bluuebunny/crossref_metadata_2025 huggingface dataset:
185 Cannabis Dependence and Health Care Utilization Following Cervical and Lumbar Spine Fusions: National Database Analysis
Authors: Alkin Victoria , Dietz Nicholas , Sharma Mayur , Drazin Doniel
Published: March 2023

INTRODUCTION:

Recent increases in cannabis use have been associated with broader legalization and social acceptance. Smoking tobacco leads to a higher incidence of pseudoarthrosis and complications following spinal fusion. However, little research has been done regarding the impact of cannabis on outcomes following spine fusions.

METHODS:

The IBM MarketScan Database (2009-2019) was used to identify patients who underwent single or multilevel cervical or lumbar fusions. Patients were categorized based on cannabis abuse disorder. Inpatient hospitalization outcomes (length of stay, discharge disposition, complications, payments), post-discharge outcomes (reoperation, readmission, outpatient services, medication refills, payments), and complications were analyzed at 6- and 12- months following index procedure. Exact match was used to control for unbalanced demographics. SAS 9.4 was used for data analysis.

RESULTS:

The exact match cohort had 2958 cervical fusion patients (1479 with a cannabis-related disorder) and 3204 lumbar fusion patients (1602 with a cannabis-related disorder). For cervical fusion, no significant difference between patients with and without cannabis-related disorder was found for most peri- and postoperative complications, overall complications, or discharge home. Users had significantly higher occurrence of sepsis (1.1% vs 0.3%, P = 0.0073) and significantly lower hospitalization payments ($18541 vs. $21137, P=0.0019). For lumbar fusion, no difference was found for overall complications or specific peri- and postoperative complications. Users had significantly lower hospitalization payments ($22612 vs. $29013, P = 0.0002). In both the cervical and lumbar groups, no differences were found in reoperation. Opioid use was lower for users directly post-operation, but higher 3-12 months post-operation.

CONCLUSIONS:

Cannabis dependence and abuse disorders are not associated with worsened perioperative outcomes in patients undergoing single or multilevel cervical or lumbar fusions.
189 Novel Wireless Battery-Free Fully Passive Flexible Brain/Spine Implant for Improved Recovery of Function Through Epidural Stimulation
Authors: Garcia Diogo P. , Gullick Daniel , Benbuk Ahmed , Liu Shiyi , Esmaeli Hamid , Nikkhah Medhi , Christen Jennifer , Quinones-Hinojosa Alfredo
Published: March 2023

INTRODUCTION:

Acquired motor impairment from diseases such as stroke, trauma, epilepsy, and cancer remains an important cause of disability. Current treatments provide insufficient brain/spine recovery, with most patients failing to recover adequate motor function with rehabilitation alone. Brain stimulation can lead to enhanced synaptic density and synaptic response after long-term stimulation and enhanced motor function recovery. However, non-invasive options remain inadequate and invasive approaches are associated with unacceptable risks.

METHODS:

A flexible and transparent silicone elastomer substrate was used through microfabrication processes, with an external antenna near the implant to control the stimulation. In vitro validation was accomplished by wireless stimulation of human-induced pluripotent stem cell derived cardiomyocytes (hiPSC-CMs). In vivo validation was performed by motor cortex stimulation on an anesthetized rat. The corresponding hindlimb motion was captured by video. To separate implant-evoked movement from spontaneous movement, we compared the peak hindlimb velocity during 0.5 sec post-stimulation periods vs. the 0.5 sec pre-stimulation periods, across a continuous series of N = 43 stimulation pulses.

RESULTS:

Cultured hiPSC-CMs cells demonstrated well-controlled beating behavior under 0.5, 1, and 2Hz wireless stimulation. Statistical analysis further confirmed the change in beating rate corresponded with stimulation frequency (p < 0.001). The recorded hindlimb movement under wireless motor cortex stimulation demonstrated synchronization with the delivered voltage pulse trains. Average peak hindlimb velocity during pre-stimulation periods was 0.8 ± 0.4 mm/sec (± S.D.); during post-stimulation periods, 47 ± 13 mm/sec. A two-sample t-test confirmed the applied wireless power directly evoked movement, (p < 0.001).

CONCLUSIONS:

We have developed a wireless, battery-less implant with demonstrated efficacy in vitro and in vivo. Efforts at long-term safety evaluation are ongoing in a smaller and larger animal model as a bridge to phase 0/1 clinical trials.
199 Rates of Upper Extremity Compression Neuropathies Among Obese Patients Compared to Non-Obese Controls and Obese Patients Who Underwent Bariatric Surgery
Authors: Khalid Syed Ibad , Maasarani Samantha , Thomson Kyle , Pires Giovanna , Becerra Adan , Adogwa Owoicho , Mehta Ankit Indravadan , Noland Shelley , Torquati Alfonso
Published: March 2023

INTRODUCTION:

Upper extremity compression neuropathies(UECN) are increasingly prevalent and decrease the quality of life of affected individuals. Studies suggest obesity as a risk factor for carpal tunnel syndrome, the most common type of UECN.

METHODS:

A retrospective cohort study was conducted using the PearlDiver Mariner Database, an all-payor claims database containing claims for over 53 million patients from 2010 to 2019 in all 50 US states. Rates and odds of all types of UECN were compared between 1:1:1 exact matched cohorts of obese patients who were medically managed, obese patients who underwent bariatric surgery, and nonobese patients (111,967 patients in each cohort).

RESULTS:

Compared with nonobese patients, patients with obesity were significantly more likely to develop any UECN (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.09–1.18), carpal tunnel syndrome (OR, 1.15; 95% CI, 1.10–1.30), and 2 or more UECN (OR, 1.34; 95% CI, 1.20–1.48). Compared with obese patients who were managed medically, obese patients who underwent bariatric surgery were significantly less likely to develop any UECN (OR, 0.87; 95% CI, 0.84–0.91) and carpal tunnel syndrome (OR, 0.85; 95% CI, 0.81–0.89).

