bluuebunny/crossref_metadata_2025 huggingface dataset:
130 Heterotopia and Neurodevelopmental Outcomes Patients With Prenatal Diagnosis of Myelomeningocele or Myeloschisis
Authors: Flanders Tracy Ma , Punchak Maria , Land Sierra , Flohr Sabrina , Bostwick Anna , Reynolds Tom , Schmidt Katie , Ertz Danielle , Schreiber Jane , Moldenhauer Julie , Soni Shelly , Adzick N. Scott , Heuer Gregory G.
Published: March 2024

INTRODUCTION:

Gray matter heterotopia is a cortical malformation and a known risk factor for seizures and epilepsy. Historically, presence of heterotopia in one or both cerebral ventricles was a concern for postnatal neurological status in patients undergoing fetal closure of myelomeningocele/myeloschisis. There is little information known regarding the overall impact of heterotopia in this patient population.

METHODS:

A retrospective chart review was conducted for all patients evaluated at the Center of Fetal Diagnosis and Treatment with a diagnosis of myelomeningocele or myeloschisis between June 2016 to March 2023. Gray matter heterotopia was determined from prenatal US and confirmed with prenatal and postnatal MRI. The Bayley Scales of Infant and Toddler Development (edition III and IV) were used for neurodevelopmental assessments.

RESULTS:

Of 497 patients evaluated with a prenatal diagnosis of myelomeningocele or myeloschisis, 99 were found to have gray matter heterotopia on prenatal MRI. In the postnatal period, 347 patients ultimately delivered at our institution, of which 26 had confirmed gray matter heterotopia on postnatal MRI as well as underwent neurodevelopmental testing. The median age at neurodevelopmental assessment was 13.3 months. The median cognitive and language scores (95 and 99, respectively) were average in those patients with gray matter heterotopia.

CONCLUSIONS:

This study suggests that the presence of gray matter heterotopia in patients with prenatal diagnosis of myelomeningocele or myeloschisis is not associated with increased cognitive or language delay on neurodevelopmental testing at approximately 1 year of age. These findings can aid clinicians during prenatal consultation regarding fetal repair of spina bifida.
133 BMAL1 is Upregulated in Pediatric High-Grade Gliomas
Authors: Nettnin Ella Adeline , Garcia Cesar Andres , Schonfeld Ethan , Arana Sophia , Barros Guinle Maria Isabel , Gibson Erin , Prolo Laura Marie
Published: March 2024

INTRODUCTION:

Pediatric high-grade gliomas (pHGG) are highly invasive brain tumors with poor survival outcomes, and novel therapeutic approaches are urgently needed. Recently, a retrospective study found timing of Temozolomide administration affects survival in adult patients with glioblastoma (Damato et al. 2021). There has, however, been limited exploration into circadian gene expression in pediatric gliomas.

METHODS:

We analyzed expression of BMAL1, a key circadian gene, in pediatric gliomas using bioinformatic approaches, Western blotting, and immunocytochemistry (ICC). We first compared BMAL1 expression in pLGGs and pHGGs using published publicly available data from cBioPortal for Cancer Genomics. Immunoblotting was utilized to determine BMAL1 protein expression levels in patient specimens of pHGG, pLGG and cortex from epilepsy surgery. Immunocytochemistry on synchronized primary tumor lines was used to show localization of BMAL1 protein.

RESULTS:

Using data from cBioPortal, we found significantly higher expression of BMAL1 in pHGGs compared to pLGGs (0.349 + 1.05 vs 0.0545 + 0.666, p < 0.001). Western blotting showed increased expression of BMAL1 in HGG tumor specimens compared to LGG and cortical specimens. Immunostaining demonstrated cellular localization of BMAL1.

CONCLUSIONS:

In this study, we found that the circadian gene BMAL1 is expressed in pHGGs, and that expression is higher in pHGGs compared to pLGGs and cortex. Next steps will be to understand how timing of Temozolomide in relationship to the circadian cycle affects tumor cell survival.
139 Alternative Anatomical Landmarks for the Lateral Femoral Cutaneous Nerve: Cadaveric Study With Implications for Difficult Decompressive Cases
Authors: Tucci Marissa , Anadkat Samir , Dumont Aaron S. , Spinner Robert J. , Tubbs R. Shane
Published: March 2024

INTRODUCTION:

During decompressive procedures, localizing the lateral femoral cutaneous nerve (LFCN) using only the anterior superior iliac spine (ASIS) can be difficult due to variations in nerve course and specific patient anatomy, e.g., body habitus. Therefore, the present anatomical study was performed to provide additional landmarks for localizing this nerve.

METHODS:

The LFCN was dissected in 30 adult cadavers (60 sides). The nerve was exposed distal to the ASIS in the proximal thigh and along an imaginary line connecting the ASIS to the midpoint of the patella with the lower limb in a neutral position.

RESULTS:

The main trunk of the LFCN was identified deep to the fascia lata on all sides, 5-8 cm distal to the ASIS along the ASIS-patella line. The nerve was bordered by the sartorius muscle superficially and medially, the tensor fasciae latae muscle laterally, and the proximal rectus femoris tendon on its deep surface. Proximal to this triangular region, the LFCN was found to cross superficially to the proximal sartorius muscle on 58 sides and through the muscle on two sides.

CONCLUSIONS:

The study findings suggest an alternative method for identifying the LFCN, which could help locate the nerve during challenging cases and reduce the incidence of iatrogenic LFCN injuries resulting from inadequate anatomical landmarks.
142 Common Peroneal Nerve Decompression for Slimmers Palsy: A Case Series With Intraoperative Stimulation
Authors: Miranda Stephen , Chauhan Daksh , Nguyen Jessica , Zager Eric L. , Ali Zarina S.
Published: March 2024

INTRODUCTION:

Slimmer’s palsy refers to common peroneal nerve (CPN) entrapment neuropathy associated with rapid or significant weight loss. Indications and outcomes for CPN decompression in this population remain unclear. While there are reports documenting functional improvement after surgical decompression, there are also case series demonstrating recovery with non-operative management, including diet modification, nutritional supplementation, and rehabilitation.

