bluuebunny/crossref_metadata_2025 huggingface dataset:
361 The Frailty-Driven Predictive Model for Failure to Rescue After Cervical Decompression and Fusion: An ACS-NSQIP Analysis of 3,632 Cases (2011-2020)
Authors: Covell Michael , Rumalla Kranti , Rumalla Kavelin , Kassicieh Alex James , Roy Joanna , Kazim Syed Faraz , Skandalakis Georgios P. , Bowers Christian
Published: March 2024

INTRODUCTION:

Cervical decompression & fusion (CDF) outcome prognostication relies on preoperative risk factors to predict complications and outcomes in order to help guide pre- and perioperative decision-making.

METHODS:

CDF cases were queried from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database 2011-2020. Patients who underwent CDF and experienced a major complication were identified. Within this cohort, FTR was calculated as death or hospice within 30 days of a major complication. Frailty was measured by the Risk Analysis Index-Revised (RAI-Rev). Demographics and baseline characteristics of patients were compared by FTR. Significant factors were assessed by univariate and multivariable regression for the development of a frailty-driven predictive model for FTR. The discriminative ability of the predictive model was assessed using a receiving operating characteristic curve analysis.

RESULTS:

There were 3,632 patients who suffered a major complication from CDF, and 7.6% (277 patients) experienced FTR. Independent predictors of FTR were non-elective surgery, frailty status, preoperative intubation, thrombosis or embolism complication, unplanned intubation, prolonged ventilator use (>48 hours), cardiac arrest, and septic shock. Frailty, and a combination of preoperative and postoperative risk factors in a predictive model for FTR achieved outstanding discriminatory accuracy (C-statistic = 0.901, CI: 0.883-0.919).

CONCLUSIONS:

Preoperative and postoperative risk factors yield a highly accurate predictive model for FTR in CDF patients. Our model may guide surgical management and/or prognostication following the development of a major complication. Future studies may determine the predictive ability of this model in other neurosurgical patient populations. Our predictive model may be deployed by-the-beside here: https://nsgyfrailtyoutcomeslab.shinyapps.io/FailureToRescueCervicalFusion/
362 Enhanced Measures to Quantify Gait and Balance Impairment in Degenerative Cervical Myelopathy: A Prospective Cohort Study
Authors: Perez Tess , Soufi Khadija , Balatbat Patricia , Martin Allan R.
Published: March 2024

INTRODUCTION:

Gait and balance impairment are among the cardinal symptoms of Degenerative Cervical Myelopathy, however, utilizing objective measurements of these functions is highly challenging.

METHODS:

A prospective cross-sectional cohort study with manual and quantitative gait/balance testing using a Protokinetics Zeno Walkway electronic pressure mat (self/fast-paced, tandem gait/stance, Romberg, one foot standing).

RESULTS:

95 DCM and 78 healthy subjects were included. For quantitave gait assesment, Velocity (p = 4.56x 10-8, 3.39x10-7), Gait Variability Index (p = 1.788x10-8, p = 0.00169), and stability ratio, single stance time/ double stance time, (p = 4.167x10^-7, p = 1.438x10^-5) were significantly different between groups for both self and fast-paced gait assessments, respectively. Balance was assessed by the variability of the center of pressure (COP). The standard deviation variability of COP in both the X (p = 0.00171) and Y directions (p = 0.000104) and cadence (p = 0.00175) were significant for tandem gait, walking heel-to-toe. Standing on either the Left or Right foot also showed a difference in the variability of COP in both directions X (p = 4.21x10^-7 Left Foot, p = 8.27x10^-7 Right Foot) and Y (p = 6.64x10^-4 Left Foot, p = 1.32x10^-4 Right Foot). On, manual assesment, DCM patients scored significantly worse in all parameters such as self-paced (p = 5.54x10^-2), fast-paced (p = 6.28x10^-2), tandem gait (p = 3.60x10^-8), Romberg eyes open (p = 1.58x10^-2), Romberg eyes closed (p = 1.90x10^-2), L foot stance (p = 6.78x10^-6), R foot stance (2.1x10^-6), and tandem stance (p = 8.83x10^-5).

CONCLUSIONS:

Quantitative parameters from an electronic pressure mat can be used to assess gait and balance impairment with high sensitivity and strong correlation with subjective measures. Manual scoring of tandem gait, standing on one foot, and tandem stance also provided robust differences and can be easily adopted into routine assessment of DCM patients.
364 Traumatic Dens Fracture Patients Comprise Distinct Subpopulations Distinguished by Differences in Age, Sex, and Injury Mechanism and Severity
Authors: Cloney Michael Brendan , Roumeliotis Anastasios , Thirunavu Vineeth , Texakalidis Pavlos , Swong Kevin , El Tecle Najib , Dahdaleh Nader S.
Published: March 2024

INTRODUCTION:

Dens fractures are an increasingly common cervical fractures, yet their epidemiology and its implications remain under-examined.

METHODS:

We retrospectively analyzed all traumatic dens fracture patients managed at our institution over a ten year period with respect to demographic, clinical, and outcomes data. Patient subsets were compared across these parameters.

RESULTS:

303 traumatic dens fracture patients were identified, who showed a bimodal age distribution with strong goodness of fit centered at age 22.3 ± 5.7 (R = 0.8781) and at 77.7 ± 13.9 (R = 0.9686). A population pyramid demonstrated a bimodal distribution among male patients, but not among female patients, which was confirmed with a strong goodness of fit for two distinct male patient subpopulations age <35 (R = 0.9791) and age =35 (R = 0.8843), but a weak fit for a second female subpopulation age <35 (24.5 ± 14.2, R = 0.5957). Patients age <35 were more likely to be male (82.4% vs. 46.9%, OR = 5.29 [1.54, 17.57], p = 0.0052). Moreover, patients age <35 were more likely to have MVC as their mechanism of injury (64.7% vs. 14.1%, OR = 11.18 [3.77, 31.77], p < 0.0001), were more likely to have a severe trauma injury severity score (17.6% vs. 2.9%, OR = 7.23 [1.88, 28.88], p = 0.0198). There was no difference with respect to underlying fracture morphology, likelihood of undergoing surgery, having concomitant atlas or subaxial fractures, or Nurick scores at presentation. Patients age <35 were less likely to have fracture nonunion at follow (18.2% vs. 53.7%, OR = 0.19 [0.041, 0.76], p = 0.0288).

