bluuebunny/crossref_metadata_2025 huggingface dataset:
388 The First Endovascular Rat Glioma Model for Pre-clinical Evaluation of Intra-arterial Therapeutics
Authors: Lim Jaims , Baig Ammad , Donnelly Brianna M. , Chaves Lee , Pol Suyog , Koenigsknecht Carmon , Pionessa Donald , Levy Bennett Reuben , Gutierrez Liza , Tutino Vincent , Levy Elad I. , Siddiqui Adnan Hussain
Published: March 2024

INTRODUCTION:

Several translational animal models have been described assessing intra-arterial (IA) treatments for malignant gliomas. We describe the first endovascular animal model that allows testing of IA drug delivery as first-line treatment, which is difficult to do in actual patients.

METHODS:

Wistar rats underwent left femoral artery catherization with a Balt Magic 1.2F catheter or Marathon Flow directed 1.5F Microcatheter with an Asahi Chikai 0.008 micro-guidewire which was navigated to the left internal carotid artery under x-ray. 25% mannitol was administered to test blood brain barrier breakdown (BBBB). Additional rats were implanted with C6 glioma cells in the left frontal lobe. C6 Glioma-Implanted Rats were monitored for overall survival and tumor growth. Tumor volumes from MRI images were calculated utilizing 3D slicer. Additional rats underwent femoral artery catheterization with Bevacizumab, carboplatin, or irinotecan injected into the left internal carotid artery to test feasibility and safety.

RESULTS:

A successful endovascular access and BBBB protocol was established. BBBB was confirmed with positive Evans-blue staining. 10 rats were successfully implanted with C6 gliomas with confirmed growths on MRI. Overall survival was 19.75 ± 2.21 days. 5 rats were utilized for development of our femoral catheterization protocol and BBBB testing. With regards to IA chemotherapy dosage testing, control rats tolerated targeted 10 mg/kg of bevascizumab, 2.4 mg/kg of carboplatin, and 15 mg/kg of irinotecan IA ICA injections without complications.

CONCLUSIONS:

We present the first endovascular IA rat glioma model that allows selective catheterization of the intracranial vasculature and assessment of IA therapies for gliomas without need for access and sacrifice of proximal cerebrovasculature.
395 A History of Smoking Is Not an Independent Risk Factor for Perioperative Outcomes in Nontraumatic Subarachnoid Hemorrhage
Authors: Rienas William , Li Renxi , Lee SeungEun
Published: March 2024

INTRODUCTION:

Nontraumatic Subarachnoid Hemorrhage (NSAH) is a rupture leading to blood accumulating in the subarachnoid region. Smoking contributes to vascular pathogenesis which can ultimately end in an aneurysm. Smoking and history of smoking often is a risk factor for complications perioperatively for vascular procedures, however patients receiving treatment for NSAH may have different perioperative outcome profiles.

METHODS:

Patients with NSAH who underwent neurosurgery were identified using ICD codes (ICD10, I60; ICD9, 430) in the ACS-NSQIP database from 2005-2021. Subjects were stratified into two study groups based on documented prior history of smoking: smokers or non-smokers. Significant preoperative differences were present between groups so a multivariable logistic regression was performed between patients with and without a prior history of smoking. The 30-day perioperative outcomes of patients with a prior history of smoking were compared to that of control. Perioperative outcomes included death, major adverse cardiovascular events (MACE), cardiac complications, stroke, wound complications, renal complications, sepsis, clot formation, pulmonary complications, return to the operating room, operation time greater than four hours, length of stay longer than 7 days, discharge not to home, and bleeding.

RESULTS:

There were 626 patients with a prior smoking history and 1336 patients with no prior smoking history. We found no significant difference between these two groups across all adverse outcomes analyzed.

CONCLUSIONS:

This study shows that although history of smoking is commonly a risk factor for vascular diseases and perioperative complications, it is not a risk factor for the perioperative variables analyzed when treating NSAH. Additional research should be done to determine if different procedures to treat NSAH may have different outcomes among smokers.
397 Rehemorrhage of Brainstem Cavernous Malformations: A Benchmark Approach to Individualized Risk and Severity Assessment
Authors: Li Zongze , Ma Li
Published: March 2024

INTRODUCTION:

Brainstem cavernous malformations (BSCMs) represent a unique subgroup of cavernous malformations with more hemorrhagic presentation and technical challenges.

METHODS:

A total of 123 consecutive BSCM patients with symptomatic hemorrhage were identified between 2015 and 2022, with untreated follow-up > 12 months or subsequent hemorrhage during the untreated follow-up. Nomograms were proposed to individualize the assessment of subsequent hemorrhage risk and neurological status (determined by the modified Rankin Scale [mRS] score) after future hemorrhage. The least absolute shrinkage and selector operation (LASSO) regression was used for feature screening. The calibration curve and concordance index (C-index) were used to assess the internal calibration and discrimination performance of the nomograms. Cross-validation was further performed to validate the accuracy of the nomograms.

RESULTS:

Prior hemorrhage times (adjusted OR [aOR] 6.78 per ictus increase) and Zabramski type I or V (OR 11.04) were associated with rehemorrhage within 1 year. A lower mRS score after previous hemorrhage (aOR 0.38 for a shift to a higher mRS score), Zabramski type I or V (OR 3.41), medulla or midbrain location (aOR 2.77), and multiple cerebral cavernous malformations (aOR 11.76) were associated with worsened neurological status at subsequent hemorrhage. The nomograms showed good accuracy and discrimination, with a C-index of 0.80 for predicting subsequent hemorrhage within 1 year and 0.71 for predicting neurological status after subsequent hemorrhage, which were maintained in cross-validation.