METHODS:

Retrospective chart review was performed to identify patients (age >18) who underwent CPN decompression between 2012-2021 with documented history of weight loss >5 kg. Demographics, weight loss, operative details, electromyography findings, onset/degree of weakness by manual muscle testing (MMT), and extent of improvement were collected. Pre- and post-decompression conduction thresholds were measured intraoperatively. Descriptive statistics were performed, including paired t-tests for pre- and post-operative MMT scores and pre- and post-decompression conduction thresholds.

RESULTS:

Five total patients were identified. Median age was 39 years. Most were male (3/5), White (5/5), privately insured (3/5), current/former smokers (3/5), and normal weight (3/5). Mean weight loss was 27 kg (range: 5-45). Reasons for weight loss included intentional, chemotherapy-related, bariatric surgery, and one case of unexplained weight loss. Mean MMT score at time of evaluation was 2.0 + 0.45 for tibialis anterior (TA), 2.0 + 0.55 for extensor hallucis longus (EHL) and 2.2 + 0.58 for peroneus longus (PL). Time to surgery ranged from 4-6 months. Mean postoperative MMT scores were significantly improved in TA (4.6 + 0.24, p = 0.007), EHL (4.6 + 0.24, p = 0.007) and PL (4.6 + 0.24, p = 0.02) compared to baseline. Mean conduction thresholds (5.75 + 1.89) were lower after decompression (1.2 + 0.31), although not statistically significant in this sample (p = 0.12).

CONCLUSIONS:

In this small series, CPN decompression restored function for patients with Slimmer’s palsy. Nerve conduction block was observed intraoperatively in most cases, perhaps supporting a compressive etiology for this condition.
147 Medial Septal Nucleus Theta Stimulation Improves Spatial Working Memory and Increases Hippocampal Neurovascular Activity in a Mouse Model of Alzheimers Disease (5xFAD)
Authors: Wu Kevin , Agyerman Kofi , Zepeda Nancy , Crown Lindsey , Bergosh Matthew , Choi Wooseong , Liu Charles Y. , Christopoulos Vasileios , Lee Darrin J.
Published: March 2024

INTRODUCTION:

Alzheimer’s disease (AD) remains among the most prolific neurodegenerative disorders. The pathogenesis is the result, in part, of aberrant cerebral circuitry; in particular, the mesolimbic-septohippocampal circuit and its associated medial septal nucleus (MSN). Interestingly, the administration of theta stimulation via deep brain stimulation (DBS) to the MSN has been demonstrated to increase hippocampal theta oscillations, which are critical to the role of the hippocampus in learning and memory. Recently, functional ultrasound imaging (fUSI) has emerged as a method of evaluating large-scale neural activity with both high spatiotemporal resolution (∼100 μm3) and sensitivity to slow blood flow (∼1 mm/s). fUSI allows for the in-vivo analyses of neurovascular changes secondary to our theta-burst neuromodulatory intervention.

METHODS:

12 male 5xFAD mice were partitioned into two groups, one received theta-burst stimulation targeting the MSN (n = 4) and the other acted as controls (n = 8). Following stimulation, spatial working memory was assessed via the Barnes maze task. An additional 44 C57BL/6 mice were partitioned into three groups: one receiving theta (7.7 Hz) stimulation to the MSN (n = 16), one receiving gamma stimulation to the MSN (100 Hz, n = 14), and the remaining group acting as the control (n = 14).

RESULTS:

The MSN theta stimulation group of 5xFAD mice demonstrated decreased latency compared to controls (p = 0.003). CBF volumes in the hippocampus were relatively increased in the theta-burst group when compared to both control and gamma stimulation groups.

CONCLUSIONS:

Our results demonstrate significant improvement in cognitive performance secondary to MSN theta-burst stimulation. Additionally, these changes were mirrored by CBF volume increases in the hippocampus in a frequency-dependent manner. These findings provide evidence for the therapeutic role of theta MSN stimulation in the treatment of AD and furthers fUSI’s role in evaluating in-vivo CBF.
150 Backbone Spiking Sequence as a Basis for Preplay, Replay, and Default States in Human Cortex
Authors: Vaz Alex , Wittig John , Inati Sara , Zaghloul Kareem A.
Published: March 2024

INTRODUCTION:

Sequences of spiking activity are a fundamental feature of many neural systems, and recent evidence suggests that they play an important role in information coding in the human brain. A parallel set of studies also asserts that sequential activity may in part derive from a pre-existing network structure. Sequential spiking activity therefore may arise as a natural property of the neurophysiologic properties of the human cortex.

METHODS:

We measured single unit spiking activity in the human cortex by implanting Utah micro-electrode arrays into participants who performed an episodic memory task while undergoing invasive monitoring for potential resective epilepsy surgery.

RESULTS:

We confirm the presence of an average backbone spiking sequence identified during pre-task rest that is stable over time and different cognitive states. These resting backbone sequences served as a scaffold for cognitively relevant sequential spiking activity occurring later in the recording session. We further demonstrate that backbone sequences are composed of both rigid and flexible sequence elements, and that flexible elements serve to promote memory specificity when forming and retrieving new memories.