CONCLUSIONS:

The dens fracture patient population comprises two subpopulations, distinguished by differences in age, sex, and injury mechanism and severity, with male dens fracture patients demonstrating a bimodal age distribution. While young patients were more likely to high-energy injury mechanisms leading severe trauma, they were less likely to have fracture nonunion at follow up.
369 Camptocormia in Parkinsons Disease: Systematic Review of Management Using Spine Surgery
Authors: Khan Ali Saif , Nandoliya Khizar Rehan , Mattei Tobias A. , Mercier Philippe , Cloney Michael Brendan , Dahdaleh Nader S. , Koski Tyler R. , El Tecle Najib
Published: March 2024

INTRODUCTION:

Postural instability or deformity manifests in a variety of ways for a Parkinson's disease (PD) patient, including the classical stooped posture, as well as antecollis, pisa syndrome, degenerative scoliosis, and a debilitating forward flexion of the trunk termed camptocormia. Camptocormia was first described in the midst of World War 1, where young soldiers were found to have a non-fixed forward-bent trunk attributed to the stress of battle.

METHODS:

PubMed was queried for studies involving spine surgery as treatment of PD-associated camptocormia. Studies that described nonsurgical management, deep brain stimulation (DBS), repetitive tran-spinal magnetic stimulation (rTSMS), or were descriptive in nature were excluded.

RESULTS:

The screening process resulted in 5 studies that reported on the use of spine surgery in PD-associated camptocormia. The total number of patients was 19, 12 of which experienced hardware failure warranting revision surgery (63.1%). Clinical and radiologic improvement was inconsistent. Patient outcomes were ultimately satisfactory, only after high reoperation and complication rates.

CONCLUSIONS:

Evidence for the feasibility of spine surgery as management for PD-associated camptocormia is lacking in the literature. In this particular patient population, these procedures carry a high risk of complications and subsequent revision operations, which may negatively affect long-term quality of life. In the absence of or resistance to conservative management, DBS, or rTSMS, spine surgery may be the only option for some patients. Continued investigation via longitudinal and large-scale studies is crucial in order to provide definitive recommendations and treatment algorithms for providers to adhere to.
373 Modified 5-Item Frailty Index: A Useful Tool for Assessing the Impact of Frailty on Postoperative Morbidity and Mortality Following Surgical Fixation of Thoracolumbar Fractures
Authors: Taghlabi Khaled , Santosh Bhenderu Lokeshwar Sai , Guerrero Jaime , Tahanis Aboud , Cruz-Garza Jesus , Faraji Amir H.
Published: March 2024

INTRODUCTION:

The modified 5-item frailty index (mFI-5) is a comorbidity-based risk stratification tool that has been shown to predict adverse events following various neurological surgeries.

METHODS:

The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. The mFI-5 score was calculated based on the presence of the 5 comorbidities: congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status, and hypertension. Multivariate analysis was used to assess the independent impact of increasing mFI-5 score on postoperative 30-day morbidity and mortality while controlling for baseline clinical characteristics.

RESULTS:

A total of 66,904 patients were included in our analysis (54.2% female, mean age 62.27 ± 12.93 years). On univariate analysis, higher mFI-5 score was significantly associated with increased risks of superficial surgical site infection(SSI), deep SSI, wound dehiscence, unplanned reoperation, pneumonia, unplanned intubation, postoperative ventilator use, progressive renal insufficiency, acute renal failure, urinary tract infection, stroke, myocardial infarction, cardiac arrest, pulmonary embolism, deep vein thrombosis, bleeding requiring transfusion, sepsis, septic shock, and longer hospital length of stay (LOS). On multivariate logistic regression, increasing mFI-5 score versus mFI-5 = 0 was associated with higher odds of overall complications (mFI-5 =2: odds ratio [OR] 1.44 CI: 1.35–1.52, p < 0.001; mFI-5 = 1: OR 1.18 CI: 1.12–1.24, p < 0.001) and 30-day mortality (mFI-5 =2: OR 2.32 CI: 1.60–3.37, p < 0.001).

CONCLUSIONS:

This study demonstrates that frailty, when measured using the mFI-5, independently predicts postoperative complications, hospital LOS, and 30-day mortality after surgical repair of thoracolumbar fractures. These findings are important for risk stratification in patients undergoing thoracolumbar fusion surgery and for standardization in reporting outcomes after those procedures.
376 Laser Interstitial Thermal Therapy for Deep-Seated Perivascular Brain Tumors: Evaluating the Risk of Distal Ischemia
Authors: Reese Jared C. , Samir Mariam , Fadel Hassan Ali , Pawloski Jacob Andrew , Haider Sameah A. , Robin Adam M. , Kalkanis Steven N. , Lee Ian Yu
Published: March 2024

INTRODUCTION:

Laser interstitial thermal therapy (LITT) is a novel minimally invasive cytoreductive treatment option for primary and metastatic brain tumors. By relying on stereotactic guidance, the use of LITT carries a risk for direct and thermal vascular injury, especially when targeting deep-seated tumors with surrounding critical vasculature. It is thought that nearby blood vessels act as heat sinks from thermal injury, however, the risk of ablation causing an ischemic stroke is not well reported.

