such as traditional angiographic monitors, holograms, virtual or augmented reality models or 3D printed models. Users are able to experience realistic 3D virtual elements with augmented depth perception and binocular field of view. Newer technology has now allowed for interaction with 3D objects within these virtual environments through the use of hand gestures or hand controllers. The authors describe our preliminary experience with MxR as an adjunct tool to traditional angiographic imaging in the preprocedural workup of patients with complex aneurysms using a novel spatial computer, the Magic Leap One device (Magic Leap, Inc Plantation, Florida) which uses a virtual retinal display, which superimposes 3D computer-generated imagery over real world objects, by projecting a digital light field into the user's eye. Materials and Methods Tomographic Angiographic (DynaCT) data was imported and segmented to create 3D meshes of the intracranial vasculature. The 3D meshes were then projected into MxR space, allowing the operator to inspect the vasculature using a MxR headset (Magic Leap) as well as interact with the aneurysm and adjacent vessels (handling, rotation, magnification, and sectioning) using hand gestures or hand controllers. Results 3D segmentation of a complex aneurysms was successfully performed and projected into MxR. Conventional and MxR visualization modes were equally effective in identifying and classifying the pathology. MxR visualization allowed the operators to manipulate the dataset to achieve a greater understanding of the anatomy of the parent vessel, the angioarchitecture of the aneurysm, and the surface contours of all visualized structures. Conclusion This preliminary study demonstrates the feasibility of utilizing MxR for preprocedural evaluation in patients with anatomically complex neurovascular disorders. This novel visualization approach may serve as a valuable adjunct tool in deciding patient-specific management, including decisions on prognostication and open surgical and endovascular treatment options.

Objectives Different parameters have been identified in patients with oral squamous cell carcinomas (OSCC) that have a serious impact on survival, including residual tumour and extracapsular spread. Moreover, other factors, including the lymph node ratio (LNR) and lymph node yield (LNY), have been suggested as prognostic markers. Material and methods This retrospective study included patients diagnosed with OSCC and cervical lymph node metastases during the years 2010–2020. Patients’ records were evaluated regarding lymph node status, final therapy regime, tumour recurrence, time to death, tumour association with death, disease-free survival (DSF), and overall survival (OS). Results In 242 patients with a mean age of 63.57 ± 11.24 years, treated either by selective neck dissection (SND; n = 70) or by modified radical neck dissection (MRND; n = 172), 5772 lymph nodes were detected. The LNR and LNY were identified as independent risk factors in OS and DFS. The optimal cut-off point for the LNY was ≥ 17 lymph nodes in the SND and ≥ 27 lymph nodes in the MRND group. The metastatic lymph node clearance (MLNC) was established as a score to relate the LNR and LNY to the extent of lymph node removal. Survival analysis showed statistically significant differences among score levels. Conclusions As information about the extent of nodal dissection is excluded from LNR and LNY, we propose the use of a new scoring system comprising individual cut-off values for LNY and LNR with regard to the extent of neck dissection. Clinical Relevance MLNC might help to identify high-risk OSCC patients with metastatic lymph nodes.

Moyamoya angiopathy (MMA) can be treated using direct, indirect, or combined revascularization procedures. We perform combined revascularization using the STA-MCA bypass and minimally invasive encephalodurosynangiosis (MIS-EDS). Due to lack of systematic analyses to date it remains unclear whether and to which extent this limited EDS serves as a growth source for extracerebral blood vessels into the brain. The objective of the current study is to characterize the extent of angiographic filling of MIS-EDS and STA-MCA bypass development over time and to determine possible predictors of EDS development in adult MMA patients. Single-center retrospective analysis of 81 MMA patients (139 hemispheres) treated with a MIS-EDS and STA-MCA bypass was performed. Angiographic images and clinical/operative data were reviewed and scored. Uni-/ and multivariate Cox regression analyses identified preoperative predictors of good EDS vascularization. At 3–6 months after surgery EDS showed moderate and high angiographic filling in 40% and 5% of hemispheres, respectively. After 12 months moderate and high filling was found in 57% and 4% of hemispheres, respectively. STA-MCA bypass filling was moderate in 47% and high in 7% of hemispheres at 3–6 months and 45% moderate and 9% high after 12 months. High STA-MCA bypass filling on angiography was a negative predictor of EDS development. MIS-EDS is a simple technique and serves as a source of vessel growth into the brain. EDS development lags behind that of STA-MCA bypass and can be recommended as an additive revascularization source when combined with a direct bypass.