CONCLUSIONS:

Obese patients have higher odds of both single and concomitant UECN, specifically carpal tunnel syndrome, compared with nonobese patients. Bariatric surgery decreases the odds of developing UECN compared with obese patients not undergoing surgical intervention.
207 An Investigation Into the Characteristics of Peri-Lead Edema After Deep Brain Stimulation Surgery
Authors: Devara Ethan , Dang Huy , Shofty Ben , Sheth Sameer A.
Published: March 2023

INTRODUCTION:

Peri-lead edema (PLE) is an increasingly recognized effect of deep brain stimulation (DBS) surgery. Despite this, PLE remains poorly characterized, with reports of the phenomenon’s incidence and clinical meaning differing widely among studies.

METHODS:

We regularly obtained 2 CT scans at each stage of routine DBS surgery (lead implantation and implantable pulse generator implantation) in 55 consecutive patients. Both image sets (early and late postoperative CTs) were inspected for PLE, and edema volume was manually segmented. Clinical characteristics were procured by chart review. Edema volume was assessed quantitatively and compared with clinical postoperative course to investigate any possible correlations.

RESULTS:

Zero (0%) and 24 (43.6%) patients were found to have PLE at stage one and stage two imaging, respectively. Nineteen of the edema patients were treated for Parkinson’s Disease and 5 for essential tremor. DBS targets were STN (12), VIM (6), and GPi (6). Mean edema volume was 8.10 ± 5.66 mL, with a median of 8.91 mL and ranging from 1.60 to 26.90 mL. Closer inspection of volume into left- and right-hemispheric PLE ascertained no discernible difference between each or to the total (ANOVA F < 0.0005, p = 0.99), nor did an analogous partition into volume by target (ANOVA F = 0.19, p = 0.90). Three patients experienced symptomatic PLE, all of whom had DBS targeting VIM. One patient had experienced seizure, another with altered mental status and gait instability, and the last had dizziness and weakness. All fully recovered following antiepileptic medication for the patient with seizure, and the other two following steroid administration.

CONCLUSIONS:

PLE occurs in about half of the patients undergoing DBS and is usually asymptomatic. Symptomatic PLE may be managed to resolution in an outpatient setting with steroid administration.
208 DBS-Induced Improvement in Cognitive Control is Mediated by Theta Oscillations in Human Intracranial Recordings
Authors: Allawala Anusha , Vartany Stephanie , Mathura Raissa , Ritz Harrison , Adkinson Joshua , Gadot Ron , Oswalt Denise , Shenhav Amitai , Goodman Wayne , Pouratian Nader , Bijanki Kelly R. , Borton David , Sheth Sameer A.
Published: March 2023

INTRODUCTION:

Deficits in cognitive control, defined as the ability to adjust response or attention in the face of competing or changing demands, are thought to be responsible for inflexible behaviors in neuropsychiatric diseases. Here, we seek to understand frontotemporal networks underlying dysfunctional cognitive function using sEEG recordings and deep brain stimulation (DBS) in human subjects with treatment-resistant depression (TRD).

METHODS:

We employed a forced two-choice cognitive control task where the strength in the target and the distractor interference of a visual stimulus was parametrically and independently varied, resulting in granular variation in response congruence. This task was performed in 13 total subjects, 10 of whom underwent sEEG implants for epilepsy monitoring, whereas 3 subjects were participating in a clinical trial of DBS for TRD and were additionally implanted with DBS leads in the ventral capsule/ventral striatum and subcallosal cingulate.

RESULTS:

Reaction time (RT) and accuracy worsened with increasing levels of conflict across all subjects (Cohen’s d-accuracy = 0.7, Cohen’s d-RT = 0.2) prior to stimulation. Single-trial regression analyses revealed a parametric effect of task conflict with theta-band (4-7 Hz) power across the dorsolateral PFC (dlPFC), dorsal anterior cingulate cortex, orbitofrontal cortex (OFC) as well as the insula. DBS significantly improved behavioral performance, demonstrated by reduced RT (1080 土 10 ms to 840 土 50 ms), and improved accuracy(70 土 9.8% to 90 土 5%). While we observed an overall increase in theta power across the PFC and ACC in TRD participants following DBS, the effect of conflict in theta power was reversed (theta power decreased with increasing conflict in dlPFC and OFC).

CONCLUSIONS:

Leveraging this unique behavioral paradigm with concurrent distributed intracranial recordings and causal manipulation broadens our understanding of neural substrates of decision-making as well as the mechanisms of therapeutic action of DBS for TRD and other psychiatric disorders.
209 What Happens to Brain Outside the Thermal Ablation Zones? An Assessment of Needle-Based Therapeutic Ultrasound in Survival Swine
Authors: Szewczyk Benjamin , Johansen Phillip , Tarasek Matthew , Campwala Zahabiya , Trowbridge Rachel , Zhao Zhanyue , Olmsted Zachary T. , Bhushan Chitresh , Fiveland Eric , Ghoushal Goutam , Heffter Tamas , Tavakkolmoghaddam Farid , Bales Charles , Wang Yang , Rajamani Dhruv Kool , Gandomi Katie , Nycz Christopher , Jeannotte Erin , Mane Shweta , Nalwalk Julia , Burdette Clif , Fischer Gregory S. , Yeo Desmond , Qian Jiang , Pilitsis Julie G.
Published: March 2023

INTRODUCTION:

For stereotactic radiosurgery, isodense lines must be considered to determine how surrounding tissue is affected. In thermal ablative therapy, such as laser interstitial thermal therapy (LITT) transcranial MR-guided focused ultrasound (tcMRgFUS) and needle-based therapeutic ultrasound (NBTU) how the surrounding area is effected has not been well studies in large animal models.

