bluuebunny/crossref_metadata_2025 huggingface dataset:
221 Submaximal Angioplasty Alone Versus Stenting Plus Angioplasty for Symptomatic Intracranial Atherosclerotic Disease a Propensity Score Matched Comparative Study With Long Term Follow-Up
Authors: Baig Ammad , Aguirre Alexander Otilio , Donnelly Brianna M. , Kuo Cathleen , Kruk Marissa , Im Justin , Joseph Naomi , Palka Charles , Maini Aniket , Hashmi Eisa , Lim Jaims , Turner Ryan C. , Lai Rosalind , Raygor Kunal P. , Siddiqui Adnan Hussain , Levy Elad I.
Published: March 2024

INTRODUCTION:

Symptomatic intracranial atherosclerotic disease (ICAD) remains an important cause of recurrent stroke and acute ischemic event. Although the high periprocedural risk of intracranial stenting from recent randomized studies has dampened enthusiasm for such interventions, submaximal angioplasty without stenting may represent a safer endovascular treatment option.

METHODS:

A prospectively maintained database was retrospectively searched for patients presenting with signs and symptoms of acute ischemic stroke or transient ischemic events. Patients subsequently underwent CT Stroke Study to confirm the diagnosis of symptomatic intracranial atherosclerotic disease. Patient baseline demographic characteristics, procedural details and post-procedure outcomes were recorded. A one-to-one matched propensity score analysis was performed to adjust for treatment selection bias using the nearest-neighbor matching technique without replacement for covariates (baseline comorbidities, previous stroke or TIA, antiplatelet use, anticoagulant use, and baseline percent diameter stenosis). Mann-Whitney U test was performed to compare the procedural parameters and the clinical outcomes between groups.

RESULTS:

We included 218 patients (Submaximal angioplasty:97 [97 after PSM]; Stenting plus angioplasty:121 [97 after PSM]). After PSM, no difference was seen between the two groups in terms of comorbidities, and initial stroke severity. Submaximal angioplasty group had significantly lower incidence of stroke/TIA secondary to restenosis on follow-up (6.2% vs. 20.6% (OR = 0.87; P = 0.003)), and longer length of follow-up after discharge (4.17 years vs. 2.88 years (OR = 0.98; P = 0.03)) when compared to stenting plus angioplasty group. Both groups had similar rates of intra- (2.1% vs. 6.2% (OR = 0.96; P = 0.15)) and post-procedural complications rates (6.2% vs. 11.3% (OR = 0.95; P = 0.21)).

CONCLUSIONS:

Submaximal angioplasty alone results in better long-term clinical outcomes in terms of stroke/TIA when compared with stenting and angioplasty for symptomatic intracranial atherosclerotic disease, and represents a potentially promising intervention.
223 An Artificial Intelligence Framework for Brain Tumor Delineation in Intraoperative Ultrasound
Authors: Dorent Reuben , Torio Erickson , Haouchine Nazim , Juvekar Parikshit , Frisken Sarah , Golby Alexandra J. , Kapur Tina , Wells William
Published: March 2024

INTRODUCTION:

Automated delineation of gliomas in intraoperative ultrasound (iUS) could provide timely information to surgeons. While artificial intelligence (AI) frameworks have shown promising results for delineating gliomas in preoperative MRI, automated delineation in iUS remains a challenging and open problem.

METHODS:

A deep learning algorithm was developed to automatically delineate gliomas in intraoperative ultrasound. Instead of using time-consuming manual delineations from experts, the algorithm was developed using MR-based automated delineations. First, a MR nnUnet was trained for delineating gliomas in 3D preoperative MRI using an annotated public dataset (N=1000; RSNA-ASNR-MICCAI-BraTS 2021). Then, this algorithm delineated gliomas in preoperative MRI of patients (N = 84) in whom pre-dural opening 3D iUS reconstructed from a tracked handheld 2D probe was also acquired. To obtain the MR-based delineations in iUS, preoperative MRI and iUS were aligned using NiftyReg. Finally, a 3D iUS nnUnet was trained using a random subset (N = 78) of this pseudo-annotated iUS dataset. The method was assessed on the remaining test set (N = 943 slices from 6 volumes), with a treating neurosurgeon delineating gliomas in 2D iUS only and then in 2D iUS and aligned MR slices to obtain gold-standard delineations.