METHODS:

A retrospective review identified patients who underwent LITT between 2013 – 2021 for brain tumors located within the insula, basal ganglia, and thalamus. Demographic, clinical, and volumetric characteristics were collected. The primary outcome was radiographic evidence of distal ischemia on post-ablation imaging.

RESULTS:

A total of 50 patients underwent 59 ablations for perivascular brain tumors located in the insula (52%), basal ganglia (24%), and thalamus (24%). Of the tumors treated, 22 (37%) were low-grade gliomas, 32 (54%) were high-grade gliomas, and 5 (8%) were metastatic. No coagulopathies were identified in any patient. A biopsy was performed in 72% of patients. The mean volume of ablation was 12.4 cm3 (S.D. 13.9) with a median extent of ablation of 92% (IQR 30%, 100%). Two patients developed symptomatic intracerebral hemorrhage. One developed a tract hemorrhage attributed to vessel injury from fiber insertion. The other presented with delayed onset hemorrhage one week later due to uncontrolled hypertension. In all patients, there was no radiographic evidence of distal ischemia following LITT on DWI sequencing . The median length of stay was 2 days with 81% of patients being discharged home.

CONCLUSIONS:

We demonstrate that LITT has minimal risk for new onset distal ischemia for deep-seated perivascular brain tumors.
377 CDKN2A Alterations Are Associated With Increased Postoperative Seizure Risk After Resection of Brain Metastases
Authors: Cummins Daniel Dighton , Garcia Joseph , Nguyen Minh , Saggi Satvir , Chung Jason , Goldschmidt Ezequiel , Berger Mitchel S. , Theodospoulos Philip , Chang Edward , Daras Mariza , Hervey-Jumper Shawn L. , Aghi Manish Kumar
Published: March 2024

INTRODUCTION:

Seizures are common and significantly disabling for patients with brain metastases (BMs). While surgical resection can provide seizure control, a subset of patients with BMs may continue to suffer seizures postoperatively. Molecular BM characteristics may influence which patients are at-risk for postoperative seizures.

METHODS:

All patients underwent BM resection at one institution with available clinical and sequencing data on > 500 oncogenes. Clinical seizures were documented preoperatively and postoperatively. Random forest machine learning classification was used to determine candidate genomic alterations associated with postoperative seizures, and clinical and top genomic variables were correlated with postoperative seizures using Cox proportional hazards models.

RESULTS:

There were 112 patients with BMs who underwent 114 surgeries and had at least one month of postoperative follow-up. Seizures occurred preoperatively in 26 (22.8%) patients and postoperatively in 25 (21.9%). Engel classification (EC) at six months achieved for those with preoperative seizures was EC I in 13 (50%); II in 6 (23.1%); III in 5 (19.2%), and IV in 2 (7.7%). In those with postoperative seizures, only 8 (32.0%) had seizures preoperatively. Preoperative seizures were not a significant predictor of postoperative seizures (hazards ratio (HR) = 1.84; 95% confidence interval (CI) = 0.79 – 4.37; p = 0.156). On random forest classification and multivariate Cox analysis controlling for factors including recurrence, extent of resection, and number of BMs, CDKN2A alterations were associated with postoperative seizures (HR = 3.22; 95% CI = 1.27–8.16; p = 0.014). Melanoma BMs were associated with higher risk of postoperative seizures compared with all other malignancies (HR = 5.23; 95% CI = 1.37–19.98; p = 0.016).

CONCLUSIONS:

CDKN2A alterations and melanoma primary malignancy are associated with increased postoperative seizure risk following resection of BMs. These results may help guide postoperative seizure prophylaxis in patients undergoing resection of BMs.
382 Precision and Individualized Medicine: Quantification of Brain Cancer Cell Invasion in Confined Microfluidic Spaces Predicts Prognosis
Authors: Suarez-Meade Paola Suarez , Ifembi Brent , Teeter Caroline , Brooks Mieu , Figueredo Luisa Fernanda , Altamirano Alice , Schiapparelli Paula , Chaichana Kaisorn L. , Konstantopolous Konstantinos , Quinones-Hinojosa Alfredo
Published: March 2024

INTRODUCTION:

Clinical prognosis of patients with glioblastoma (GBM) is calculated with clinical scores, extent of resection, molecular markers, and tumor subtypes. However, these are often hampered by patient comorbidities, drug toxicity, and other confounding factors. We designed a confined 3D microfluidic technology based on the brain cytoarchitecture by mimicking the diameters of the perivascular spaces and white matter tracts utilized by GBM to invade.

METHODS:

Patient-derived GBM cell lines (n = 13) were obtained from patients undergoing surgery. After cell culture, the GBM cells’ abilities to migrate and proliferate with MAqCI were evaluated. MAqCI score was calculated via logistic regression. Patients were categorized into low- and high-PFS. Predicted scores were correlated with the clinical status of patients. Cells were treated with gold standard and experimental drugs, and scores were calculated to predict response to treatment.

RESULTS:

MAqCI Predicted PFS with 83% accuracy, 84.6% sensitivity, and 75% specificity and allowed for the classification of short- and long-PFS (*p = 0.035). Survival based on MAqCI scores separated by short-term (n = 5) and long-term (n = 8) PFS, showed a significant difference between groups (**p = 0.002). After treatment with gold-standard therapy, responder patients were identified based on changes in the MAqCI score. RNAseq of highly motile cells isolated from MAqCI allowed for the identification of druggable targets. An FDA-approved antidepressant against the adrenomedullin gene was selected for MAqCI testing. Changes in MAqCI score after treatment allowed for the identification of responder patients.