METHODS:

Four swine underwent MRgRA NBTU using varying treatment doses. Neurological evaluation of swine was performed up to 30 days post-procedure. Serial MRI images were obtained, and the most representative were overlaid with isodose lines and compared to brain tissue acquired post-mortem which underwent histopathologic analysis. These results were also compared to predicted volumes using a finite element analysis (FEA).

RESULTS:

NBTU applicator orientation at 360° induced smaller lesion volumes (33.19 mm3; 120 s, 3 W; 30.05 mm3, 180 s, 4 W) versus 180o (77.20 mm3, 120 s, 3 W; 109.29 mm3; 180 s; 4 W). The ablation-zone was characterized by dense macrophage infiltration and glial/neuronal loss as demonstrated by glial fibrillary acidic protein (GFAP) and neurofilament (NF) absence and avid CD163 staining. The transition-zone between lesion and normal brain demonstrated decreased macrophage infiltration and measured ∼345 microns. None of the experimental swine suffered any long-term neurologic or behavioral complications. MRTI/histology overlay demonstrated the boundary of ablation at ∼200 (cumulative equivalent minutes) CEM43 isodose boundary.

CONCLUSIONS:

We successfully performed MRgRA NBTU ablation in swine and demonstrated minimal histologic changes extended past the ablation-zone. The lesion was characterized by macrophage infiltration and glial/neuronal loss which decreased through the transition-zone. Whether NBTU offers advantage over tcMRgFUS and LITT in this regard warrants further study.
210 Intra-Operative Electrocorticography (ECoG) for Lesional Epilepsy: A Randomized Controlled Trial (IO-ECoG Trial)
Authors: Rajeev Sreenath , Chandy Vilanilam George , Abraham Mathew , Easwer Hariharan Venkat , Menon Ramshekhar , Radhakrishnan Ashalatha , Cherian Ajith , Thomas Sanjeev , Vimala Smita , A N Deepti
Published: March 2023

INTRODUCTION:

Usage of Electrocorticography (ECoG) is not clearly established. Robust evidence doesnot exist to support its regular usage in Long term Epilepsy associated tumors (LEATs) which constitutes approximately 25-35% cases of drug resistant epilepsy.

METHODS:

Prospective randomized controlled trial, including all patients operated for drug resistant epilepsy with non-eloquent area LEATs. Patients were randomized into 2 groups namely Group I (without usage of ECoG) and Group II (with ECoG usage). Group II patients further underwent tailored resections if necessary, as per ECoG practice protocols. Surgical outcomes were evaluated for seizure outcome (Engel scale) and adverse event profile.

RESULTS:

Total of 38 patients operated for LEATs having drug resistant epilepsy were included in the study with mean age of 21.1 years (range 2-46 years). 18 patients belonged to Group I and 20 patients belonged to Group II with mean follow-up period of 11.02 months (range 3-22 months). 30% patients (n = 6) in Group II underwent extended resection based on rhythmic persistent post resection spikes. 90% of Group II patients had Engel score Ia during follow up compared to 77.7% of Group I with Engel score Ia (p = 0.302). In Group II, 85.7% patients with extended tailored resection had Engel score Ia compared to 83.8% cases without extended resection (p = 0.904).

CONCLUSIONS:

Though ECoGs role may have been established in focal cortical dysplasia, its utility in LEATs is limited. Our randomized study confirmed that there is no added benefit conferred by the use of ECoG in LEATS. Additional tailored resections aided by ECoG also did not yield seizure outcome benefits in LEATS.
215 Extent of Resection in Glioblastoma: Prognostic Validation of a New Classification from the RANO Resect Group
Authors: Karschnia Philipp , Young Jacob , Ostorga Antonio Gabriel Dono , Häni Levin , Sciortino Tommaso , Bruno Francesco , Jünger Stephanie T. , Teske Nico , Morshed Ramin A. , Haddad Alexander F. , Zhang Yalan , Stöcklein Sophia , Weller Michael , Vogelbaum Michael A. , Beck Juergen , Tandon Nitin , Hervey-Jumper Shawn L. , Molinaro Annette , Rudà Roberta , Bello Lorenzo , Schnell Oliver , Esquenazi Yoshua , Ruge Maximilian I. , Grau Stefan J. , Berger Mitchel , Chang Susan M. , van den Bent Martin , Tonn Joerg-Christian
Published: March 2023

INTRODUCTION:

Terminology to describe extent of resection in glioblastoma is inconsistently applied. Based upon residual contrast-enhancing (CE) tumor, a surgical classification system was previously proposed.

METHODS:

The members of the RANO resect group retrospectively searched the databases from international seven neuro-oncological centers for newly diagnosed glioblastoma per WHO 2021 classification. Volumetric information (from pre- and post-operative MRI) and clinical data were collected.

RESULTS:

We identified 1021 patients with newly diagnosed glioblastoma. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC 26981/22981 (TMZ/RT→TMZ) following surgery. Among such homogenously treated IDHwt patients, lower absolute residual tumor volumes (in cm3) were superiorly associated with outcome. Accordingly, individuals with ‘maximal CE resection’ (class 2) had more favourable outcome compared to individuals with ‘submaximal CE resection’ (class 3) or ‘biopsy’ (class 4) (median OS: 19 versus 15 versus 10 months; p = 0.001). Additional resection of non-CE tumor (with ≤ 5 cm3 residual non-CE tumor) translated into an additional survival benefit in patients with complete CE resection, thus defining class 1 (‘supramaximal CE resection’) (median OS: 24 versus 19 months; p = 0.008). The prognostic role of the resection classes was retained on multivariate analysis when adjusting for clinical and molecular markers. Notably, relative tumor reduction (in percentage) was not prognostic on multivariate analysis, and inter-rater agreement for CE and non-CE tumor on post-operative MRI was sufficient.