CONCLUSIONS:

Here we demonstrate that backbone sequences can be measured in the human cortex and that they persist over time and through different cognitive states. Our data show that backbone sequences are composed of both rigid and flexible elements, and flexibility around the backbone allows for the formation of memory specific spiking sequences. Taken together, our results provide the first evidence for backbone spiking sequences in the human cortex, and more generally suggest a cognitive role of predetermined spiking network dynamics in the human brain.
156 Stenting of Intracranial Stenosis With a Fibrin-heparin Coated Stent Multicentre Experience
Authors: Nordmeyer Hannes , Dorn Franziska
Published: March 2024

INTRODUCTION:

Mechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke due to large vessel occlusions (LVO). However, in up to 30% MT may not result in successful recanalization due to an underlying stenosis or clot recalcitrant to retrieval. Bail-out stenting has been reported to be a treatment option to achieve permanent recanalization.

METHODS:

We retrospectively analysed data from 16 stroke centres. Patients treated with the CREDO heal Stent were divided into two groups: symptomatic high-grade intracranial stenosis (sICAD group) and persisting LVO due to underlying stenosis after at least one mechanical thrombectomy attempt (Rescue Stenting group). Primary endpoints were the improvement of stenosis grade and the rate of successful recanalization after stenting defined as mTICI = 2b for the sICAD and the Rescue Stenting group respectively. Favourable neurological outcome was defined by modified Rankin Score (mRS) at 90 days.

RESULTS:

121 patients were treated from 2021-2023 with the CREDO heal Stent. Rescue stenting and sICAD treatment was performed in 82 and 39 cases respectively. Overall, a final TICI = 2b score was achieved in 94.5%. In 14% periprocedural complications occurred were in-stent thrombosis accounted for 6.3% (rescue stenting group). The mean stenosis grade in the sICAD group was 90% before and 15% after PTA and stenting. On follow-up (n = 27) restenosis was observed in 2.8%.

CONCLUSIONS:

The CREDO® heal stent offers a new treatment option for patients with sICAD or with persistent occlusion during thrombectomy procedures. The final mTICI sore is in accordance with uncoated devices. The rate of restenosis is low compared to previous trials. Its effectiveness with regard to long-term ischemic complications has to be evaluated in the prospective ReCHRUT trial.
164 Characterization of Market Movements and Private Equity in Neurosurgery Practices and Hospitals
Authors: Koester Stefan Wolfgang , Dambrino Robert J. , Bishay Anthony , Bhamidipati Akshay , Liles Campbell , Cole Tyler S. , Gooldy Tim , Youngerman Brett E. , Chambless Lola Blackwell
Published: March 2024

INTRODUCTION:

Surgical services could be faced with shifts in corporate management, restructuring, and incentives as trends such as private equity (PE) investment in healthcare continue to evolve. The number of surgical services acquired by PE firms has increased significantly over the last 20 years. Due to financial vulnerability and movement towards digital health, PE activity within healthcare has further grownsince the COVID pandemic.

METHODS:

PitchBook and Mergermarket were used to query deals involving neurosurgical practice within the United States at any time. Exclusion criteria consisted of non-neurosurgery practices and debt restructuring deals without a change in ownership. The company name, deal type, financing year, and state were extracted for each deal. Deal type was stratified by the following categories: angel investment, mergers and acquisitions, private equity and venture capital (PE/VC), and corporate buyout. Internal debt refinancing such as leveraged recapitalization was excluded from the analysis.

RESULTS:

A total of 125 companies were discovered in the initial search. After further review, 63 companies were included in final analysis. The deals occurred between 1994 to 2022 and involved companies in 27 different states. Of the 63 companies, 36 (57.1%) involved mergers or acquisitions, 16 (25.4%) involved private equity or venture capital firms, 7 (11.1%) involved corporate buyouts, and 4 (6.3%) involved angel investments.

CONCLUSIONS:

PE is increasingly involved with neurosurgery practices, with an associated decline in mergers and acquisitions. Future qualitative investigation is required to help characterize physician attitudes of PE-run practices in comparison to non-PE practices.
168 Sustenance of Substantial Clinical Benefit in Adult Spinal Deformity Corrective Surgery Patients: A Minimum 5-Year Outcomes Analysis
Authors: Mir Jamshaid M. , Galetta Matthew , Tretiakov Peter S. , Dave Pooja , Das Ankita , Janjua Burhan , Jankowski Patrick , Schoenfeld Andrew , Passias Peter G.
Published: March 2024

INTRODUCTION:

Clinical outcomes for adult spinal deformity patients has been extensively reported on, however factors associated with sustaining two year (2Y) substantial clinical benefit (SCB) till five year (5Y) remains unclear.

METHODS:

ASD patients fused from at least L1 to sacrum with 5Y postoperative data were included. Good Outcome(GO) was defined as: no reoperation, mechanical failure, proximal junctional failure(PJF) based on Lafage criteria, and [meeting either: (1) SCB for Oswestry Disability Index(ODI)(decrease of >18.8), or (2) ODI <15 and Scoliosis Research Society(SRS-22r) Total>4.5]. Multivariable analysis controlled for age, BMI, CCI, frailty, deformity, HRQLs, and surgical variations.

RESULTS:

330 ASD patients were included. 42% achieved GO at 2Y(2+) while 47% at 5Y(5+) did. 71% of 2+ cohort attained 5+. In 2- cohort, 29% achieved 5+.

Isolating 2+ cohort, assessing 5+ vs 5-: 5- had greater SVA deformity at 5Y (p < .05).

Regaining the level of activity postoperatively was associated with 4x higher odds of maintaining GO from 2Y to 5Y (p < .05).

The odds of achieving GO at 5Y in 2+ decreased by 47% for each additional comorbidity and decreased by 74% in those that had lower extremity paresthesias at BL (both p < .05). Decreased number of levels fused, decreased correction in SVA and increased correction in PI-LL to be predictive of sustaining 2Y GO till 5Y (all p < 0.05).