CONCLUSIONS:

Cell invasion properties are directly correlated with patient prognosis. MAqCI could be utilized clinically as a companion assay for predicting tumor recurrence and selecting drugs for individualized GBM treatment.
383 Epigenetic Potentiation of Anti-tumor Immune Responses Using Viral Mimicry for Gliomas
Authors: Seetharam Deepa , Chandar Jay , Desgraves Jelisah , Govindarajan Vaidya , Mendez Valdez Mynor J. , Ramsoomair Christian , Castro Jesus , Rivas Sarah , Johnson Kory , Zhang Yong , Nath Avindra , Heiss John D. , Shah Ashish H.
Published: March 2024

INTRODUCTION:

Human endogenous retroviruses (HERVs) account for approximately 8% of our genome and are evolutionary relics of a germline retroviral infection. Although normally silenced by a master epigenetic regulator, np220, HERVs may be re-expressed in cellular states with marked epigenetic dysregulation and induce innate anti-viral inflammatory responses. This viral mimicry immune response sensitizes tumors to immunotherapy by eliciting double-stranded RNAs (dsRNA)-mediated interferon signaling cascades. Hence, viral mimicry could serve as a predictor of clinical responses to immunotherapy.

METHODS:

We conducted a preclinical study on the role of np220 in GBM and mediating viral mimicry responses.

RESULTS:

Using a tailored bulk transcriptional dataset from 71 newly diagnosed high-grade GBMs, we demonstrated significantly negative correlations between np220 expression and 48 HERV superfamilies. Additionally, using a transcriptional deconvolution pipeline of low-and high-grade gliomas, we demonstrated that np220 is negatively correlated with innate antiviral immune response signatures (TLR3) (RTLR3 = -0.300, pTLR3 = 0.00006). Our in vitro studies have shown that NP220 knockdown induces intracellular HERV-mediated dsRNA-signaling cascades via RIG-1 and TLR3. NP220 knockdown exponentially increases PD-L1 expression (p-value: <0.001), and, increases cytoplasmic accumulation of cellular endogenous dsRNA in established human and mouse glioma cell lines which may induce the interferon-mediated response. This response was recapitulated in recurrent GBM samples with radiographic responses to checkpoint inhibition (anti-PD1) with widely increased expression of dsRNA, PD-L1 and perivascular CD8 cell infiltration, suggesting dsRNA-signaling may mediate response to immunotherapy. Furthermore, we showed np220 is linked to reduced immune cell infiltration (CD8, Dendritic Cells) in the glioma microenvironment through deconvolution of RNA-seq data from TCGA (RCD8 = -.202, RDC = -0.198) (pCD8 = 8.79E-06, pDC = 1.34E-05).

CONCLUSIONS:

Our findings suggest that np220 could serve as a target to potentiate glioma ICI for immune response.
390 Modelling Glioma Associated Macrophages Using Human Embryonic Stem Cell Derived Microglia
Authors: Hopland Kelsey , Hei Yu Kenny Kwok , Mrad Zaki Abou , Torckenczy Kristof , Bander Evan D. , Tabar Viviane S.
Published: March 2024

INTRODUCTION:

Glioma associated macrophages/microglia (GAMs) are the most abundant immune cell type in glioblastoma and play a key role in immunotherapeutic resistance. The tumor microenvironment (TME) is thought to modulate GAM phenotype and function leading to a more pro-tumorigenic immune milieu however the exact nature of this crosstalk is unclear. Existing systems to study human GAMs are suboptimal as primary human GAMs are difficult to culture. There is therefore a need to develop human model systems of sufficient fidelity to probe GAM function. Here we report on the development of a human embryonic stem cell (hES)-based platform to derive microglia without recourse to immortalizing oncogenic transduction. This technology can assess the impact of tumor derived factors on the microglial phenotype and represents a novel, scalable model system to investigate GAM function.

METHODS:

hES-microglia were generated using a stepwise cytokine-based differentiation protocol. Upon exposure to conditioned media obtained from cultures of a panel of patient-derived glioblastoma cell lines (n=6 biological replicates), hES-GAMs were analyzed using flow cytometry, single cell RNA sequencing (scRNA). Functional assays included phagocytosis of pH rhodo particles, wound scratch migration assays and intracellular proteome analysis.

RESULTS:

Exposure to tumor media leads to transcriptional changes similar to those seen in primary GAMs with increased chemotactic genes such as CCL2(MCP1), CCL3 and CCL4, with corresponding changes in cytokine profile at the protein level. Other upregulated cytokines of note include VEGF, OSM, CCL4 and IL10RB. Functional impact of co-culture with tumor media included a dramatic increase in GAM motility (>30 fold) and a statistically significant decrease in phagocytic ability (29.1% p < 0.001).

CONCLUSIONS:

The hES-derived GAM model is a promising novel platform to dissect the impact of the TME on tumor-derived GAMs.
391 Intraarterial Verapamil for Neuroprotection in Ischemic Stroke
Authors: Newman Madison , Binning Mandy Jo , Veznedaroglu Erol , Liebman Kenneth M. , Hakma Zakaria , Rahme Rudy J. , Ross Jennifer
Published: March 2024

INTRODUCTION:

Verapamil is an FDA-approved calcium channel blocker administered for the standard-of-care treatment of vasospasm. Preclinical studies have shown that verapamil reduces inflammation and protects penumbra neurons from further damage and eventual death.

METHODS:

Patients were recruited based on inclusion and exclusion criteria in a clinical protocol reviewed and approved by two institutional review boards. The final cohort comprised 42 emergency care patients with an acute onset focal neurological deficit consistent with ischemic stroke and/or a computed tomographic scan consistent with acute cerebral ischemia. All patients were 18 years of age or older that presented within 24 hours of symptom onset and had a significant but not severe neurological deficit, measured by a National Institutes of Health Stroke Scale (NIHSS) score greater than four but less than 22. All patients received a mechanical thrombectomy intervention after identifying a large vessel occlusion (LVO).