CONCLUSIONS:

An individualized approach to risk and severity assessment of BSCM rehemorrhage was feasible with clinical and imaging features.
400 Brain AVMs-Related MicroRNAs: Machine Learning Algorithm for Expression Profiles of Target Genes
Authors: Lucifero Alice Giotta , Luzzi Sabino
Published: March 2024

INTRODUCTION:

microRNAs (miRNAs) are a class of non-coding RNAs playing a myriad of important roles in regulating gene expression. Of note, recent work demonstrated a critical role of miRNAs in the genesis and progression of brain arteriovenous malformations (bAVMs).

METHODS:

A PRISMA-based literature review was performed using PubMed/Medline database with the following search terms: "brain arteriovenous malformations", "cerebral arteriovenous malformations", "microRNA", and "miRNA". All preclinical and clinical studies written in English, regardless of date, were selected. For our bioinformatic analyses, miRWalk and miRTarBase machine learning algorithms were employed; the Kyoto Encyclopedia of Genes and Genomes (KEGG) database was quired for associated pathways/functions.

RESULTS:

4 studies were ultimately included in the final analyses. Sequencing data consistently revealed the decreased expression of miR-18a in bAVM-endothelial cells, resulting in increased levels of vascular endodermal growth factor (VEGF), Id-1, matrix metalloproteinase, and growth signals. Our analyses also suggest that the downregulation of miR-137 and miR-195* within vascular smooth muscle cells (VSMCs) may foster the activation of inflammation, aberrant angiogenesis, and phenotypic switching. In the peripheral blood, the overexpression of miR-7-5p, miR-629-5p, miR-199a-5p, miR-200b-3p, and let-7b-5p may contribute to endothelial proliferation and nidus development. The machine learning algorithms employed confirmed associations between miRNA-related target networks, vascular rearrangement, and bAVM progression.

CONCLUSIONS:

miRNAs expression appears to be critical in managing bAVMs' post-transcriptional signals. Targets of microRNAs regulate canonical vascular proliferation and reshaping. Although additional scientific evidence is needed, the identification of bAVM miRNA signatures may facilitate the development of novel prognostic/diagnostic tools and molecular therapies for bAVMs.
406 Long-term Outcomes of Lumbar Facet Arthroplasty versus Spinal Fusion in the Treatment of Degenerative Spondylolisthesis and Stenosis
Authors: Shaffer Annabelle , Arnold Paul M.
Published: March 2024

INTRODUCTION:

Facet arthroplasty is a proposed alternative to lumbar fusion for treating degenerative lumbar spondylolisthesis and stenosis. Facet arthroplasty provides stabilization and preserves range of motion.

METHODS:

Patient-reported outcomes (PROMS), including Oswestry disability index (ODI), visual analog pain scales (VAS), and Zurich claudication questionnaires (ZCQ), were assessed at baseline and at multiple timepoints postoperatively. Flexion/extension range of motion (ROM) were radiographically evaluated at baseline, 12 months, and 24 months. Data were analyzed following an intention-to-treat model.

RESULTS:

A total of 299 patients were included (TOPS = 206, TLIF = 93). There were no significant differences at baseline. At 2 years, the TOPS group had a significantly greater proportion of patients report =30% improvement for ODI (93.8% versus 74.3%, p = 0.004) and =20-point improvement for VAS back (84.4% versus 61.8%, p = 0.014). At 1 year, TOPS group had a significantly greater proportion of patients report clinically significant improvements in all ZCQ categories (91.6% versus 78.5%, p = 0.012). In patients <65 years, the TOPS group had significantly improved PROMS compared to TLIF at 2 years; however, these differences were not observed in patients =65 years old. The TOPS groups preserved significantly more ROM at 12 (2.8° 95% CI [1.87; 3.74], p < 0.0001) and 24 (2.99° 95% CI [1.82; 4.15], p < 0.0001) months postoperatively compared to TLIF. ROM was similarly preserved in patients aged <64 and =65. The rate of adverse events did not differ significantly between groups (65.2% TOPS versus 61.5% TLIF).

CONCLUSIONS:

Facet arthroplasty preserves significantly more ROM and leads to improved PROMS compared to TLIF, particularly in younger patients. In older patients, the procedure improved outcomes significantly from baseline.
411 Perioperative Complications and Radiographic Outcomes Following Cervical Laminoplasty: A Review of 105 Cases From a Single Academic Center
Authors: Paul David , Liu Serena , Phan Amy , Shah Shalin , Silberstein Howard J. , Puvanesarajah Varun , Rubery Paul T. , Mesfin Addisu
Published: March 2024

INTRODUCTION:

With advancements in technology, the safety and efficacy of cervical laminoplasty have increased, leading to a reduction in complications frequently associated with posterior cervical surgical approaches, including C5 nerve palsy, axial neck pain, loss of lordosis, and loss of motion. However, the impact of these advancements on cervical radiographic parameters remains poorly documented, and the prevalence of complications in North American populations has not been adequately studied.

METHODS:

We evaluated patients undergoing cervical laminoplasty between 2011 to 2022 at an academic medical center. Patient demographics, intraoperative and postoperative complications, preoperative and post-operative radiographic parameters were recorded.

RESULTS:

150 patients undergoing cervical laminoplasty during this study period were identified. 105 patients met the inclusion criteria. We identified a total of 22 (21.0%) adverse events in 20 patients. There were 4 intra-operative (3.8%), 10 peri-operative (9.5%), and 8 delayed post-operative (7.6%) adverse events. Amongst them, 13 (12.4%) were judged to be minor and 9 (8.6%) were judged to be major complications. Six (5.7%) patients required revision surgery. Forty-seven (44.8%) of the 105 patients had both pre-and post-operative cervical spine radiographic imaging. The average pre-and post-op C2-7 cobb angles were 14.7 degrees and 12.3 degrees (p-value of 0.04). The pre-and post-op SVA was 29.2 mm and 33.3 mm (p-value of 0.07). The pre-op and post-op T1 slopes were 32.3 and 30.2 deg (p-value of 0.07).