CONCLUSIONS:

Overall, 47% had substantial clinical benefit till 5Y. While 71% of patients at 2Y sustained good clinical outcome till 5Y, major contributors to its loss were adjacent segment changes and rod fracture. The odds of achieving SCB till 5Y decreased by nearly 50% for each additional comorbidity. Decreased levels fused along with decreased correction of SVA and increased correction in PI-LL were predictive of optimal sustaining of clinical outcomes.
172 Does the Number of Social Risk Factors Affect Long-term Patient-Reported Outcomes and Satisfaction in Those With Cervical Myelopathy? A QOD Study
Authors: Park Christine , Shaffrey Christopher I. , Than Khoi Duc , Bisson Erica Fay , Sherrod Brandon , Asher Anthony L. , Coric Domagoj , Potts Eric A. , Foley Kevin T. , Wang Michael Y. , Fu Kai-Ming G. , Virk Michael S. , Knightly John J. , Meyer Scott A. , Park Paul , Upadhyaya Cheerag D. , Shaffrey Mark Edwin , Lee Buchholz Avery , Tumialan Luis Manuel , Turner Jay D. , Agarwal Nitin , Chan Andrew , Chou Dean , Chaudhry Nauman Shaukat , Haid Regis W. , Mummaneni Praveen V. , Michalopulos Giorgos , Bydon Mohamad , Gottfried Oren N.
Published: March 2024

INTRODUCTION:

It is not clear whether there is an additive effect of social risk factors in affecting patients with cervical spondylotic myelopathy (CSM) from achieving both a minimum clinically important difference (MCID) in outcomes and satisfaction after surgery.

METHODS:

This was a retrospective study of the prospective Quality Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) cohort. Social risk factors included race, education, employment, and insurance. Patients were considered to have improved from surgery if 1) they reported a score of 1 or 2 on the NASS index and 2) met the MCID in patient-reported outcomes (VAS neck and arm pain, NDI, EQ5D, or mJOA score) at 24-month follow-up.

RESULTS:

Of the 1,141 patients included in the study, 205 (18.0%) had zero, 347 (30.4%) had one, 334 (29.3%) had two, and 255 (22.3%) had three social risk factors. The 24-month follow-up rate was 87.4% for patient-reported outcomes. After adjusting for all significant covariates, patients with one or more social risk factors were less likely to improve from surgery in all measured outcomes including VAS neck and arm pain, NDI, EQ-5D, and mJOA (all p < 0.05) compared to those without any social risk factors. Patients with two or three social risk factors were more likely to fare worse in all outcomes compared to those with only one social risk factor (all p < 0.05).

CONCLUSIONS:

Compared to those without any social risk factors, patients who had at least one social risk factor were less likely to achieve MCID and feel satisfied after surgery. The effect of social risk factors is additive in that those with a higher number of risk factors are less likely to improve compared to those with only one social risk factor.
189 Describing a Novel Diagnosis Pathway for Cluneal Neuropathy
Authors: Vinjamuri Shreya , Trivedi Jay , Queenan Natalia , Reyes Maikerly , Sathe Anish , Shelley India , Gonzalez Ozuna Glenn Arturo , Harrop James S. , Heller Joshua E.
Published: March 2024

INTRODUCTION:

Sacroiliac (SI) pain is frequently experienced by individuals who have undergone lumbosacral surgery, with a quarter of cases due to SI joint dysfunction (SIJD). Diagnosing SIJD involves following rigorous NASS guidelines. If these criteria are not met, cluneal neuropathy (CN), a rare cause of SI pain, should be considered. In this study we describe a novel diagnostic pathway for identifying CN as there are currently no formal diagnostic criteria.

METHODS:

A single institution’s medical records were queried for patients who underwent US testing for CN from 2018-2022. Data was extracted for the following variables: SI provocative maneuvers (PM), PSIS tenderness, SIJD injection pain relief, CN ultrasound, and CN injection pain relief. Demographic information and surgical history were recorded. SIJD negative patients were evaluated using proposed diagnostic pathway and data was analyzed using descriptive statistics.

RESULTS:

24 patients (mean age 58.8 years, 62.5% female) were included. All patients presented with comorbid spinal pathology. 87% were positive for both CN (positive entrapment on ultrasound + <75% pain relief on SI injection) and Thigh Thrust, 78% for FABER, 86% for Compression, 100% for Sacral Distraction, 89% for Gaenslen’s. 79% had tenderness upon PSIS palpation. 92% of patients with >3 positive PMs had positive CN.

CONCLUSIONS:

This novel pathway effectively showcases cluneal neuropathy as a potential etiology for low-back-pain. Ultimately, SIJD provocative maneuvers were positive in patients with CN, likely because these maneuvers cause compression of the cluneal nerves. Thus, a diagnosis of CN should be considered, particularly in patients with PSIS tenderness or previous SI fusion.
190 Do Fractional Anisotropy and Apparent Diffusion Coefficient From Diffusion Tensor Imaging Correlate to Symptoms of Radiculopathy? A Case Series From BACPAC MRI
Authors: Park Christine , Liu Felix , Han Misung , Cummings Jennifer , Bharadwaj Upasana , Mummaneni Praveen V. , Majumdar Sharmila , Chin Cynthia
Published: March 2024

INTRODUCTION:

Quantitative diffusion tensor imaging (DTI) parameters such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) are used to detect axonal pathology in nerve injuries.

METHODS:

Ganglia of the lumbar plexus nerves (L1-5) were input as seeds to track the nerve fibers using Constant Solid Angle reconstruction. Fiber tracts and values of FA and ADC were extracted along the lumbar plexus nerve profiles. Change in pain (VAS) and disability (ODI) after interlaminar epidural steroid injection at site of compression was compared to the changes in FA and ADC values.