RESULTS:

The Verapamil-treated group (N = 23) included 22 patients with middle cerebral artery (MCA) occlusions and 1 with a basilar posterior cerebral artery (PCA) occlusion. In these patients, investigators administered 10 mg of Verapamil intraarterially following mechanical thrombectomy. Patients exposed to control conditions (N = 19) were matched for age, biological sex, admission NIHSS score, occlusion location, administration of tPA, and achieved TICI score. Intraarterial Verapamil treatment did not significantly increase sICH, hemorrhagic transformation, or death compared to standard of care treatment, demonstrating safety in an acute ischemic stroke patient population. Verapamil treatment was associated with significantly greater changes in mRS score, improved recovery time, and shortened length of hospital stay compared to standard-of-care treatment.

CONCLUSIONS:

This study suggests that verapamil is a safe and effective neuroprotective drug in ischemic stroke clinical populations that require mechanical thrombectomy for treatment.
392 Validation of a Mathematical Model for Rupture of Spherical Intracranial Aneurysms
Authors: Street Seth , Johnson Mark D. , Palmisciano Paolo , Schaffer Lauren , Dierker David , Prestigiacomo Charles J.
Published: March 2024

INTRODUCTION:

An accurate mathematical model of intracranial aneurysm (IA) mechanics is of great value for its potential utility in assessing probability of IA rupture, thus informing the decision to pursue surgical intervention with its associated risks. Such a model for spherical IAs has been proposed which predicts a wall-thickness-to-IA-radius ratio (WTR) of 6.1*10-3 at which IAs rupture (Chaudhry et al. 2006). To our knowledge, no further work has been done to validate this model with clinical data. We assess the accuracy of this model using cases of ruptured and unruptured IAs.

METHODS:

Aneurysm height, width, neck diameter, and vessel radius were measured on CTAs/MRAs/DSAs of IAs of the basilar tip, anterior communicating, and posterior communicating arteries. Binary logistic regression analysis was performed to determine the WTR where there is a 50% probability of rupture.

RESULTS:

52 unruptured and 28 ruptured spherical IAs were included. Binary logistic regression revealed a strong association between decreased WTR and rupture status. The point at which there is a 50% chance of rupture was found to be WTR = 8.6*10-3, from which the proposed 6.1*10-3 differs by only 29%.

CONCLUSIONS:

The model for IA rupture mechanics proposed by Chaudhry et al. agrees reasonably well with clinical data and could serve as a foundation upon which further investigation may be based. This study was limited primarily by its method of approximating aneurysm wall thickness, which may have over- or under-estimated the actual thickness. Future studies may improve on this by utilizing direct measurements of wall thickness through histological examination.
396 Creating a High-Precision, Dynamic Machine Learning Model Using Time Series Data to Predict Cerebral Vasospsm in Aneurysmal Subarachnoid Hemorrhage
Authors: Sen Rajeev D. , McGrath Margaret , Wang Lucy , Shenoy Varadaraya , Meyer R. Michael , Kim Louis J. , Levitt Michael Robert , Sekhar Laligam N.
Published: March 2024

INTRODUCTION:

Cerebral vasospasm (CV) occurs in up to one-third of patients who suffer from aneurysmal subarachnoid hemorrhage (aSAH) and can result in significant morbidity. Prior attempts to predict CV after aSAH have failed because they use static data collected on the day of presentation. We hypothesize that trending clinical and radiographic data including transcranial dopplers (TCDs) throughout 14 intensive care unit (ICU) days can be used to create a highly predictive, dynamic machine learning model for CV.

METHODS:

We conducted an IRB-approved retrospective study including 428 patients with aSAH hemorrhage treated at our institution between June 2014 and December 2018. For each patient, 74 features were trended including vital signs, lab values and ventriculostomy output. TCD measurements included anterior and posterior circulation velocities, Lindegaard Ratios and pulsatility indices. We employed a generative transformer-based model that uses patient representations from aggregate prior time points to predict the likelihood of CV.

RESULTS:

Of the 428 aSAH patients, 85 had angiographic-proven CV. There was no difference in demographic features including age, gender distribution and BMI between the CV and no-CV groups. Throughout 14 ICU days, the CV patients consistently displayed elevated mean arterial pressure and cerebral perfusion pressure. All TCD measurements were higher for the CV group. Initial logistic regression models based on static data from post-ictus days 1 through 4 showed steadily increasing F1 scores from 0.67 to 0.76. Feature analysis identified Lindegaard Ratios as the most heavily weighted features.

CONCLUSIONS:

Daily TCDs paired with additional longitudinal clinical data can be used to create a high-precision dynamic machine learning model for predicting CV after aSAH. These methods could also permit identification of patients at low risk of CV for reduced ICU length of stay.
399 Infundibulum Study: A Retrospective Analysis of Cerebral Vascular Infundibula. An Analysis on Growth and Its Significance at an Australian Tertiary Neurosurgical Centre
Authors: Yousif Saif , Vile Alex , Pattavilakom Anathababu , Jayalath Rumal
Published: March 2024

INTRODUCTION:

Debate exists regarding the natural history of cerebral infundibula. Pre-aneurysmal lesions and benign anatomical variants have both been proposed. To date there are no large cohort studies defining natural history.

METHODS:

Retrospective surveillance infundibula were undertaken in a single tertiary cerebrovascular centre. All Infundibula diagnosed on either MRA, CTA or DSA and followed up for 5 years were eligible for inclusion. Radiological and demographic characteristics were recorded at baseline. Infundibula growth, rupture and aneurysmal formation were outcomes of interest. Kaplan Meir curves were used to assess variables of interest with respect to time on surveillance. Groupwise comparison as conducted via Fischer exact testing.