RESULTS:

The median Dice scores of the nnUnet and the neurosurgeon were respectively 78.6% (IQ:15.5%) and 84.3% (IQ: 21.1%) against the gold-standard delineations. In this preliminary study, the network's performance was comparable to the neurosurgeon's (two paired one-sided tests, equivalence margin:5%, p<1e-5, N = 943), with rapid delineation (<10 second) of 3D iUS (95-216 slices) compared to neurogeons (32-93 minutes), making automated delineation practical during surgery.

CONCLUSIONS:

The results demonstrate the feasibility of using AI-based methods for automated delineation of brain tumors in iUS, which could improve surgical outcomes by providing real-time information to surgeons.
226 Advancing Neurovascular Diagnostics for Abnormal Hemodynamic Conditions Through AI-Driven Physics-informed Neural Networks
Authors: Williams Kyle , Rudin Stephen , Bednarek Daniel , Baig Ammad , Siddiqui Adnan Hussain , Levy Elad I. , Ionita Ciprian
Published: March 2024

INTRODUCTION:

Many studies have explored the application of machine learning and neural networks in extracting critical diagnostic information from structural and functional medical imaging. While these methods show potential for improving efficiency, concerns arise when interpreting subtle imaging features, especially when training data is limited. Physics-informed neural networks (PINNs) address these issues by incorporating governing equations from physical and mechanical models into the analysis.

METHODS:

We examined the use of a PINN that enforces the convection equation, relating contrast media propagation to blood velocity, the Navier-Stokes equations for velocity and pressure distributions, and the conservation of mass requirement to calculate velocity and pressure distributions within patient-specific blood vessels. We also implemented a boundary condition that accounts for real contrast-media propagation from 1000 fps high-speed angiographic (HSA) image sequences, allowing for an assumption-free problem space within a medical imaging framework. Velocity fields and pressure gradients were calculated for flow in aneurysms and carotid bifurcations.

RESULTS:

Our method demonstrates comparable results to computational fluid dynamics (CFD) without requiring manual data processing, significantly improving the efficiency of calculating high-resolution velocity and pressure fields. By integrating AI with physics modeling, this novel approach holds the potential for advancing neurovascular diagnostics and providing more accurate, personalized treatment plans for patients with neurovascular pathologies.

CONCLUSIONS:

This innovative approach, integrating physics modeling and artificial intelligence, offers more accurate and personalized diagnostics for patients with neurovascular pathologies. The PINN method not only achieves results comparable to computational fluid dynamics without the need for manual data processing but also greatly enhances the efficiency of calculating high-resolution velocity and pressure fields.
228 Expert Hand Motion During Microvascular Anastomosis Simulation: Big Data Analysis Using Machine Learning Hand Detection
Authors: Gonzalez Nicolas Ivan , Mignucci-Jiménez Giancarlo , Xu Yuan , Abramov Irakliy , Park Wonhyoung , Wanebo John E. , Tanikawa Rokuya , Lawton Michael T. , Preul Mark C.
Published: March 2024

INTRODUCTION:

Microanastomosis is a complex surgical technique that demands delicate and coordinated hand movement. Advances in machine learning technology have enabled new methods to study human motion. Convolutional neural networks are algorithms specialized in visual tasks that enable discrete object detection and tracking including the hands of a surgeon.

METHODS:

A machine learning hand detector was developed using a pre-trained convolutional neural network capable of tracking 21 hand landmarks without sensors attached. En-to-side microanastomosis was simulated using 2 mm polyvinyl-alcohol vessels and 10/0 micro-suture and recorded with a video camera capturing hand movement in the surgical field. Participants (n = 4) were expert cerebrovascular surgeons with significant operative experience in cerebral bypass surgery. Calculation of motion of 14 hand joint angles was performed using a vectorization method from landmark detections. Time series analysis was performed to calculate the absolute angular motion for each joint of the hand.