CONCLUSIONS:

Cervical laminoplasty carries a significant risk of adverse events, the majority of which are minor and has a low rate of re-operation (5.7%). The procedure does not result in significant changes in SVA or T1 slope. Cervical laminoplasty remains a valuable surgical option for selected patients with cervical myelopathy.
413 Evaluation of Osteoporosis in the Lumbar Spine in Multiple Myeloma Patients Using 18F-NaF PET/CT
Authors: Gandhi Om , Park Peter , Gujral Jaskeerat , Park Mia , Werner Thomas , Høilund-Carlsen Poul , Alavi Abass
Published: March 2024

INTRODUCTION:

Multiple myeloma (MM) is a plasma cell malignancy that structurally damages and weakens the bone, most commonly in the spine, by inducing osteoporosis, osteolytic lesions and pathological fractures. Detecting molecular changes in bone metabolism, such as reduced osteoblastic activity and bone remodeling associated with MM, would allow for early diagnosis of osteoporosis in the lumbar spine and reduce risk for surgical spinal interventions. One such imaging candidate is 18F-NaF PET/CT, a molecular imaging technique sensitive to bone formation.

METHODS:

The FULIMA clinical trial (NCT02187731) was conducted with 70 newly diagnosed MM patients, with exclusion criteria leaving 33 patients for analysis (9 females, 24 males; mean age 66.6y). Patients’ trabecular body of the L1-L4 vertebrae was analyzed using 18F-NaF PET/CT scans to calculate and evaluate the linear associations among mean standardized NaF uptake value (SUVmean), mean Hounsfield unit (HU) values, and age. Receiver-operating characteristic (ROC) curve analysis with area under the curve (AUC) using the Wilson/Brown method assessed the predictive value of NaF uptake via SUVmean for osteoporosis determined by HU threshold.

RESULTS:

There was significant positive correlation between HU value and SUVmean (r = 0.64, p < 0.0001) and negative correlations between age and both HU value (r = -0.59, p < 0.0003) and SUVmean (r = -0.53, p = 0.002). Additionally, on average, there was a 29.1% difference in the NaF uptake of MM patients with osteoporosis (SUVmean = 7.0 ± 1.48) compared to normal MM patients (SUVmean = 4.96 ± 1.46). Predictive value of NaF per AUC analysis was 0.857 with p = 0.002.

CONCLUSIONS:

18F-NaF PET/CT detects the decreased osteoblastic activity of osteoporosis in the lumbar spine with high precision and accuracy in MM patients, facilitating timely interventions and reducing risk for invasive procedures.
416 Redefining Treatment Expectations: Exploring Long-Term Outcomes of Venous Sinus Stenting in Idiopathic Intracranial Hypertension
Authors: Midtlien Jackson , Klever Lucas , Kiritsis Nicholas , Fargen Kyle Michael
Published: March 2024

INTRODUCTION:

Idiopathic intracranial hypertension (IIH) is a condition characterized by various symptoms such as pulsatile tinnitus, chronic headaches, and papilledema. Venous sinus stenosis has been associated with IIH, and venous sinus stenting (VSS) has emerged as a potential treatment option. However, there is a lack of standardized outcome definitions and limited long-term data on the effectiveness of VSS in current literature.

METHODS:

In this study, we analyzed the long-term outcomes of 178 patients with medically-refractory IIH who underwent VSS by the senior author. Demographic information, pressure gradients, symptom improvement, recurrence, and persistence were recorded. Quality of life and symptom severity scores were assessed using standardized HIT-6, WHO-BREF, and pulsatile tinnitus surveys. Follow-up duration and patient-reported outcomes were also considered.

RESULTS:

Among the VSS cohort, 52.8% reported initial symptom relief followed by recurrence, and 13.5% experienced persistent symptoms without improvement. Overall failure rate of VSS was found to be 66.3%. Repeat procedures, such as lumbar puncture or additional stenting occurred in many patients. Survey data showed varying degrees of improvement in symptom severity and quality of life, and these changes were found to be statistically insignificant long-term.

CONCLUSIONS:

Our study challenges the prevailing notion of favorable outcomes in VSS suggests a need for reevaluation of the procedure as a long-term treatment option for severe IIH. High rates of symptom recurrence, persistence, and the need for repeat interventions indicate limitations in the efficacy of VSS. Improved understanding of the underlying factors contributing to poor outcomes and the development of alternative interventions are essential for better management of this debilitating condition.
419 Synergistic White Matter Injury Secondary to Chronic Cerebral Hypoperfusion and Air Pollution is Reduced by Microglia-Specific TLR4-Knockdown
Authors: Sizdahkhani Saman , Shkirkova Kristina , Lamorie-Foote Krista , Zhang Hongquiao , Zhao Lifu , Diaz Arnold , Sioutas Constantinos , Finch Caleb , Pike Christian , Mack William
Published: March 2024

INTRODUCTION:

Air pollution is recognized as a neurotoxin which damages white matter and increases the risk of cognitive decline. Our previous work in a murine model found that air pollution in the setting of chronic cerebral hypoperfusion (CCH) leads to a synergistic deleterious effect on white matter. Air pollution studies have shown that increased microglial activation was associated with neurotoxicity. We hypothesize that inhibition of a microglial-specific TLR4 pathway will decrease the neurodegenerative effects that normally result from combined CCH and air pollution.