RESULTS:

420 cerebral infundibula were followed prospectively, across 402 patients over 2418 infundibula-years. Eleven (2.62%) grew on surveillance, and three (0.7%) formed de-novo aneurysms. Median time to growth was 85 months (36-263) and median time to aneurysm formation was 112 months (96-142). Of the Infundibula that grew, the proportion that were male sex was significant higher compared to those that did not (p < 0.007). Of the Infundibula that grew in surveillance, 2/11 (18.2%) formed aneurysms (p = 0.001). With respect to Kaplan Meir analysis, male sex remained a significant predictor of growth (p = 0.007) and growth on surveillance (p < 0.001) remained a significant predictor of aneurysm formation.

CONCLUSIONS:

Growing infundibula are high risk of forming aneurysms and warrant ongoing surveillance.
402 Minimally Invasive Parafasicular Surgery for Hemorrhagic Stroke. First Experience. From January 2018 to December 2022. Panama
Authors: De Leon Alvino , Wong Eduardo
Published: March 2024

INTRODUCTION:

Hemorrhagic stroke represents 10-15% of all strokes, with a mortality of 40% and independence of 25% at six months, and represents a significant burden for public health. Minimally invasive surgery (MIS) methods through parafasicular approaches are a new option.

METHODS:

A prospective study from January 2018 to December 2020. The evaluation includes age, gender, comorbidities, GCS, and mRS scales. CT was the only form of imaging, establishing size, signs of intracranial hypertension, hydrocephalus, intraventricular bleeding, and surgical planning. The craniotomy is done through craniometrics points, and employing a tubular port for the parafasicular approach was done within the first 24 hours. The ultrasound, microscope, and endoscope were used. The objective was the reduction of the hematoma to less than 15cc. The postoperative period was semi-intensive.

RESULTS:

25 patients were included, mean age 56 years, 56% men and 44% women. Location: 5 frontal, 18 basal nuclei, and 2 temporal. 60% left. 32% intraventricular extension. The average ICH Score was 1.84. The average volume was 50 cc. Mean GCS of 10 and mean mRS of 4. The mean ICH reduction was 95%, and the mean residual volume was 2.4cc. Not deceased. A reoperation. Larger ICH and intraventricular hemorrhage had a worse outcome (p = 0.01 and p = 0.04). Higher ICH Scores were associated with a worse outcome than those with a lower score (2.4 vs. 1.5; p = 0.008). Average follow-up of 4 months. Mean mRS at the discharge of 4 and the follow-up of 3 GCS in the follow-up of 14.

CONCLUSIONS:

MIP surgery reduces the size of the hematoma, improves the quality of life, and is safe.
404 Mobile Pupillometry for Detection of Vasospasm, Delayed Cerebral Ischemia, and Neuro Exam Change in Subjects With Aneurysmal Subarachnoid Hemorrhage
Authors: Maxin Anthony , Gulek Bernice G. , Shaibani Rami , McGrath Lynn , Abecassis Isaac Josh , Levitt Michael Robert
Published: March 2024

INTRODUCTION:

The pupillary light reflex (PLR) parameters are quantitative biomarkers that can be used to detect neurological disease. Vasospasm complicates aneurysmal subarachnoid hemorrhage (aSAH) trajectory, causing morbidity and mortality.

METHODS:

We prospectively collected PLR parameters from patients with aSAH admitted to a neurological intensive care unit twice daily using quantitative smartphone pupillometry recordings. PLR parameters included: Maximum pupil diameter (MAX), minimum pupil diameter (MIN), percent change in pupil diameter (CHANGE), latency in beginning of pupil constriction to light (LAT), mean constriction velocity (MCV), maximum constriction velocity (MAXCV), mean dilation velocity (MDV). One-tailed t-tests were performed to determine changes in PLR parameters between the following comparisons: (1) patients with and without radiographic vasospasm (defined by computed tomography angiography (CTA) or digital subtraction angiography (DSA)); (2) patients with and without delayed cerebral ischemia (DCI); and (3) patients with and without neurological exam change due to vasospasm.

RESULTS:

42 total subjects were enrolled. For patients with (n = 13) and without (n = 29) radiographic vasospasm, significant PLR parameter differences were observed in: MAX (p = .024) and MIN (p = .0018). For patients with (n = 14) and without (n = 28) DCI, significant PLR parameter differences were observed in: CHANGE (p = .008). For patients with (n = 13) and without (n = 29) neurological exam change due to vasospasm, significant PLR parameter differences were observed in: MIN (34.7 vs 31.7, p = .014), CHANGE (20.6 vs 24.7, p = .025), and LAT (.36 vs .2, p = .0002). All other PLR parameters were not significantly different between groups for the three comparisons.

CONCLUSIONS:

Quantitative smartphone pupillometry may be of clinical use in the detection of radiographic vasospasm, DCI, and neuro exam changes via separate and distinct parameters from the PLR.
410 Can a Universal Width Fit all? Exploring Optimal Dimensions for Cervical Disc Arthroplasty Implants
Authors: Ibrahim Sufyan , Nieves Antonio Bon , Nathani Karim , Bhandarkar Archis R. , Graepel Stephen , Freedman Brett , Bydon Mohamad
Published: March 2024

INTRODUCTION:

Given the wide spectrum of implant widths, which are typically coupled to specific height and/or depth dimensions, and the desire to match native bony anatomy, as opposed to resecting/burring the bones to achieve implant-fit, there is need to clearly delineate subaxial cervical anatomy, especially at superior endplate (SEP).

METHODS:

Scans of the cervical spines from a convenience sample of 50 young, healthy patients (29 males, 21 females), aged 23-28 years (mean: 25.1±1.3 years), with mean BMI of 30.44 kg/m2, who underwent CT for negative trauma evaluations. The following measurements were estimated.