CONCLUSIONS:

The suggested “RANO categories for extent of resection in glioblastoma” are prognostic for outcome and may therefore be used for stratification of clinical trials. Removal of non-CE tumor beyond the CE tumor borders is associated with improved survival, providing a rationale to explicitly denominate such ‘supramaximal CE resection’.
304 Correlation of Preoperative Suzuki Stage, Postoperative Matsushima Grade, and Clinical Outcomes in Surgically Treated Pediatric Moyamoya
Authors: Wilson Christopher , Newman Sharlé , Martinez Mesha , Huh Andrew , Avila Stephen , Ducis Katrina
Published: March 2023

INTRODUCTION:

Moyamoya disease and syndrome among pediatric patients is often treated with surgical revascularization. There is limited literature regarding associations between preoperative angiography, postoperative angiography, and clinical outcomes.

METHODS:

We report a case series of consecutive moyamoya disease (MMD) and moyamoya syndrome (MMS) pediatric patients who underwent pial synangiosis. Correlations between preoperative Suzuki stage, Matsushima grade at one year postoperatively, and pediatric modified Rankin score (mRS) were assessed using Speakman’s Rank correlation testing. Factors associated with angiographic and clinical outcomes were analyzed using Fisher’s Exact tests.

RESULTS:

40 patients (60 hemispheres) were treated with median follow up 2.29 years. No significant correlation between preoperative Suzuki stage and postoperative Matsushima grade was identified overall. Suzuki stage two hemispheres developed less robust revascularization. Preoperative Suzuki stage was not associated with postoperative disability severity whereas a nonsignificant trend towards improved clinical outcomes was observed with better Matsushima grade. Poor angiographic revascularization was more frequent in MMS patients, Sickle Cell Disease (SCD) patients, patients with preoperative ivy sign, preoperative NIHSS ≥3, and preoperative symptom duration more than 6 months. Postoperative intracranial hemorrhage, reoperation, Suzuki stage ≥5, and postoperative ischemic stroke conferred more unfavorable clinical outcomes whereas Matsushima A and B revascularization and symptom duration <6 months were protective from unfavorable outcomes.

CONCLUSIONS:

Although Suzuki stage does not significantly correlate with Matsushima grade, the degree of revascularization according to Matsushima grade may be associated with clinical outcomes. Multiple factors associated with degree of revascularization and clinical outcomes are identified.
305 Enhancing Endothelialization of Flow Diverting Stents: An In Vitro Study
Authors: Abdelsalam Ahmed , Corsaletti Gina , Haniff Rianna , Sheinberg Dallas L. , Ramsay Ian , Ehiemua Uchechi , Starke Robert M. , Thompson John
Published: March 2023

INTRODUCTION:

Flow diverting (FD) stents revolutionized the management of broad neck aneurysms. Several FD stents surface modifications have been developed over the last decade to reduce thromboembolic complications or enhance aneurysmal occlusion rates. Promoting FD endothelization through surface coating has emerged as a novel modality to enhance stent coverage, thus improving aneurysmal occlusion, reducing aneurysmal progression and post-treatment failure. Herein, we report our in vitro experience with FD surface modification using gelatin.

METHODS:

PED Flex stents were incubated overnight with either PBS (unmodified) or gelatin, followed by a three-hour incubation with human microvascular endothelial cells. Endothelial cell attachment and proliferation were assessed at various time points.

RESULTS:

There was a significant increase(p < 0.05) in endothelial cell attachment on gelatin(6.3 ± 2.1)surface modified stents compared to unmodified control stents. This increase in endothelial cells was maintained 14 days gelatin 6.3 ± 2.7, fold of control)following cell incubation but gradually decreased until it became insignificant by day 21. Next, we analyzed the temporal rate of endothelial stent coverage. Following cell incubation, 20% of surface-modified stents were coated by endothelial cells on day 5 compared to just 2% in unmodified stents. This difference in cell coverage remained significant (p < 0.05), with surface-modified stents being entirely covered by 2 weeks while unmodified stents were only 50% covered. We also observed a significant increase (p < 0.05, fold of unmodified) in endothelial cell migration onto (1.8 ± 0.2) and from (1.5 ± 0.033) gelatin-coated stents compared to unmodified controls.

CONCLUSIONS:

Our in vitro experience demonstrates that gelatin has the potential to enhance the endothelialization of FD, leading to increased aneurysm occlusion rates, thereby minimizing post-treatment failure. Further investigations are essential to fully evaluate this novel modality and compare it to the commercially available devices.
307 Clinical Efficacy of Thrombolytic Therapies in Mothership Versus Drip and Ship Model: A Systematic Review and Meta-Analysis
Authors: Mohamed Ahmed , Fatima Nida , Altahou Abraham , Ahmed Ayman , Shuaib Ashfaq , Saqqur Maher
Published: March 2023

INTRODUCTION:

There exist substantial uncertainty in understanding the benefit of organizational paradigms in stroke centers.

METHODS:

Studies between 1990 and 2021 were analyzed from electronic databases. Critical time measurements, functional independence, and mortality were all compared. IBM SPSS 23 and Rev Manager were used for statistical analysis.

RESULTS:

7,232 patients’ data were collected from 24 studies. MT+IVtPA vs. IVtPA only did not show significant difference between both cohorts when analyzing NIHSS (p = 0.461). When conducting a subgroup analysis to interpret differences between MS and DS patients in each treatment method, no significant difference (p > 0.05) was noted for the mean time of symptoms to onset and the mean stroke onset to successful recanalization time for the Mt+IVtPA (p = 0.267) and IVtPA cohorts (p = 0.461). The MT+/-IVtPA reported significant differences between MS and DS patients in both these times (p < 0.001 and p = 0.011, respectively). Moreover, no significant difference was noted for mortality at 90-days and symptomatic intracranial hemorrhage (sICH) among these different thrombolytic groups for the DS and MS model patients in all three treatment method cohorts (p = 0.941 for the MT+IVtPA group, p = 0.993 for the MT+/-ItPA and N/A for IVtPA only). The MT+/-IVtPA cohort was the only one to show a significantly larger percentage of patients in the DS group, compared to the MS, to have a mRS score of 3-6 (bad functional outcome) (p = 0.034).