RESULTS:

Five exams from three patients with bilateral L4-5 foraminal narrowing were included in this study. Two patients were imaged at two time points, three months apart. The average age of the cohort was 62.6 ± 5.3 years. Mean FA values were lowest at L3 (left: 0.32 ± 0.08; right: 0.35 ± 0.05) and L4 (left: 0.39 ± 0.06; right: 0.38 ± 0.03). Correspondingly, mean ADC values were highest at L3 (left: 0.0017 ± 0.0002; right: 0.0016 ± 0.0001) and L4 (left: 0.0.0013 ± 0.0001; right: 0.0015 ± 0.0002). For one patient, pain did not change in severity and ODI improved from severe to moderate disability after steroid injection: FA increased with no significant change in ADC. For another patient, pain increased from moderate to severe and ODI stayed the same after injection: FA decreased and ADC did not significantly change.

CONCLUSIONS:

The tractography generated from the segmentation model demonstrated lowest FA and highest ADC values corresponding to the level of compression. For patient outcomes, the FA values were observed to be more sensitive to changes in pain and disability compared to the ADC values.
193 Price Transparency and Cash Discounts for Implantable Pulse Generator Implantation in the United States
Authors: Koester Stefan Wolfgang , Bishay Anthony , Paulo Danika Lea , Triana Austin , Dambrino Robert J. , Feldman Michael , Liles Campbell , Ball Tyler Joseph , Bick Sarah K.B. , Chambless Lola Blackwell , Englot Dario J.
Published: March 2024

INTRODUCTION:

Since the Healthcare PRICE Transparency Act (January 2021), hospitals are required to publicly disclose standard prices for care and procedures.

METHODS:

This is a cross-sectional study conducted with data obtained from Turquoise Health from January to April 2021. Current procedural terminology (CPT) code 61885 was used to query cases of DBS IPG connected to a single electrode. Inclusion criteria required reporting of both commercial and cash prices. Hospitals were filtered for cash to commercial price ratios <2. The Healthy Marketplace Index (HMI) was used to assess city-level hospital competition and the 2022 Lown Institute Hospital Index (LIHI) was used to assess hospital bed size. Differences in continuous variables were analyzed with a Kruskal-Wallis test.

RESULTS:

Eight-hundred forty-six centers met inclusion criteria, of which 98 (11.6%) provided commercial and cash prices and a cash to commercial ratio of <2. Of those 98, the median commercial price was $18,562 (IQR $1,572-28,476) and the median cash price was $4,340 ($1,596-27,223), with a median intrahospital cash to commercial price ratio of 0.78. Sixty-eight of those 98 (69.4%) hospitals provided a discount for cash payments (cash:commercial ratio<1) of 41% relative to commercial and 39% discount relative to Medicare prices (p<0.001). Medicaid prices significantly differed between hospital sizes. Univariate analysis demonstrated that hospital size and market share were not significant predictors of providing a fair cash estimate. Twenty-eight (56%) states provided a cash discount.

CONCLUSIONS:

Prices for IPG implantation varied greatly, with self-pay cash pricing providing significant discounts relative to commercial pricing. Cost data should be systematically analyzed and leveraged to increase cost awareness of the procedure, inform hospital reimbursements, and broaden patient accessibility to this valuable therapy.
204 Laster Interstitial Thermal Therapy for Primary and Recurrent Meningioma: A Prospective and Retrospective Multi-institutional Study
Authors: Pugazenthi Sangami , Leidig William , Chiang Veronica , Rodriguez Analiz , Prabhu Sujit S. , Haskell-Mendoza Aden Pepe , Fecci Peter Edward , Placantonakis Dimitris G. , Abram Steven R. , Lega Bradley Charles , Kim Albert H.
Published: March 2024

INTRODUCTION:

Meningiomas are a common central nervous system tumor, and a subset are aggressive lesions resistant to standard therapies. Laser interstitial thermal therapy (LITT) has been successfully applied to other brain tumors, but its role in meningioma treatment is understudied.

METHODS:

Eight United States-based hospitals enrolled patients with meningioma in the prospective multicenter registry and pooled additional retrospective enrollments for this cohort study. Demographics, procedural, safety, and outcomes data were collected and analyzed using standard statistical methods.

RESULTS:

Twenty adult patients (12 prospective, 8 retrospective) with LITT-targeted meningiomas were accrued. Patients underwent LITT for primary (6 patients) and recurrent tumors (14 patients, ranging from 1st to 12th recurrence). Twenty percent of patients (4/20) had exhausted all other treatment options. Median length of follow-up was 1.3 years. One-third of primary (2/6) and one-half of recurrent meningiomas (7/14) recurred during follow-up. Of those with grading information, grade 2 meningiomas were most common (9/18), followed by Grade 1(5/18), and Grade 3 (4/18). Sixty percent (60%) of patients (12/20) had convexity meningiomas treated with LITT. 2 patients (10%) had post-procedural complications, of which one resolved. One-year estimated local control (LC), progression-free survival, and overall survival were 55.3%, 48.4%, and 86.3%, respectively. In the 10 patients who had 91% ablative coverage, 1-year estimated LC was 64.8%. High grade (Grades 2 and 3) patients (n = 13) treated with LITT had a 1-year LC of 46.3%.

CONCLUSIONS:

This cohort represents the largest series of patients with meningioma undergoing LITT and supports the safety of the procedure in this tumor type. LITT can offer a much-needed treatment option, especially for those with multiply recurrent meningiomas and where heavy pretreatment limits remaining treatment options. LITT should be considered in the armamentarium of treatment options for meningiomas.
206 Spinal Meningioma: An Institutional Case Series With Preliminary Results of Molecular Profiling
Authors: Nandoliya Khizar Rehan , Youngblood Mark W. , Chaliparambil Rahul , Wolinsky Jean-Paul
Published: March 2024

INTRODUCTION:

Spinal meningiomas have historically been considered similar entities to intracranial meningiomas, but recent developments in molecular profiling have identified unique features.