RESULTS:

The mean IUD at the posterior-third(A3), was the limiting width at all levels, which only increased from 11.3 ± 2 mm at C4 to 13.4 ± 2.9 mm at C7. The 3rd quartile of mean A3 distance were: C4–12.61 mm, C5–13.38 mm, C6–15.18 mm, C7–15.25 mm. A1 and A2 were both greater than 14 mm in majority of the subjects (C4–50%, C5–56%, C6–72%, C7–90%), whereas A1 and A2 were >17 mm (most contacted depth by all marketed implants) only in 2% at C4, 4% at C5, 16% at C6 and 44% at C7. While linear parameters differed significantly between the male and female sex, there was no statistically significant difference in mean A3 at any level (all p > 0.05). There also was no appreciable statistically significant difference between measured indices when grouped by BMI category.

CONCLUSIONS:

IUD increases from cephalad-to-caudad but reduces from anterior-to-posterior at each level. For vast majority, regardless of gender/BMI, the IUD is at least 14 mm, especially in most commonly CDA-treated disc spaces(C5-6, C6-7), suggesting that 14 mm could serve as "one-width" for all CDAs, especially since primary goal of the arthroplasty is to create proper width-fit of implant without bony resection.
418 CXCL-10 Influences Local Regulation of Neuroinflammation After Intracranial Hemorrhage
Authors: Barker William , Wolfe Stacey Q. , Xiang Zhidan , Ma Renate , Yager Brock , Diz Debra
Published: March 2024

INTRODUCTION:

Mitigating secondary injury from neuroinflammation is a critical investigation to identify therapeutic targets and improve ICH outcomes. Plasma CXCL10, a chemokine of chemo-attraction for monocytes/macrophages, T cells, and NK cells, is significantly elevated in hypertensive patients; therefore, we investigated the role of CXCL10 in local neuro-inflammation after hypertensive ICH. Furthermore, it is also vital to understand the local effects of common risk factors of ICH such as hypertension and cardiometabolic disease on pro-inflammatory chemokines.

METHODS:

A pilot study of autologous-injection ICH was induced in hypertensive (mREN2)7 (n = 5) and normotensive Hanover Sprague-Dawley male rats (n = 5). Tail-cuff blood pressure measurements and pre- and post-ICH neurobehavioral testing was performed. Rat sacrifice was performed at 5 days post-ICH with subsequent homogenization of hematoma area and contralateral area (2 mm brain slice around injection site). Hemoglobin was measured using whole hemispheres, but small slices were used for assessing immune inflammation. Lastly, qPCR testing was performed to determine CXCL-10 level of expression.

RESULTS:

CXCL-10 was significantly different in the local ipsilateral hemisphere of both the cardiometabolic mREN model (P = 0.012) and control SD (P = 0.025) rats compared to the contralateral hemisphere at 5 days post-ICH. There was no significant difference in CXCL-10 expression between SD and mREN rat models in contralateral or ipsilateral hemispheres.

CONCLUSIONS:

Cerebral CXCL-10 levels ipsilateral to ICH are significantly elevated compared to the contralateral hemisphere indicating the locally injured brain tissue expressed CXCL-10 to recruit immunocyte infiltration. CXCL-10 elevation does not appear to be influenced by comorbidities of cardiometabolic disease or hypertension. These results implicate CXCL-10 mediated processes such as activation and recruitment of leukocytes in post-ICH secondary injury, which may prove to be an important therapeutic target.
429 Sub-internship Academy: Implementation and Evaluation of Single-Day Resident-Driven Focused Sub-internship Preparation Course
Authors: Gal Zsombor Tamas , Nanda Pranav , Hsueh Brian , Robertson Faith C. , Razak Shahaan S. , Mazurek Mercy H. , West Timothy , Perez Nicole , Coumans Jean-Valery , Jones Pamela Stuart , Shankar Ganesh , Stapl Christopher James
Published: March 2024

INTRODUCTION:

Strong performance in neurosurgical sub-internships requires familiarity with clinical and technical skills which may not otherwise be covered in standard medical school curricula. Thus, a need exists for immersive and comprehensive sub-internship preparation programs, which should be optimized based on student feedback.

METHODS:

Academy curriculum involved hands-on and discussion-based elements split into three stations: (1) suturing and general information, including a suturing and knot tying workshop and discussion of expectations of sub-interns; (2) introduction to the operating room and drilling, covering patient positioning, surgical technology, OR etiquette, and craniotomy basics; and (3) cases and clinical skills, reviewing clinical imaging, focused neurological exams, and medical note writing. An anonymous online post-survey was administered to collect data on participants’ perceptions of the utility of the academy.

RESULTS:

Twelve medical students participated in the inaugural neurosurgery sub-internship academy. Nine responded to a post-survey, which revealed following ratings: the overall program was rated as having maximal impact on sub-internship readiness and enthusiasm for neurosurgery by eight (88.9%) and seven (77.8%) respondents, respectively, and trends were comparable for individual curriculum components. A largely positive impact on mentorship access was also observed.

CONCLUSIONS:

Student perceptions of the relevance and utility of the sub-internship academy were positive, and the program fostered enthusiasm for neurosurgery and opportunities for mentorship. Evaluation of the program’s actual impact on preparedness and sub-internship performance as well as student retention in the field of neurosurgery will be performed in the future, in accordance with the Kirkpatrick model of training evaluation.
430 Academic Productivity of Neurosurgical Trainees Is Associated With Productivity of Gender Concordant Faculty
Authors: Bauer Isabel L. , Nosova Kristin , Deaver Courtney , Pico Annie , Challapalli Mahesh K. , Jukic Alma , Russell Rachel , Kern Ashley , Okonya Tracy , Fabrega Sofia del Carmen , Ramaiah Priya , Kenner Haley , Mamaril-Davis James , Seideman Travis , Kelber James
Published: March 2024

INTRODUCTION:

Mentorship disparity is a commonly cited barrier to female neurosurgery trainees. The extent to which gender concordance with faculty impacts trainees’ academic productivity is underexplored.