CONCLUSIONS:

Our results showed that there is no sufficient significant difference in clinical efficacy based on MS or DS models in each treatment type.
312 Neutrophil Extracellular Trap (NET) Proteins Enriched in Emboli Retrieved from Stroke Patients with Atrial Fibrillation
Authors: Akkipeddi Sajal Medha , Rahmani Redi , Schartz Derrek , Chittaranjan Siddharth , Gunturi Aditya , Bhalla Tarun , Mattingly Thomas , Morrell Craig , Bender Matthew T.
Published: March 2023

INTRODUCTION:

Recent literature has demonstrated remarkable heterogeneity in the composition of acute ischemic stroke (AIS) emboli from different etiologies, which may directly impact their susceptibility to current standard-of-care therapies.

METHODS:

The full proteomic composition of retrieved thromboembolic material from 24 patients with AIS was evaluated by mass spectrometry. Of the 1797 total proteins identified, 88 known marker proteins were sorted into groups representing broad classes of embolus components: RBCs, PLTs, PMNs, histones, complement proteins, and other clotting-associated proteins (e.g., fibrinogen). The abundance of individual proteins in patients with AF was compared to that of patients without AF using Mann-Whitney U-tests, with significant differences described by the fold change (FC) in abundance. Functional implications of identified differences were explored using the Gene Ontology (GO) enRIchment anaLysis and visuaLizAtion tool (GOrilla).

RESULTS:

There were no significant differences in protein abundance in the RBC, complement, or clotting-associated protein groups. One out of the 11 PLT group proteins (p = 0.042, FC = 2.46), eight out of the 15 PMN group proteins (p < 0.05, FC > 2), and four out of the 14 histone proteins were significantly enriched in emboli from patients with AF (p < 0.05, FC > 2). The most significantly represented functional GO pathways in patients with AF involved PMN activation and degranulation (p < 10-7).

CONCLUSIONS:

The enrichment of PMN proteins and histones, as well as pathways culminating in PMN activation and degranulation, suggests the presence of neutrophil extracellular traps (NETs) in emboli of stroke patients with AF. NETs are a significant though understudied structural component of clots, and so this work hints at not only significant pathological immunothrombosis in patients with AF, but also at potential therapeutic targets for AIS in this population.
318 Designing and Developing a Novel Deep Computer Vision Platform for Intraoperative Prediction and Analytics
Authors: Blue Rachel , Doiphode Nehal , Jena Rohit , Madsen Peter J. , Lee John Y.K. , Shi Jianbo , Buch Vivek
Published: March 2023

INTRODUCTION:

Robust artificial intelligence (AI)-based surgical video analysis platforms could lead to novel insights for intraoperative guidance.

METHODS:

Microvascular decompression surgeries were recorded using a Storz endoscope. A dataset of 2611 frames from 4 operative videos were segmented to create ground truth images. A sparse labeling paradigm was used, and training data comprised only 3% of the total video frames. Surgical anatomy including the brain stem, cerebellum, cranial nerves, vascular structures and surgical instruments were annotated. We developed a custom deep learning framework built on top of a state-of-the-art instance segmentation algorithm SOLOv2, the baseline. Model was trained for each video and pre-training was transferred across videos. Mean average precision(mAP) was computed within and across videos as an evaluation metric. Lastly, a novel metric to quantify arterial pulsation-induced nerve deformation is introduced, and compared before and after Teflon sponge placement.

RESULTS:

Our model consistently outperforms the baseline, with an average mAP of 63.75 for within video, and shows feasibility on novel patient video test set with mAP of 40.13 using few-shot learning. For the novel test video, our pulsatility index during compression is 9.5 whereas after decompression is 6.0, indicating successful dampening of artery-nerve pulsation after sponge insertion.

CONCLUSIONS:

In a sparse labeling paradigm, we design and develop a custom deep computer vision-based instance segmentation architecture to predict and track anatomical structures and surgical objects with high accuracy. We create a novel metric, the “pulsatility index”, which is able to quantify the nerve-artery interface for the first time. Once correlated with outcome measures, real-time AI-based video feed analysis may have the transformative potential to re-define intraoperative standard of care.
323 Pre-Operative MRI Radiomics Model Non-Invasively Predicts Key Genomic Markers and Survival in Glioblastoma Patients
Authors: Pease Matthew , Gersey Zachary Charles , Colen Rivka R. , Zinn Pascal O.
Published: March 2023

INTRODUCTION:

Although Glioblastoma (GBM) is the most common type of primary brain malignancy, few tools exist to pre-operatively risk stratify patients by overall survival (OS) or common genetic alterations.

METHODS:

We retrospectively identified 236 patients with pathologically confirmed GBMs from the Cancer Genome Atlas (89; TCGA) and MD Anderson Cancer Center (147; MDACC). After two neuro-radiologists segmented MRI tumor volumes, we extracted first order and second order radiomic features (gray-level co-occurrence matrixes). We used the Maximum Relevance Minimum Redundancy technique to identify the 100 most relevant features and validated models using leave one out cross validation (LOOCV) and validation on external datasets (i.e., TCGA). Our results were reported as area under the curve (AUC).