METHODS:

Our air pollution model used eight weeks of standardized Diesel Exhaust Particles (DEP) from National Institute of Science and Technology (DEP NIST2975). We performed bilateral carotid stenosis (BCAS) surgery to induce CCH using Wild Type (WT) and TLR4 flx/flx (CX3CR1CreER +/-) (TLR4-KD) in 2-month-old male mice. WT and TLR4-KD mice were randomized into eight groups as follows: WT-filtered air (FA), WT-DEP, WT-FA-BCAS, WT-DEP-BCAS, TLR4-KD-FA, TLR4-KD-DEP, TLR4-KD-FA-BCAS, and TLR4-KD-DEP-BCAS. Neurotoxicity was quantified with immunohistochemistry of degraded myelin basic protein (dMBP), ionized calcium-binding adaptor molecule-1 (Iba-1), and complement (C5a).

RESULTS:

DEP exposure resulted in increased white matter injury in corpus callosum (dMBP), worsened by the presence of CCH (p = 0.004) and significantly attenuated by TLR4-KD (p = 0.005). DEP exposure resulted in increased white matter microglial activation (Iba-1), worsened by the presence of CCH (p < 0.0001) and significantly attenuated by TLR4-KD (p = 0.04).DEP exposure resulted in increased white matter complement activation (C5a), worsened by the presence of CCH (p < 0.0001) and significantly attenuated by TLR4-KD (p < 0.0001).

CONCLUSIONS:

Microglial-specific TLR4-KD reduces air pollution-induced neurotoxicity measured by white matter injury, microglial activation, and neuroinflammation.
443 Myeloid Immunometabolic Reprogramming Mitigates Chronic Neurodegeneration After Experimental Traumatic Brain Injury
Authors: Moore Nicholas , Jarrahi Abbas , Lu Yujiao , Khodadadi Hesam , Jones Earl Dane , Kaoutzani Lydia , Vale Fernando L. , Vender John R. , Baban Babak , Dhandapani Krishnan
Published: March 2024

INTRODUCTION:

Traumatic brain injury (TBI) induces immediate mechanical injury, including diffuse axonal shearing and myelin degradation. Epidemiological studies suggest a single, severe TBI initiates progressive neurodegeneration, including extensive white matter injury and culminating in long-term cognitive decline. While underlying mechanisms remain undefined, the degree of chronic inflammation correlates with delayed white matter tract damage after TBI.

METHODS:

Immune cell infiltration and activation was measured using preparative and analytical flow cytometry after controlled cortical impact, a pre-clinical model of focal penetrating injury, in adult mice. To assess T cell priming, APCs pulsed with myelin or isolated after experimental TBI were co-cultured with naÏve splenic T cells. Progressive neurodegeneration was assessed by histology and magnetic resonance imaging at eight weeks post-injury.

RESULTS:

Peripheral macrophages predominated as APCs within the CNS parenchyma after severe TBI. Myelin-pulsed APCs or APCs isolated after experimental TBI efficiently primed naÏve T cells ex vivo, generating myelin-reactive Th1/Th17 cells. Activity of the master metabolic regulator AMPK, previously shown to promote counter-inflammatory immune polarization, was decreased in myeloid cells after injury. Treatment with metformin, an AMPK activator, restored myeloid AMPK activity and attenuated neurodegenerative changes at eight weeks post-TBI.

CONCLUSIONS:

TBI-induced immunometabolic dysregulation allows generation of auto-reactive T cells that may contribute to chronic inflammation and progressive neurodegeneration. Metabolic reprogramming of myeloid cells via metformin restores AMPK activity and reduces progressive white matter loss after TBI, representing a potential therapeutic intervention to mitigate long-term consequences of TBI.
444 Quantitative Mapping of Cerebral Blood Flow and Blood-Brain Barrier Water Exchange Rate (Kw) Reveals the Mechanobiological Impact of Cranioplasty: A Magnetic Resonance Imaging Study of Patients With Cranial Defects
Authors: Abedi Aidin , Ojogho Brandon , Lee Darrin J. , Shao Xingfeng , Russin Jonathan , Wang Danny J. J. , Liu Charles Y.
Published: March 2024

INTRODUCTION:

Large cranial defects may cause neurological decline due to brain shift, while cranioplasty may improve cognitive function, although the underlying mechanisms remain poorly understood. Blood-brain barrier (BBB) water exchange rate (Kw) is a novel magnetic resonance imaging (MRI) method which provides insights into the processes underlying the effects of cranioplasty.

METHODS:

Adult patients with cranial defects who were candidates for elective cranioplasty were consented and enrolled. Using a 3T MRI, we conducted baseline imaging on all patients, and repeated the imaging during the early post-cranioplasty period. The Kw and CBF were quantified, and asymmetry was calculated as the difference between the values on the ipsilateral and contralateral hemispheres relative to the cranial defect, divided by the sum of those values. Pairwise comparisons of the changes from baseline to post-cranioplasty period were performed using Wilcoxon signed-rank test.

RESULTS:

A total of 10 patients were enrolled (mean age: 35.4 ± 9.49, 9/10 men). The global CBF showed significant improvements after cranioplasty. There was a remarkable Kw asymmetry in the caudate area at baseline (low on defect side), which significantly improved post-operatively (median: -0.077 vs. 0.021, p = 0.049), while the changes in CBF in this area were not significant (median: -0.002 vs. 0.014, p = 0.160). Other brain regions yielded no significant changes in Kw asymmetry.