METHODS:

Retrospective study of patients undergoing resection of spinal meningioma between 2010–2022 at our institution. Patient, radiographic, and clinical characteristics were reviewed and analyzed with standard statistical methods. Molecular profiling was conducted on three tumors.

RESULTS:

A total of 33 tumors were resected in 26 patients. Median follow-up was 39.5 (0–149) months. Twenty-five (89.3%) procedures were in female patients. The median age at surgery was 62 (18–84) years. The median tumor was 1.9 (0.9–9) cm. Six tumors (18.2%) were in the cervical region, 28 (48.5%) were thoracic, and 2 (6.1%) were lumbar. Sixteen (48.5%) tumors were located dorsally, 11 (33.3%) ventrally, and six (18.2%) extended dorsoventrally. Gross total resection was achieved in 25 (75.8%) tumors. Median progression-free survival was 139 months. On histological analysis of 28 tumors, 26 (92.9%) were WHO grade 1 and 2 (7.1%) were WHO Grade 3 with a median Ki-67 of 3 (1–20)%. Fourteen (50.0%) tumors were psammomatous, seven (25%) were meningothelial, two (7.1%) were anaplastic, and one was transitional. Molecular profiling was available for three tumors. All three were negative for TERT promoter mutations and exhibited loss of chromosome 22. Chromosomal microarray analysis also detected gains in chromosomes 3p, 9, 11, 12, and 20 and loss of chromosomes 16 and 19 in Tumor 1. Tumor 3 also showed loss of chromosomes 12p and X, with copy-neutral loss of heterozygosity affecting chromosomes 5q, 7q, and 14q.

CONCLUSIONS:

Preliminary molecular profiling studies of spinal meningiomas show features distinct from intracranial meningiomas, so there is a need for their further molecular characterization.
210 Defining the Learning Curve for Cerebral Angiography Using a Novel Web-Based Feedback Application and Head-Mounted Video Review
Authors: Nguyen Vincent , Motiwala Mustafa , Dallas Jonathan , Parikh Kara , Hopkins Benjamin , Khahera Anadjeet Singh , Sorenson Jeffrey M. , Arthur Adam S. , Mack William J. , Khan Nickalus
Published: March 2024

INTRODUCTION:

The milestones that a resident or fellow should reach to achieve competence in cerebral angiography have yet to be defined.

METHODS:

Two neurosurgical residents were given a written knowledge exam before and after rotating on the endovascular service. Cerebral angiography diagnostic and treatment cases were prospectively collected in a novel web-based, multi-institutional feedback application. These residents performed cerebral angiography cases under graduated supervision while wearing head-mounted cameras for subsequent review with direct feedback. Residents and reviewers independently utilized CaseCurve, a novel neurosurgical resident performance tracking application, as a platform for performance rating. Numerical scores were assigned ranging from 1 (novice) to 5 (masterful) in the following categories: access, catheter navigation, table operation, closure, efficiency, finesse, angiographic interpretation, and catheter knowledge. The number of times the supervising surgeon had to take over the case was recorded. Arch anatomy and vessel tortuosity were graded. Operative videos were analyzed for operator inefficiencies and time metrics for sheath insertion and target vessel selection. Angiographic efficiency was assessed with fluoroscopic doses/times and procedural durations.

RESULTS:

Both residents demonstrated improvement in cognitive performance as measured by written assessment scores. Significant improvements were observed in technical performance as measured by numerical scores assigned by self-evaluation, faculty review, objective measures of angiographic efficiency, and the number of times the supervising surgeon had to take over the procedure. Concordance between faculty and resident self-evaluations was 74.2%, with residents underestimating their performance in 21% and overestimating in 5%.

CONCLUSIONS:

There is significant educational value for the trainer and trainee offered by our novel web-based feedback application and head-mounted video review. This data allows for accurate assessments of skill acquisition and delineation of appropriate milestones/learning categories for trainees in endovascular neurosurgery.
220 Outcome Evaluation of Repeat Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations
Authors: Mantziaris Georgios , Dumot Chloe , Liscak Roman , Lee Cheng-Chia , Lunsford L. Dade , Niranjan Ajay , Peker Selcuk , Mathieu David , Kondziolka Douglas S. , Tripathi Manjul , Palmer Joshua , Zada Gabriel , Cifarelli Christopher Paul , Pikis Stylianos , Dayawansa Sam , Sheehan Jason P.
Published: March 2024

INTRODUCTION:

Repeat stereotactic radiosurgery (SRS) for persistent cerebral arteriovenous malformation (AVM) has generally favorable patient outcomes. However, reporting studies are limited by small patient numbers and single-institution biases.

METHODS:

This multicenter, retrospective cohort study included patients treated with repeat, single-fraction SRS between 1987 and 2022. The primary outcome was a favorable patient outcome, defined as a composite of nidus obliteration in the absence of hemorrhage or radiation-induced neurological deterioration. Secondary outcomes were obliteration, hemorrhage risk, and symptomatic radiation-induced changes. Competing risk analysis was performed to compute yearly rates and identify predictors for each outcome.