RESULTS:

MDACC has significantly higher OS (22 months) compared to the TCGA dataset (14 months). On both LOOCV and external validation, our radiomics models were able to identify EGFR amplification (all AUCs >0.83), MGMT methylation (all AUCs >0.85), GBM subtype (classical; proneural; mesenchymal; all AUCs >0.92), and OS (AUC >0.91 on LOOCV and 0.71 for TCGA validation). We developed a personalized radiomics “report card” that pre-operatively risk stratifies patients by likely genetic alteration.

CONCLUSIONS:

Our robust radiomics pipeline has the potential to pre-operatively discriminate common genetic alterations and patients with favorable survival.
326 Sleep Stages Variation in Intracranial Pressure and Pulse Amplitude
Authors: Darie Lucia , Bancroft Matthew , Glorioso Dolora , Pandit Anand , Moncur Eleanor , Thorne Lewis , Radcliffe Jeremy , Eriksson Sofia , Watkins Laurence Dale , Toma Ahmed
Published: March 2023

INTRODUCTION:

It is thought that CSF pulsatility has an important role in brain physiology during sleep. Yet few studies have looked into changes of ICP and pulsatility during sleep.

METHODS:

A single centre prospective cohort study. Patients undergoing 24 h ICP monitoring for suspected CSF dynamic disorders underwent concomitant polysomnography. Clinical and radiological presentation were derived from the patient’s records. Aggregate mean ICP and pulse amplitude (mPA) values were recorded for each sleep stage. Sleep staging was performed in conformity with the AASM guidelines. Within subject values were compared using repeated-measures, one-way ANOVA. Post-hoc paired t-tests were used to compare sleep stages between groups corrected for multiple comparisons (Benjamini-Hochberg method).

RESULTS:

A total of 12 patients (10 females, 2 males; mean age 40.8 years, SD+/- 12.9) with complete data were analysed. There were significant differences in mean ICP between sleep stages (F(3,33) = 10.7, p < 0.00001). Post-hoc paired t-tests revealed significant differences between rapid eye movement (REM; mean ICP 14.4 mmHg) and all other sleep stages (mean ICP/N1 = 12.0 mmHg, t = -3.6, p = 0.004; ICP/N2 = 11.8 mmHg, t = -4.3, p = 0.001; ICP/N3 = 12.3 mmHg, t = -3.5, p = 0.004). Significant differences were also found in mPA between sleep stages (F(3,33) = 5.7, p = 0.003) confirmed on post-hoc paired t-tests: REM (mean mPA 5.5 mmHg and all other sleep stages: mPA/N1 = 4.7 mmHg, t = -2.3, p = 0.04; mPA/N2 = 4.3 mmHg, t = -2.7, p = 0.02; mPA/N3 = 4.5 mmHg, t = -2.3, p = 0.04).

CONCLUSIONS:

REM is characterized by higher ICP and mPA values, result confirmed in near-normal patients included in this cohort.
327 Identification of Clinically Relevant Patient Endotypes in Traumatic Brain Injury (TBI) Using Latent Class Analysis
Authors: Qiu Steven , Zador Zsolt E. , Sharma Sunjay Vishnu
Published: March 2023

INTRODUCTION:

Despite advances in medical knowledge, TBI still has a significant burden of disease. Better prognostic factors would allow for earlier identification of patients at risk for poor outcomes and enable targeted interventions to improve outcomes and reduce costs.

METHODS:

We obtained clinical information from a subset of TBI patients from the MIMIC-III dataset and codified each patient's comorbidities based on the Elixhauser comorbidity groups. Latent class analysis was performed on the patients based on their codified comorbidities to identify distinct patient endotypes. The characteristics (comorbidity distribution, mortality rate) of these patient endotypes were then visualized using Matplotlib. A Chi-squared test of homogeneity was performed to determine if mortality rates differed across patient endotypes. Relationships between the codified comorbidities were visualized using a network graph across all TBI patients and within each patient endotype.

RESULTS:

2981 patients qualified under our TBI query. Average age was 58 ± 21. The network graph shows that there is only one major connected component composed of the most common comorbidities. An elbow plot was constructed to help identify 8 as the optimal number of classes to model patient endotypes. The distribution of comorbidities differs between patient endotypes. Furthermore, there was a significant difference in survival rates between the patient endotypes (p < 0.0001) with Endotype 1 having the lowest survival and Endotype 6 having the highest. Intra-endotype network analysis and comorbidity distributions suggest that Endotype 1 is a cancer-related endotype whereas Endotype 6 is a relatively "healthy" endotype with some degree of alcohol and drug abuse.

CONCLUSIONS:

In this study, we use LCA to demonstrate the existence of patient endotypes in a TBI population that differ in their comorbidity profiles and clinical outcomes.
330 Interactions of Brain, Blood, and CSF: A Novel Mathematical Model of Cerebral Edema
Authors: Doron Omer , Zadka Yulyia , Barnea Ofer , Rosenthal Guy
Published: March 2023

INTRODUCTION:

Previous models of intracranial pressure (ICP) dynamics have not included flow of cerebral interstitial fluid (ISF) and changes in resistance to its flow when brain swelling occurs.

METHODS:

We developed a lumped parameter model which includes a representation of cerebral ISF flow within brain tissue and its interactions with CSF flow and CBF. The model is based on an electrical analog circuit with four intracranial compartments: the (1) subarachnoid space, (2) brain, (3) ventricles and (4) cerebral vasculature. We determined changes in pressure and volume within cerebral compartments at steady-state and simulated perturbations: Rapid injection into the intracranial space, hyper-and hypoventilation. We simulated changes in resistance to flow or absorption of CSF and cerebral ISF to model hydrocephalus and cerebral edema.

RESULTS:

The model accurately replicates features of intracranial physiology including the pressure–volume curve, increased ICP pulse pressure with rising ICP, hydrocephalus from increased resistance to CSF outflow, and changes associated with ventilation. Importantly, modeling edema with increased resistance to ISF flow mimics key features of brain swelling including elevated ICP, increased brain volume, effaced ventricles, and a contracted subarachnoid space. Similarly, decreased resistance to flow of fluid across the BBB leads to an exponential-like rise in ICP and ventricular collapse.

