline to 134 ± 20 mmHg at latest follow-up (p = 0.05), with the mean number of prescribed antihypertensive medications decreasing from 2.8 ± 1.5 preoperatively to 1.6 ± 0.5 (p = 0.11).

Intrapericardial ascending-to-descending aortic grafting is a safe and effective approach for adults with complex coarctation of aorta or re-coarctation not suitable for a percutaneous or conventional surgical approach. Improved blood pressure control and reduced anti-hypertensive use were observed long-term.

Congenitally corrected transposition of the great arteries is a rare congenital cardiac condition with varied presentations, complicating treatment decisions. This study evaluates the impact of medical management, physiologic repair, and anatomic repair on health-related quality of life.

A cross-sectional follow-up was conducted on 50 congenitally corrected transposition of the great arteries patients from a cohort of 240 at Cleveland Clinic (1995-2020). Health-related quality of life was assessed using MacNew and PROMIS-10 questionnaires. Echocardiographic data on systemic atrioventricular valvular regurgitation and systemic ventricular dysfunction were analysed. A time-varying coefficient model evaluated these factors’ impact on health-related quality of life.

Anatomic repair had significantly higher PROMIS-10 Physical T-scores compared to physiologic repair (median 50.9 vs 41.6, p = 0.04). MacNew Social scores were significantly higher for medical management compared to physiologic repair (median 6.8 vs 6.0, p = 0.02). Echocardiographic analysis revealed that systemic ventricular dysfunction had a stronger immediate impact on health-related quality of life. Systemic atrioventricular valve regurgitation showed a delayed negative effect, significant at 6-10 years after echo, although this effect gradually decreased over time. Anatomic repair patients had better systemic ventricular function (84.6% normal), and less systemic atrioventricular valve regurgitation (69.2% had none) compared to medical management and physiologic repair groups.

Anatomic repair improves health-related quality of life in congenitally corrected transposition of the great arteries patients, with physiologic repair showing some gains over time. Health-related quality of life data should provide important guidance regarding treatment decisions, especially in well-balanced congenitally corrected transposition of the great arteries patients.

Few studies have investigated stapedotomy using 1470 nm diode laser, and the present article contributes with clinical experience.

A retrospective analysis was conducted to investigate hearing performance of 22 patients undergoing 1470 nm diode laser-assisted primary stapedotomy.

In 8/22 cases, accidental breaches to the inner ear by the laser and in 14/22 cases the stapedotomy was performed as planned only by drill. Air–bone gap and loss of sensorineural hearing were low and with no significant differences for groups at follow-up. No patients with breaches by laser reported new or worse tinnitus.

Accidental breaches in the stapes footplate using this diode laser did not appear to equate with inner ear damage within this limited cohort. Hearing outcomes were not significantly affected. These findings should be interpreted with caution. Further studies evaluating this laser wavelength in stapedotomy is required.

The virtues of the scapular tip free flap for reconstruction of complex midface oncologic defects have been claimed by many. To obtain optimal functional and aesthetic results, precise positioning of the free flap used for reconstruction is paramount.

Four cases illustrate our approach to midface reconstruction with angular branch-based scapular tip flaps. A standard surgical navigation device was used both to plan bone cuts for the oncologic resection and to optimise the positioning of the flap.

Case 1 illustrates the usefulness of navigation for reconstruction of total palato-septectomy defects, using a horizontally positioned flap. Optimal neo-palate height, alignment of the anterior nasal spine and nasal projection were obtained. For cases 2–4, vertical inset of the flap yielded optimal midface projection and orbital floor position.

Surgical navigation systems are useful adjuncts for midface reconstruction.