RESULTS:

The cohort comprised 505 patients [254 (50.3%) males; median (IQR) age, 34 (15) years] from 14 centers. The median clinical and MRI follow-up was 52 (61) months and 47 (52) months, respectively. At last follow-up, favorable outcome was achieved by 268 (53.1%) patients (5-year probability = 50%, 95% CI = 45%-55%). Obliteration was achieved by 300 (59.4%) patients (5-year probability = 56%, 95% CI = 51%-61%). Twenty-eight patients (5.6%) experienced post-SRS hemorrhage with an annual incidence rate of 1.38 per 100 patient-years. Symptomatic radiation-induced changes were evident in 28 (5.6%) patients, with most occurring in the first 3 years. Larger nidus volumes (between 2 and 4cm3, subdistribution hazard [SDH] 0.61, 95% CI 0.44-0.86, p = 0.005; >4 cm3, SDH 0.47, 95% CI 0.32-0.7, p < 0.001) and brainstem/basal ganglia involvement (SDH = 0.6, 95% CI = 0.45-0.81, p < 0.001) were associated with reduced probability of favorable outcome.

CONCLUSIONS:

Repeat stereotactic radiosurgery confers reasonable obliteration rates with a low complication risk. With most complications occurring in the first three years, extending the latency period to 5 years generally increases the rate favorable patient outcomes and reduces the necessity of a third intervention.
225 SpineTrak: The First Randomized Controlled Trial Using the Apple Watch to Objectively Track Spine Surgical Patients
Authors: Tang Megan , Leung Christopher , Fatemi Parastou , Desai Atman , Tomkins-Lane Christy , Zygourakis Corinna Clio
Published: March 2024

INTRODUCTION:

Early mobilization after surgery is associated with reduced complications, shorter hospitalization, and improved psychological well-being. Current methods for evaluating spine surgery outcomes rely on subjective, patient-reported outcome measures (PROMs). Wearable activity monitors, including the Apple Watch (AW), allow for real-time tracking of objective activity metrics.

METHODS:

Eligibility: Adult patients undergoing elective spine surgery. Patients are randomized 1:1 to the intervention vs control group. All patients complete PROMs pre-operatively and at 6-weeks, 3-months, 6-months, and 1-year post-operatively. Only intervention patients receive AW and download a study-specific app to collect AW data. AW health measures are visualized in reports provided to patients and surgeons.

RESULTS:

To date, we have enrolled 200 patients (n=100 intervention; n=100 control). Among patients past 1-year post-operation (n=129), 74% reached the minimal clinically-important difference in improvement for ODI/NDI, SF-36 PCS, and/or EQ-VAS relative to pre-operation. Intervention patients (n=95) have worn AW 81.3%±21.1% of the days for 14.6±4.7 hours/day. At 6-weeks post-operation, 73% of patients responded that they were very satisfied with using the AW in their spine care. 61% found seeing their AW activity data helpful. 96% of neurosurgeons agreed that AW reports help them understand their patients’ recovery. Preliminary analyses of patient recovery profiles have predicted the requirement for revision surgery in some participants.

CONCLUSIONS:

Preliminary results indicate patients are compliant with wearing the AW, and both patients and surgeons are satisfied with its use in their spine care. Initial analyses show poor correlation between AW measures and PROMs, emphasizing the need for a metric that combines objective and subjective measures to better track spine surgery recovery.
227 Spine-tuned Natural Language Models and Bespoke Regular Expression Classifiers for Automated Spinal Surgery Registry Development
Authors: Alber Daniel Alexander , Cheung Alexander , Kurland David B. , Lee Sangwon Karl , Jiang Lavender , Liu Chris , Oermann Eric Karl
Published: March 2024

INTRODUCTION:

Surgical research demands the development of clinical registries, often through time-intensive manual chart review. Natural language processing (NLP) may accelerate registry development, and an ideal automatic registry (autoregistry) algorithm would be highly accurate while requiring minimal manual data annotation. NLP approaches including bespoke Regular Expression (RegEx) classifiers and Large Language Models (LLM) possess distinct strengths and weaknesses and have not been compared in the setting of autoregistry development.

METHODS:

We used an institutional data lake to retrieve 31,502 neurosurgical operative notes. A standardized set of spinal procedures was chosen for inclusion in the autoregistry. 200 manually annotated notes were used for training and testing purposes. RegEx classifiers were engineered to retrieve procedural info from unprocessed notes. A family of 110-million parameter BERT models, including LLM pre-trained on clinical text, was fine-tuned for the same tasks. We also tested a open-source 7-billion parameter LLM chatbot, Vicuna, without fine-tuning.

RESULTS:

The RegEx classifiers were able to identify spinal procedures and associated vertebral levels in nearly 99% of operative notes. Fine-tuned LLM identified common procedures (e.g. spinal fusion and laminectomy) with greater than 95% accuracy but performed poorly for rarer procedures (e.g. XLIF, corpectomy) and vertebral body identification. Qualitative evaluation of the Vicuna chatbot showed potential for the same tasks, following iteratively refined prompting.

CONCLUSIONS:

The goal of autoregistry development is to minimize time- and labor-intensive manual chart review. We found that fine-tuned LLM could not match the accuracy and efficiency of the RegEx classifier. However, LLM may be well-suited to expand existing clinical databases that provide a robust training set. Further work combining NLP approaches will attempt to develop a pipeline for autoregistry development from natural language (plain English) queries.
234 Predictive Radiomics in Glioblastoma: A Machine Learning Approach for Personalized Survival Outcomes and a Novel Web Application
Authors: Karabacak Mert , Margetis Konstantinos
Published: March 2024

INTRODUCTION:

Diverse characteristics of glioblastomas (GBMs) complicate survival predictions, requiring personalized approaches.