CONCLUSIONS:

Reduced Kw has been reported in cognitive decline and cerebral small vessel diseases, and may be related to impaired water circulation in the brain. We observed increased global CBF and Kw asymmetry in caudate which may reflect improved brain physiology and water circulation following cranioplasty. Kw is a non-invasive and non-contrast method that offers an opportunity to understand the intricate changes in brain homeostasis following reconstruction surgery.
450 Inflammatory Brachial Plexitis Mimics Postoperative Iatrogenic Neurological Deficits
Authors: Ambati Vardhaan Sai , Madugala Neha , Anderson Noriko , Shah Vinil , Mummaneni Praveen V. , Poncelet Ann
Published: March 2024

INTRODUCTION:

A common cause of neurosurgical malpractice cases is the misrepresentation of idiopathic brachial neuritis (incidence: 1/1000) as an iatrogenic neurological insult caused by a surgeon.

METHODS:

Confirmed postprocedural brachial neuritis patients from a single quaternary care institution were identified and analyzed.

RESULTS:

We identified 6 (3 female) postprocedural brachial neuritis patients with mean age 63.7 (range 50-75) years. Procedures included 5 cervical spine surgeries (3 multilevel ACDFs, 2 multilevel posterior fusions with laminectomies, 1 multilevel disc arthroplasty) and 1 intrajugular central venous catheter placement. Average time to symptom onset was 1 week post-procedure (range 1 day-2.5 weeks). Initial symptom was moderate-to-severe shoulder (5), arm (4), and/or neck (1) pain. Subsequently, all developed axillary/shoulder weakness; 3 distal arm/hand weakness, 2 winged scapula, and 2 dyspnea/orthopnea. For diagnosis, two patients had confirmatory EMG, 1 had MR neurography confirming plexus inflammation, and 3 had both (positive EMG findings and inflammation on MR Neurography). Average time to accurate diagnosis was 3.1 (range 1.5-5) months. Average number of clinicians seen prior to accurate diagnosis: 5. Treatments included opioids (5), steroids (1), and/or physical therapy (6). All experienced partial pain relief by 1-8 weeks; 2 had persistent pain requiring gabapentin past 6 months. All patients continued to experience motor deficits past 6 months: (4 patients had atrophy and 2-4/5 motor strength in proximal the proximal arm, 1 had distal arm 3/5 motor strength, and 1 had scapular winging).

CONCLUSIONS:

Postoperative idiopathic brachial plexitis mimics iatrogenic nerve damage following neurosurgical procedures. Recognition of this entity is difficult, and 6 patients at our institution saw on average 5 providers over 3 months prior to accurate diagnosis. Brachial plexitis has a prolonged course with typically only partial recovery at 6 months.
458 Endoscopic Versus Open Carpal Tunnel Release: An Umbrella Review and a Meta-Analysis
Authors: Chanbour Hani , El Masri Jad , Masri Diala , Liles Campbell , Ghazi Maya , Jonzzon Soren , Younus Iyan , Salemeh Pascale , Hill Brad , Zuckerman Scott L.
Published: March 2024

INTRODUCTION:

Whether open carpal tunnel release (OCTR) versus endoscopic carpal tunnel release (ECTR) has super outcomes remains a controversial topic.

METHODS:

A PubMed, Scopus and Cochrane databases was conducted for all meta-analyses comparing OCTR and ECTR performed between 2000-2022 in accordance to PRISMA and Joanna Briggs Institute guidance of umbrella reviews. The primary outcomes were: 1) functional ability: symptoms severity, grip strength, pinch strength, two-point discrimination, and pain, 2) operative outcomes: operation time, total complications, nerve injury, scar formation, and 3) time to return to work. Pooled analysis was performed to compare outcomes using Review Manager Version 5.2.11.

RESULTS:

9 meta-analyses were included, 5 were of high quality and 4 were moderate quality on the Assessment of Multiple Systematic Reviews (AMSTAR) scale. Functional ability: OCTR was associated with better pinch strength after 3-months (0.70, 95% CI = 0.00, 1.40, p = 0.05) and after 6-months (0.77, 95% CI = 0.14, 1.40, p = 0.02, I2 = 84%). Operative outcomes: OCTR was associated with less nerve injury (3.26, 95% CI = 1.20, 8.86, p = 0.02, I2 = 0%) and more risk of scars formation (0.40, 95% CI = 0.24, 0.66, p = 0.0003, I2 = 41). Return to work: OCTR was associated with longer return to work (-10.89, 95% CI = -15.14, -6.64, p < 0.00001, I2 = 83%). There were no significant differences between OCTR and ECTR in the hand function, symptom severity, grip strength, pain, operation time and total complications.

CONCLUSIONS:

In an umbrella review and meta-analysis of OCTR vs. ECTR, we found that while OCTR demonstrated higher pinch strength and lower nerve injury risk, ECTR was associated with less scar formation and a shorter time to return to work.
468 Does the Choice of C2 Versus Subaxial Upper Instrumented Vertebrae Impact 24-month Outcome and Satisfaction in Patients With Cervical Myelopathy? A QOD Study
Authors: Park Christine , Shaffrey Christopher I. , Johnson Sarah , 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 , Haid Regis W. , Mummaneni Praveen V. , Michalopoulos Giorgos , Bydon Mohamad , Gottfried Oren N.
Published: March 2024

INTRODUCTION:

There is limited data on the outcomes regarding the effect of upper instrumented vertebrae (UIV) selection in patients with cervical spondylotic myelopathy (CSM).

METHODS:

This was an analysis of the prospective Quality Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) cohort which included adult patients who were diagnosed with primary CSM undergoing elective surgery. Patient-reported outcomes including VAS neck and arm pain, NDI, mJOA, EQ-5D, and NASS patient satisfaction were collected at baseline and 24 months.