CONCLUSIONS:

The model accurately depicts the complex interactions that occur between pressure, volume, and resistances to flow in the different intracranial compartments under specific pathophysiological conditions. In modelling resistance to bulk flow of cerebral ISF, it may serve as a platform for improved modelling of cerebral edema and blood–brain barrier disruption that occur following brain injury.
331 A Randomized Controlled Clinical Trial using α-Tocopherol and Ascorbic Acid in the Treatment of Moderate Traumatic Brain Injury
Authors: Philip Jerry , Jung Josephine , Kyesmen Nanpan , Olomo Surajudeen , Nwibo Onyemaechi , Jeneral Dumura , Bot Gyang Markus , Shilong Danan , Tolias Christos , Binitie Peter
Published: March 2023

INTRODUCTION:

Traumatic Brain Injury (TBI) is a major public health concern and a leading cause of disability worldwide. It accounts for 40% of all deaths from acute injuries worldwide. Oxidative brain damage is one of the most validated pathophysiologic hallmark of secondary traumatic brain injury.

METHODS:

120 patients admitted to Jos University Teaching Hospital with moderate TBI were included in this study. Patients were randomized into 4 equally sized groups: control, enteral α-Tocopherol, intravenous ascorbic acid, or a combination of the latter treatments. Patients were administered the designated drugs for a period of one week in addition to the standard management of head injuries. The control group received neither of these drugs but just the standard management of head injury. Outcome data were collected prospectively including demographics, head injury characteristics, mortality, length of stay (LoS) and Glasgow outcome score (GOS).

RESULTS:

92.5% (n = 111) of patients were male. The most common cause for TBI was road traffic accidents (n = 102). GOS was significantly higher in all treatment groups when compared to the control group at discharge (ascorbic acid p < 0.01, α-Tocopherol p < 0.001, combination p < 0.001), and at 1 and 3 months follow up. Overall mortality was significantly lower in patients treated with either α-Tocopherol (n = 1, 3.3%), ascorbic acid (n = 1, 3.3%) or a combination (n = 0, 0%) compared to the placebo group (n = 8, 26.7%, p < 0.05). The lenght of hospital stay was significantly reduced in the α-Tocopherol (p < 0.05) and the combination groups (p < 0.001)

CONCLUSIONS:

The use of ascorbic acid and/or α-Tocopherol improved survival in this cohort. A combination of both drugs had a potentially synergistic effect in these patients.
334 In-hospital Resource Utilization among Traumatic Brain Injury Patients Presenting With Alcohol and Drug Use: A TRACK-TBI Study
Authors: Sherrod Brandon , Baker Cordell , Young Jacob , Barber Jason , DiGiorgio Anthony Michael , Temkin Nancy , Grandhi Ramesh
Published: March 2023

INTRODUCTION:

Premorbid alcohol and drug use is frequently seen in traumatic brain injury (TBI), yet in-hospital resource utilization in this population has not been thoroughly studied.

METHODS:

The multicenter TRACK-TBI database was queried for patients with blood alcohol content (BAC, positive ≥0.08), cannabinoid (THC), and hard drug (cocaine, amphetamines, PCP, MDMA) screening at presentation. Patient demographics, presenting GCS, ICU admission, ventilator time, number of head CTs, ICP monitor placement, and length of stay (LOS) were analyzed after stratifying by substance use.

RESULTS:

Of 2032 TRACK-TBI subjects, 1448 (71.3%) had BAC screening, 891 (43.8%) had THC screening, and 891 (43.8%) had hard drug screening. BAC+ patients (n = 370 [25.6%]) had lower presenting GCS (11.5 ± 4.7 v. 12.7 ± 3.9, p<0.001) as did THC+ patients (n = 136 [15.3%], 10.9 ± 4.7 v. 12.6 ± 4.0, p < 0.001), although hard drug+ patients (n = 82 [9.2%]) did not (p = 0.119). BAC+ and hard drug+ patients had higher positive head CT rates (p < 0.001 and p = 0.034, respectively), although THC+ patients did not (p = 0.248). All substance use groups were more likely to be admitted to ICU but did not have more ICU days on average. Hard drug+ patients were more likely to require ICP monitor placement (27% v. 14%, p = 0.003) despite having similar presenting GCS. BAC+ patients had significantly more CTs performed (p = 0.007). Only hard drug+ patients required more ventilator days (p = 0.04). LOS was significantly longer for THC+ and hard drug+ patients (mean 10.8 v. 8.1 d, p = 0.035 and 11.5 v. 8.2 d, p = 0.017, respectively) but not BAC+ patients. On multivariate analysis, THC+ (aHR = 1.21, 95% CI 1.04-1.40, p = 0.012) and moderate GCS BAC+ patients (aHR = 1.67, 95% CI 1.20-2.31, p = 0.002) had higher number of head CTs performed.

CONCLUSIONS:

Substance use associated with TBI is correlated with greater ICU admission rates and imaging resource utilization.
337 Quantitative Analysis of Admission Electroencephalography Predicts Post-Traumatic Epilepsy After Severe Traumatic Brain Injury
Authors: Pease Matthew , Elmer Jonathan , Mallela Arka , Rodriguez Juan Francisco Ruiz , Sexton Daniel , Barot Niravkumar , González-Martínez Jorge Alvaro , Castellano James , Okonkwo David O.
Published: March 2023

INTRODUCTION:

Up to one-third of severe traumatic brain injury (TBI) patients develop post-traumatic epilepsy (PTE), often years after their injury. Currently, there is no validated predictive model to identify patients at high risk for PTE.