METHODS:

From The Cancer Imaging Archive (TCIA) database, 611 patients from the UPENN-GBM collection and 500 patients from the UCSF-PDGM collections were included in this study. UPENN-GBM collection was used as the training set and for 5-fold internal cross-validation, whereas the UCSF-PDGM collection was used for external validation. Survival at 3, 6, 12, and 24 months were the outcomes of interest. Necrotic tumor core, enhancing tumor, and whole tumor segmentation masks for T1 with contrast, T1, T2, and FLAIR images were obtained automatically with a pre-trained Swin UNETR model. From these regions of interest, radiomic features were extracted using the PyRadiomicsLibrary. The LASSO (least absolute shrinkage and selection operator) method was employed for radiomic feature selection. The ML algorithms TabPFN, XGBoost, LightGBM, Support Vector Machine (SVM), and Random Forest (RF) were utilized to predict the survival outcomes of interest.

RESULTS:

The highlight of our study, our web application is available for use via the following link: https://huggingface.co/spaces/MSHSNeurosurgeryResearch/Radiomics_Based_Glioblastoma_Survival_Prediction_Tool.

CONCLUSIONS:

This study not only provides a radiomics pipeline for predicting the GBM survival outcomes, but it also contributes to the clinical adoption of these models by developing a fully automatic and user-friendly web application which make them available to clinicians worldwide.
236 Bilateral Intrathalamic Infusion of rAAVrh8-Hexa/Hexb in a Phase 1/2 Clinical Trial for Gene Therapy in Infantile and Juvenile Tay-Sachs and Sandhoff Disease; Surgical Technique
Authors: Cataltepe Oguz , Daci Rrita , Owusu-Adjei Thomson Brittany , Mietus Constance Jennifer , Shazeeb Mohammed , Kuhn Anna , Sena-Esteves Miguel , Flotte Terrence
Published: March 2024

INTRODUCTION:

Tay-Sachs (TSD) and Sandhoff (SD) diseases are rare,monogenic and severe neurodegenerative disorders due to Hexosaminidase A deficiency. We performed the first-in-human bilateral thalamic (BiTh) delivery of rAAVrh8-HEXA/HEXB in 8 children in a Phase 1/2 clinical trial.

METHODS:

Stereotactic infusion cannula placement was performed using ROSA robotic platform. Bilateral trajectories were planned via the trans-frontal route..Head stabilization was accomplished using radiolucent horse-shoe head rest and radiolucent pin-skull clamps. Flexible infusion cannulas were placed through small drill holes using ROSA guidance. Cannula stabilization was achieved using a construct which combined the Navigus brain biopsy platform and flexible cannula bolt. Insertion accuracy was verified with intraoperative CT images. Patients received one of the three doses in each thalamus: 180 mcl (5.87E + 12vg), 360 mcl (1.17E + 13vg) or 720 mcl (2.35E + 13vg). Drug infusion rate was 4 mcl/minute and completed in 90-360 minutes depending on drug dosage.

RESULTS:

Eight patients received treatment; 5 infants (6, 11, 13, 17, and 20 months) and 3 juvenile (5, 6, 12 years). Duration of follow up was 2-28 months. Outcome assessments included safety, CSF biochemistry, MRI/MRS/DTI, and neurodevelopmental observations. Surgery and drug infusions were well-tolerated. Post-infusion MRIs showed signal enhancement volume coverage in thalamus from 8%-44% parallel to escalating doses. The only surgery related complication was superficial wound dehiscence in two patients. Infants showed partial stabilization or improvement, including in oral feeding and myelination. In juveniles, dystonic posturing worsened after dosing in all 3 patients treated. Two patients died much later from reasons unrelated to surgery or drug infusion.

CONCLUSIONS:

Surgery for BiTh infusion of rAAVrh8-HEXA/HEXB for gene therapy in infants with TSD and SD is well-tolerated. Patients respond well to treatment with some stabilization or improvement.
241 Disparities in Access to Epilepsy Surgery Care in Children With Drug Resistant Epilepsy: Implications For Long-Term Survival Outcomes
Authors: Scoville Jonathan , Zhang Lu , Hall Matt , Lam Sandi
Published: March 2024

INTRODUCTION:

Our recent publication in Lancet Child and Adolescent Health examined long-term survival rates for pediatric patients with drug-resistant epilepsy (DRE) treated with antiseizure medications (ASMs) only, ASMs plus vagus nerve stimulation (VNS), and ASMs plus cranial epilepsy surgery in a large United States (US) administrative database. The difference in survival probabilities was statistically significant (p < .001). Adjusted probabilities of survival beyond 10 years were 89.27% for the ASMs only cohort (95%CI, 87.71%-90.85%), 92.65% for VNS cohort (95%CI, 90.62%-94.72%), and 98.45% for cranial surgery cohort (95%CI, 97.53%-99.38%).

METHODS:

Patients aged 0-17 years with DRE between 01/01/2004-31/12/2020 were identified from the Pediatric Health Information System data set across 49 US pediatric hospitals. Patients treated with ASMs only or ASMs plus VNS or ASMs plus cranial epilepsy surgery were included. Chi-square tests determined associations between treatment time and preoperative factors such as treatment type, age, sex, race/ethnicity, insurance type, geographic region, epilepsy type, and medical complexity (presence of pediatric complex chronic conditions [PCCCs]).

RESULTS:

18,292 total patients were included: 10,240 patients treated with ASMs only, 5,019 patients with ASMs plus VNS, 3,033 patients with ASMs plus cranial epilepsy surgery. There were significant differences in age, geographic region, race/ethnicity, presence of PCCCs, diagnosis, and insurance type (p < 0.001). Those treated surgically, either with VNS implantation or cranial epilepsy surgery, were 2 years older than ASMs only. ASMs only patients were less ikely to be reported as non-Hispanic white (51.78%), less likely have a focal/partial epilepsy diagnosis (8.74%), and less likely carry private medical insurance (35.82%).

CONCLUSIONS:

We show a link of disparities in pediatric epilepsy surgery care and survival outcomes. Focused strategies are needed to expand access to comprehensive epilepsy care with neurosurgical evaluation and offerings when appropriate.