RESULTS:

Of the 239 patients with CSM who underwent PCF, 48 (20.1%) had UIV of C2 and 191 (79.9%) had UIV of C3/below. The 24-month follow-up rate was 87.4% for patient-reported outcomes. At baseline, C2 group had a higher frequency of motor deficit (83.3% vs 68.1%, p = 0.04) compared to the C3/below group; otherwise, there was no difference in pain, function, and quality of life. C2 group had greater number of treated levels (6.1 ± 2.0 vs 4.5 ± 1.3, p < 0.01) compared to the C3/below group. At 24-month follow-up, the two groups achieved similar rates of satisfaction and MCID for pain, disability, myelopathy, and quality of life (all p > 0.05) postoperatively.

CONCLUSIONS:

Although the C2 group had greater number of treated levels compared to the C3/below group, the two cohorts had overall similar baseline characteristics and achieved similar MCID rates of the measured outcomes. The results of this study suggest that UIV of C2 may not have appreciable benefit over subaxial UIV in patient-reported outcomes.
473 Does Bioactive Glass Ceramic Cage Achieve Early Fusion in Anterior Cervical Discectomy and Fusion?: A Prospective Multicenter Study
Authors: Moon Bongju
Published: March 2024

INTRODUCTION:

Bioactive glass ceramic (BGC) is known to chemically bond with bones by forming a hydroxyapatite layer and inducing osteoblastic differentiation.

METHODS:

A total of 40 patients who underwent 1-level ACDF using BGC cage to treat degenerative cervical radiculopathy/myelopathy were enrolled in multicenter (3 hospitals) prospectively. Fusion defined by CT and X-ray, subsidence, and breakage of BGC cage were evaluated at postoperative six months period. Demographic data, fusion rates, visual analog scale (VAS) scores for neck or arm pain, Neck Disability Index (NDI) scores, SF-36 and complications were also checked.

RESULTS:

Fusion rates were 88.5% when assessed by interspinous motion and 92.3% when CT assessed by intragraft and extragraft bone bridging in the BGC group at 6-month follow-up. The neck pain or arm pain VAS scores, NDI scores and SF-36 significantly improved. No material-related complications were observed related BGC cage, such as graft resorption and breakage. Subsidence occurred 3 patients who improved neck pain or arm pain VAS scores, and NDI scores compared to preoperative status.

CONCLUSIONS:

BGC cage was effective and safe when used in ACDF, conferring a early and high fusion rate and favorable clinical outcomes at postoperative 6 months period.
476 Middle Cranial Fossa Encephaloceles With Temporal Lobe Epilepsy: An Underdiagnosed Entity
Authors: McCormack Ryan , Tandon Nitin
Published: March 2024

INTRODUCTION:

Temporal lobe epilepsy with encephalocele (TLEE) is a lesional epilepsy increasingly recognized as underdiagnosed. Here we report our experience with TLEE-associated epilepsy managed with both traditional ATL with AH compared to a targeted lesionectomy of the encephalocele.

METHODS:

We used a prospectively maintained database of surgical epilepsy patients to identify all patients with TLEE-associated epilepsy managed over a 13-year interval using ATL with AH, ATL only, or a targeted encephalocele-only lesionectomy. Details regarding epilepsy, neuropsychology, management, complications, and outcomes at the last follow-up were compiled.

RESULTS:

793 surgical epilepsy patients were evaluated, with 56 (7.1%) demonstrating TLEE. The average age of epilepsy onset was 31.7 years (range 2-57); the age at the time of surgery was 38.3 years (range 15-69). Twenty-one patients (37.5%) were managed with ATL with AH, 20 (35.7%) with temporal pole resection without AH, and 15 (26.7%) with targeted lesionectomy/LITT of the temporal encephalocele. Forty-seven patients (84%) had good surgical epilepsy outcomes with no significant difference in modality. Targeted lesionectomy demonstrated significantly greater language preservation (p = 0.046) and verbal memory (p = 0.038) when compared to more extensive surgical resections.

CONCLUSIONS:

TLEE is an overlooked and underreported etiology of epilepsy. In select cases, good surgical epilepsy outcomes can be achieved with targeted lesionectomy of the encephalocele when the epilepsy network is not widespread.
477 Identifying the Neural Correlates of the Triple Code Model in Numerical Cognition Using Stereotactic Electroencephalography in Epilepsy Patients
Authors: Ramos Christian Lopez , Tan Hao , Rockhill Alexander P. , Yamamoto Erin A. , Shahin Maryam Nour , Nerison Caleb , Raslan Ahmed M. T.
Published: March 2024

INTRODUCTION:

The capacity to process numerical quantities is an essential human trait. The “Triple Code Model” (TCM) in numerical cognition, theorizes that different neural substrates encode the processing of visual, auditory, and nonsymbolic numerical representations formats. Limited data exists examining the direct electrophysiological activity involved in numerical cognition.

METHODS:

Thirteen patients with medically refractory epilepsy that underwent sEEG for the localization of seizures performed a passive numerical recognition task. Subjects were presented with a number quantity from 1 to 9 in one of five different representation formats: two were auditory (spoken numbers, sequential beeps) and three were visual (Arabic numeral, written word, assortment of dots). A total of 2,482 electrode contacts were analyzed. Time-frequency spectrograms were reduced with principal component analysis (PCA) and passed into a linear support vector machine (SVM) classification algorithm to identify neural correlates of number processing.