METHODS:

The website of each ACGME accredited neurological surgery residency program was queried to identify the name and gender of all current (2022-2023) neurosurgical residents and academic faculty. Academic productivity, defined as the number of publications per person between 2021-2023 in 15 neurosurgery journals, was compiled into an original database. For each program, the average number of publications per female and male faculty and resident were recorded. Pearson correlation coefficients were calculated.

RESULTS:

A total of 959 faculty (female: 121, 12.6%) and 790 residents (female: 179, 22.7%) across 112 programs were identified. Forty (38%) programs had no female faculty; 32% had no female residents. The absence of female faculty was not statistically associated with the absence of female residents. In programs with only male faculty, academic productivity of male attendings was negatively associated with that of female residents (-0.47, p 0.0104).

CONCLUSIONS:

Academic productivity of male faculty correlates with productivity of male residents in their program; this relationship is not observed between faculty and residents of opposite genders. In programs with only male faculty, faculty productivity is inversely correlated with productivity of female residents. These findings reveal limited collaboration between residents and faculty of the opposite gender as a potential barrier to academic productivity. Furthermore, efforts to promote effective cross-sex collaboration could increase productivity for all members of neurosurgery divisions.
431 The Role of Stroke Prophylaxis in Traumatic Vertebral Artery Injury: A Literature-Based Cohort Study
Authors: Bambakidis Peter , Katsos Konstantinos , Michalopoulos Giorgos , Pennington Zach , Lakomkin Nikita , Meyer Fredric B. , Bydon Mohamad
Published: March 2024

INTRODUCTION:

Vertebral artery injury (VAI) can precipitate posterior circulation strokes acutely following blunt trauma. VAI severity is conventionally classified by the Denver grading system, but at present, there remain no guidelines that translate Denver injury grade to antiplatelet or anticoagulant recommendations.

METHODS:

Four databases (Ovid MEDLINE, Ovid Embase, Cochrane Central, and Scopus) were queried to identify all studies evaluating stroke risk following blunt VAI. Stroke rates following VAI were compared for patients managed with observation only or antiplatelets. Sub-analyses stratifying outcomes by injury severity (Denver grade) were performed. Effectiveness of antiplatelet use was summarized by the number needed to prevent (NNP) post-VAI stroke.

RESULTS:

Of 2,256 unique studies identified, 34 comprising 1,138 patients were incluced. Overall VAI-related stroke risk was 1.75% before admission and 3.40% after admission. Grades I and II had a cumulative stroke risk of 2.43% (95% CI: 0.98-4.94), which differed significantly (p < 0.01) from Grade IV-associated risk (10.10%; 95% CI: 4.95-17.79). Overall stroke risk in patients without prophylactic treatment was 10.00% (95% CI: 9.07-10.9), and 0.43% (95% CI: 0.01-1.06) in their counterparts who received antiplatelets (NNP = 10). Patients with grade I-II VAI receiving no treatment had 5.19% (95% CI: 1.43-12.77) stroke risk compared to 0.55% (95% CI: 0.01-3.02) treated with antiplatelet agents (NNP = 22). Among grade IV VAI, the stroke risk among patients that received no treatment was 21.21% (95% CI: 8.98-38.91), while none of the patients that received antiplatelet therapy developed stroke (NNP = 5).

CONCLUSIONS:

The majority of VAI-related stroke occurs after initial presentation, suggesting a potential for prevention of post-VAI stroke. Antiplatelet treatment was associated with significantly lower odds of post-VAI stroke among patients with Grade I, II, or IV injury, with the impact increasing within injury grade. The results suggest the positive impact of antiplatelet therapy with increasing VAI injury severity.
432 Middle Meningeal Artery Embolization Reduces Recurrence Following Surgery for Septated Chronic Subdural Hematomas
Authors: Zeineddine Hussein A. , Martinez-Gutierrez Juan Carlos , Hugh Dawes Bryden , Wroe William , Dannenbaum Mark J. , Ciavarra Bronson , Blackburn Spiros L. , Chen Peng Roc , Chen Ching-Jen , Kitagawa Ryan Seiji
Published: March 2024

INTRODUCTION:

Chronic subdural hematoma (cSDH) causes a significant burden of disease and plagued by hematoma recurrence after surgical evacuation, particularly in septated cSDH. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment both as an adjunct to surgery and as a primary treatment.

METHODS:

This a single center, retrospective cohort study of patients treated with surgery for septated cSDH. Patients in the surgery + MMAE cohort were identified from a prospectively collected MMAE registry and compared to a historical surgery cohort presenting over a 2-year period prior to the introduction of MMAE in our institution. Included patients had evacuation of septated cSDH with either burrholes or craniotomy. CT imaging was assessed hematoma width and midline shift perioperatively and at follow up. The primary outcome was reoperation and secondary outcome recurrence and change in hematoma depth and midline shift.

RESULTS:

A total of 34 cSDHs in 23 patients (MMAE + surgery) and 94 cSDHs in 76 patients (surgery) met the inclusion criteria. No significant differences of baseline characteristics was identified.The rate of reoperation was significantly higher in the surgery cohort (n = 16) compared with the surgery + MMAE cohort (n = 0) (p = 0.006).

CONCLUSIONS:

MMAE for septated cSDH was found to be highly effective in preventing recurrence and reoperation. MMAE is an adjunct to surgical evacuation may be of particular benefit in this patient cohort.