METHODS:

We retrospectively analyzed a prospective database of severe TBI patients treated at a single level one trauma center from 2012 through 2018. Outcomes were recorded with the Expanded Glasgow Outcomes Scale (GOSE) at 6- and 12-months post-injury. We identified a cohort of patients who survived to two years and did not have an early post-traumatic seizure, defined as a seizure within 7 days of initial injury. From this cohort, we matched patients with PTE to those without using age and Glasgow coma scale score at admission. All patients underwent continuous EEG for 3-5 days upon admission, and a board-certified epileptologist identified 5-minute artifact-free segment for analysis. We extracted qEEG features, described them with qualitative statistics, and developed a logistic regression model using backwards selection.

RESULTS:

We identified 27 patients with PTE and 23 without who survived two years post-injury. The median time to onset of PTE was 7.2 months post-trauma and GOSE was similar when stratified by PTE at 6- and 12-months (p > 0.73). On qEEG analysis, patients with PTE had higher spectral power in the delta frequencies (p = 0.003), more variance in the delta and theta frequencies (p < 0.04), a higher mean amplitude (p = 0.01), and peak envelope (p = 0.01). On multivariate modeling, delta power (Odds Ratio [OR] 1.8), theta power (OR 0.2), and rhythmic spectrum (1.7) all increased risk of PTE and had an AUC of 0.85 for predicting PTE.

CONCLUSIONS:

In a cohort of severe TBI patients, quantitative qEEG features in the acute phase after injury identified future risk of PTE.
338 Ultra-Early Cranioplasty Versus Conventional Cranioplasty: A Retrospective Review at an Academic Level 1 Trauma Center
Authors: Chee Keanu , Sethi Akal , Kaakani Alia , Beauchamp Kathryn M. , Kang Jennifer S.
Published: March 2023

INTRODUCTION:

Decompressive craniectomy (DC) is a common neurosurgical procedure for management of intracranial hypertension following traumatic brain injury. Traditionally, cranioplasty has been delayed for as long as three-to-six months following initial DC. Few studies have assessed the effect of 'ultra-early' cranioplasty on rates of postoperative complications following DC.

METHODS:

A retrospective review of cranioplasties performed at our institution between January 2016 and July 2020 was performed. Craniectomies performed at other institutions were excluded. Seventy-seven cranioplasties met inclusion criteria.Ultra-early cranioplasty was defined as cranioplasty performed within 30 days of craniectomy whereas conventional cranioplasty occurred after 30 days. Postoperative wound infection rates, rate of return to the operating room with or without bone flap removal, operative length, and rate of post-cranioplasty hydrocephalus were compared between the two groups.

RESULTS:

39 and 38 patients were included in the ultra-early and conventional cranioplasty groups, respectively. The average number of days to cranioplasty in the ultra-early group was 17.7 ± 7.75 days compared to 95.7 ± 65.60 days in the conventional group. The mean GCS upon arrival to the ER was 7.28 ± 3.90 and 6.92 ± 4.14 for the ultra-early and conventional groups, respectively. The operative time was shorter in the ultra-early cohort that in the conventional cohort (ultra-early, 2.4 ± 0.71 hours; conventional, 3.0 ± 1.63 hours; p = 0.0336). The incidence of post-cranioplasty hydrocephalus was also lower in the ultra-early cohort (ultra-early, 10.3%; Conventional, 31.6%; p = 0.026). No statistically significant differences were observed regarding postoperative infection, return to the operating room, or bone flap removal.

CONCLUSIONS:

Our study shows that ultra-early cranioplasty can significantly reduce the rate of post-cranioplasty hydrocephalus, as well as operative time in comparison to conventional cranioplasty. However, the timing of cranioplasty following DC should remain a patient-centered consideration.
340 Predicting Progression and Recurrence of Pediatric Low Grade Gliomas Using miRNA Composition in Plasma and CSF
Authors: Coyle Anne , Rathi Komal , Koptyra Mateusz , Foster Jessica , Hollawell Madison , Beck Christopher , Choudhari Namrata , Storm Phillip B. , Resnick Adam C. , Tucker Alexander M. , Madsen Peter J.
Published: March 2023

INTRODUCTION:

Liquid biopsy is a non-invasive method of diagnosing and monitoring brain tumor patients. miRNA profiling from cerebrospinal fluid (CSF) and plasma has become an increasingly attractive biomarker, however targets have yet to be established in CNS tumors. Low grade glioma (LGG) patients often have excellent outcomes, but some have progressive disease or unresectable lesions. There has been limited work in establishing a clinically approved liquid biopsy assay for such patients.

METHODS:

miRNA profiling of 17 plasma and 12 CSF samples from 10 pediatric LGG and 7 DMG patients was performed using the HTG EdgeSeq platform. Clinical information was obtained through chart review. miRNA expression was evaluated with unsupervised consensus clustering and differential analysis.

RESULTS:

At time of data analysis, 5 LGG had progression or recurrence. The remaining LGG (5) had stable or no evidence of disease. Mean follow-up was 23 months. miRNA consensus clustering revealed that LGG with a recurrence, progression, or malignant transformation clustered with DMG rather than with tumors of similar histology or WHO classification. Pilocytic astrocytoma could be identified by miRNA composition in CSF. In plasma, 103 unique miRNAs were identified with significant differential expression between the progression/recurrence LGG cohort versus those with stable or no evidence of disease (logFC > 1, FDR < 0.05). miR-16-5p, a miRNA correlated with tumor growth and invasion in non-CNS tumors, had higher expression in the more aggressive cohort (p = 0.0022). Over 100 miRNAs correlated with histology, survival, disease state, and presence of leptomeningeal disease (p < 0.05).

CONCLUSIONS:

miRNA profiling of CSF and plasma in patients with LGG may predict disease course to better inform patient care and treatment monitoring.