RESULTS:

The highest classification accuracy in number processing, irrespective of representation format occurred in the bilateral parietal lobes, right lingual cortex, and bilateral putamen. A total of 407, 776, 854, 475, and 513 contacts had significant classification values during Arabic, beep, spoken, written, and dots, respectively. Bilateral superior temporal cortices demonstrated the best classification value for the processing of auditory formats, whereas visual formats (Arabic and written number) showed greatest involvement in the frontal lobe and inferior precentral gyrus. Classification of dots indicated preferential engagement of the left parietal cortex. Spectral analyses revealed that non-gamma frequency bands held greater than chance classification values to characterize format-specific number representations.

CONCLUSIONS:

Using a linear SVM classifier with PCA, we examined the Triple Code Model in numerical cognition and identified several neural structures with high classification values involved in numerical processing.
491 Scalp Incisions With Stairstep Pericranial Edges to Minimize Sequalae of Poor Wound Healing in Supratentorial Brain Tumor Surgery
Authors: Popp Nicholas , Singhal Ishan , Laing Brandon , Krucoff Kate , Krucoff Max Ostrinsky
Published: March 2024

INTRODUCTION:

Wound healing problems are especially prevalent in craniotomies for intra-axial brain tumors as patients often require radiation, chemotherapy, and chronic steroids. All surgeons have postoperative patients with poor skin healing (i.e., excessive scabbing) at follow up, some of whom progress to infections that may involve the bone graft or hardware. While newer techniques like minimally invasive approaches and routine vancomycin powder use have helped overall complication rates, poor skin healing remains a frustratingly persistent cause of morbidity.

METHODS:

Ninety-one consecutive patients underwent supratentorial, intra-axial brain tumor surgery with a single surgeon at a single institution using this technique. Patient demographics, pathology, adjuvant interventions, and other independent risk factors were analyzed.

RESULTS:

No wound-related complications requiring readmission, intravenous antibiotics, or reoperation were encountered at a median 3-month follow up. There were also no surgical site infections, dehiscences, or CSF leaks. Fifty-one patients (57.3%) had postoperative radiotherapy, eighty-five patients (93.4%) had perioperative steroids, and fifty-six patients (61.5%) had postoperative chemotherapy. Six patients (6.5%) had concerns for poor initial scalp healing at routine follow up and were placed on a short course of oral antibiotics prophylactically. None (0%) of these individuals progressed to infection or required further intervention. One other patient developed a shunt infection in this interval that required removal unrelated to the craniotomy site.

CONCLUSIONS:

Here we outline the principles and demonstrate the execution of stairstep pericranial edges in supratentorial brain surgery. This technique, designed with plastic surgeons, provides an intact, vascularized layer of pericranium beneath the incision and over the bone graft/hardware to optimize wound healing and prevent morbid sequelae in inevitable cases of poor initial skin healing.
492 Novel BH3 Mimetic Bcl-2 Inhibitor Promotes Autophagic Cell Death and Reduces in Vivo Glioblastoma Tumor Growth
Authors: Avsar Timucin , Calis Seyma , Kilic Turker
Published: March 2024

INTRODUCTION:

Anti-apoptotic members of the Bcl-2 family proteins play central roles in the regulation of cell death in glioblastoma, the most malignant type of brain tumor. Despite the advances in GBM treatment, there is still an urgent need for new therapeutic approaches.

METHODS:

In silico studies resulted in 500,000 molecules being screened with computer-aided drug design methods and the molecule with the highest binding affinity was selected and named BAU-243. Cell viability, IC50 value, tumor formation potential, tumor spheroid formation potential, tumor invasion studies were investigated following BAU-243 application. The molecular changes caused by Bcl-2 inhibition were demonstrated by quantitative PCR, western blot and immunofluorescence methods. In in vivo studies, glioma tumors were transplanted intracranially into Nod Scid Gamma(NSG) mice using the mouse xenograft model.

RESULTS:

Here, we report a novel 4-thiazolidinone derivative BH3 mimetic, BAU-243 that binds to Bcl-2 with a high affinity. BAU-243 effectively reduced overall glioblastoma cell proliferation including a subpopulation of cancer-initiating cells in contrast to the selective Bcl-2 inhibitor ABT-199. While ABT-199 successfully induces apoptosis in high BCL2-expressing neuroblastoma SHSY-5Y cells, BAU-243 triggered autophagic cell death rather than apoptosis in A172 cells, indicated by the upregulation of BECN1, ATG5, and MAP1LC3B expression. Lc3b-II, a potent autophagy marker, was significantly upregulated following BAU-243 treatment. Moreover, BAU-243 significantly reduced tumor growth in vivo in orthotopic brain tumor models when compared to the vehicle group, and ABT-199 treated animals. To elucidate the molecular mechanisms of action of BAU-243, we performed computational modeling simulations that were consistent with in vitro results.

CONCLUSIONS:

Results indicated that BAU-243 activates autophagic cell death by disrupting Beclin 1:Bcl-2 complex, and may serve as a potential small molecule for the treatment of glioblastoma.
499 Silent Corticotroph Staining Pituitary Neuroendocrine Tumors: Prognostic Significance in Radiosurgery
Authors: Maragkos Georgios A. , Mantziaris Georgios , Pikis Stylianos , Chytka Tomas , Liscak Roman , Peker Selcuk , Samanci Yavuz , Bindal Shray , Niranjan Ajay , Lunsford L. Dade , Kaur Rupinder , Tripathi Manjul , Pangal Dhiraj J. , Strickland Ben Allen , Zada Gabriel , Langlois Anne-Marie , Mathieu David , Warnick Ronald E. , Patel Samir , Minier Zayda , Speckter Herwin , Kondziolka Douglas S. , Lee Cheng-chia , Lee Vance Mary , Sheehan Jason P.
Published: March 2024

INTRODUCTION:

There is conflicting evidence on the significance of adrenocorticotrophic hormone (ACTH) staining in the prognosis of nonfunctioning pituitary neuroendocrine tumors (NFpitNETs).

METHODS:

This retrospective, multicenter study included patients managed with SRS for NFpitNET residuals. The patients were divided into two cohorts: 1) silent corticotroph (SC) for NFpitNETs with positive ACTH immunostaining and 2) non-SC NFpitNETs. Rates of local tumor control, as well as the incidence of post-treatment pituitary and neurological dysfunction were documented. Factors associated with radiological and clinical outcomes were also analyzed.

RESULTS:

The cohort included 535 patients from fourteen centers with 84 (15.7%) patients harboring silent corticotroph NFpitNETs (SCs). At last follow-up, local tumor progression occurred in 11.9% of patients in the SC compared to 8.1% of patients in the non-SC cohort (p = 0.27). No statistically significant difference was noted in new-onset hypopituitarism rates (10.7% vs 15.4%, p = 0.25) or visual deficits (3.6% vs 1.1%, p = 0.088) between the two cohorts at last follow-up. When controlling for residual tumor volume, maximum dose, and patient age and gender, positive ACTH immunostaining did not have a significant correlation with local tumor progression (HR = 1.69, 95% CI = 0.8 - 3.61, p = 0.17).

CONCLUSIONS:

In contemporary radiosurgical practice with a single fraction dose of 8-25 Gy (median 15 Gy), ACTH immunostaining in NFpitNETs did not appear to confer a significantly reduced rate of local tumor control after SRS.
507 Neuroprotective Effects of a Steroid Receptor Coactivator Stimulator in a Murine Model of Acute Ischemic Stroke with Reperfusion
Authors: Garcia Roberto Losoya , McClendon Lisa , Robledo Ariadna , Von Waaden Nicholas , O'Leary Sean , Husain Adam , Lonard David , Dacso Clifford , O'Malley Bert , Kan Peter T.
Published: March 2024

INTRODUCTION:

Stroke is the leading cause of adult disability and the fifth leading cause of mortality in the United States. Despite the study of many neuroprotective agents for acute ischemic stroke, none has been shown to be effective in large randomized clinical trials. Steroid receptor coactivator (SRC) is a promising class of agents since they are involved in cellular proliferation and regeneration, immune modulation, angiogenesis, antioxidant protection and are expressed in the brain.

METHODS:

Twenty c57bl/6 mice were randomly assigned to control or treatment groups (n = 10 mice per group). All mice underwent middle cerebral artery occlusion for 90 minutes followed by reperfusion via the intraluminal filament method. Occlusion was confirmed by laser doppler flowmetry. Intraperitoneal injections of saline (control) or 10-1 (treatment) were given 30 minutes after reperfusion. Each animal was tested using a modified Bederson’s neurological deficit scale (mNDS) and euthanized at the conclusion of the 24-hour survival period. Brain slices were stained with 2,3,5- triphenyltetrazolium chloride (TTC) to identify ischemic brain tissue.

RESULTS:

When compared with the control group, 10-1 treated mice showed significantly lower mNDS scores (p = 0.000336) and incidence of circling (p = 0.00256). Calculated infarct volumes, based on TTC staining, of the 10-1 treated group were significantly lower (p = 0.0009) when compared to the control group.

CONCLUSIONS:

We have shown that 10-1 is a promising therapeutic agent and provides substantial neuroprotection through its many multicellular processes in a rodent study. Current studies are being conducted to investigate the mechanism of 10-1 as neuroprotectant.
690 Residual In-stent Carotid Stenosis and Cigarette Smoking are Predictors of Restenosis After Stenting (CAS)
Authors: Lai Rosalind , Snyder Kenneth Vincent , Baig Ammad , Jacoby Wady , Kruk Marissa , Donnelly Brianna M. , Siddiqi Manhal Munir , Davies Jason , Siddiqui Adnan Hussain , Levy Elad I.
Published: March 2024

INTRODUCTION:

Atherosclerosis of the internal carotid artery remains a significant contributor to stroke morbidity and mortality. While patient risk factors have been identified to be associated with carotid restenosis after carotid stenting (CAS), conflicting theroies exist on whether residual stenosis is an independent risk factor.

METHODS:

A single-center, prospectively maintained database was retrospectively reviewed for CAS procedures over a 12-year period. Patient demographic, procedural characteristics, radiographic and clinical details were noted. Comparison of baseline characteristics of patients with and without carotid restenosis were performed using chi-squared test for categorical variables and student t-test for continuous variables. Univariate and multivariate analyses were performed to determine risk factors associated with restenosis, defined as >70% on digital subtraction angiography.

RESULTS:

1017 consecutive carotid artery stenting (CAS) procedures were performed in 905 patients over the 12-year period, with 738 CAS procedures in 632 patients included after exclusion criteria. Overall restenosis rate was 17%, with a 14% restenosis rate at 2 years-time. Multivariable analysis demonstrated former/current smoking status (OR=2.1 [95%CI 1.2-3.9]), moderate contralateral stenosis (OR 3.0 [95%CI 1.4-6.7]), severe contralateral stenosis (OR3.0 [1.4-6.3]), and residual stenosis (OR 454 [95% 85-2413]) were associated with restenosis. AUC for the multivariable model was 0.78. Cut-point degree for residual stenosis was ∼30%, where there was a 9% and 35% rate of restenosis in those less than, and greater than, 30% residual stenosis, respectively.

CONCLUSIONS:

We present the largest single-center data in the US to date on carotid artery stenosis treated with CAS, and factors associated with restenosis. Residual in-stent carotid stenosis and smoking history were independent predictors. Maximizing treatment of initial stenosis within stent for carefully selected patients and aggressive smoking cessation education are important steps in preventing future carotid restenosis.