RESULTS:

Four minutes of simulation for each surgeon yielded a total of 784.294 angular detections (14 hand joints total). For the dominant hand, the mean (SD) absolute angular motion was expert 1: 178.2 rad (98.3); expert 2: 261.8 rad (164.3); expert 3: 449.9 rad (307); expert 4: 380.1 rad (198.1).For the non-dominant hand, the mean (SD) absolute angular motion was expert 1: 132.9 rad (64.6), expert 2: 149.2 rad (72.3); expert 3: 389.2 rad (243); expert 4: 162.6 rad (87.2).

CONCLUSIONS:

A machine learning hand detector system can calculate hand joint motion during microvascular anastomosis. The absolute angular motion is a quantitative performance metric providing information about hand stability during microanastomosis simulation. Such studies using powerful artificial intelligence detection algorithms may have educational potential in the assessment of complex and delicate surgical skills and supervision of surgical training.
239 The Influence of Apolipoproteins E Gene Polymorphism on Cognitive Outcome in Patients with Moderate Degree Diffuse Brain Injuries
Authors: Grandhi Aditya
Published: March 2024

INTRODUCTION:

APO-lipoproteins have a primary role in solubilizing and transporting lipids across cell membranes. APO-lipoprotein E isoform 4 (among APOE ε 1,2,3,4) is least efficient in clearing Aβ protein from the brain and is considered as a risk factor for Alzheimer disease.

METHODS:

After institutional ethics committee clearance, a prospective cohort study was done from 2017 to 2021 on adult patients who sustained moderate degree diffuse brain injury. APOE gene analysis were carried out on them. Patients who went on to subsequently develop focal lesions, those who died or were lost to follow up were excluded. Fifty consecutive patients who fulfilled the criteria, subsequently participate in a Mini Mental State Examination at the end of 1 month and 3 months were analysed.

RESULTS:

In our study, the allele frequencies for APOE gene ɛ2, ɛ3, ɛ4 were 36%, 53%, 11%, respectively. Patients were categorized into group A (who had at least one APOE ɛ4 allele) and group B (who did not have any APOE ɛ4 allele). In our study patients in group A had a prolonged hospitalisation and increased risk of convulsion than group B. The lack of improvement in MMSE scores (language and praxis subdomains) in group A as compared to group B after 3 months was statistically significant. The difference between the two groups in the rest of subdomains (attention, calculation, memory, orientation) and total MMSE scores at 3 months compared to that at discharge were insignificant.

CONCLUSIONS:

The presence of the APOE ɛ4 allele affects language and praxis during recovery. It increases the risk of post-traumatic seizures and increases the length of hospital stay but does not have a significant outcome on overall cognition after a course of 3 months.
243 Intracranial Theta-burst Stimulation Modulates Cortical Excitability in a Dose and Location-dependent Fashion
Authors: Huang Yuhao (Danny) , Cash Sydney , Keller Corey , Paulk Angelique
Published: March 2024

INTRODUCTION:

Direct electrical stimulation is a powerful therapeutic approach to treating a wide range of brain disorders. In particular, theta-burst stimulation (TBS) which delivers electrical pulses in rhythmic bursts of 3-8 Hz to mimic endogenous brain rhythms, has been increasingly used to improve cognitive processes and relieve symptoms of depression. However, how TBS alters underlying neural activity is poorly understood.

METHODS:

In nine neurosurgical epilepsy subjects undergoing intracranial monitoring, we applied direct cortical TBS at varying stimulation amplitudes and locations (prefrontal, temporal, parietal). We obtained single-pulse corticocortical evoked potentials (CCEPs) prior to stimulation to map functional connectivity. Intracranial EEG (iEEG) was recorded from non-stimulated electrodes before, during and after TBS.

RESULTS:

We found that TBS evoked consistent responses after each burst. These responses were observed in regions with high amplitude CCEPs and resting spontaneous delta (1-4 Hz) phase-locking to the stimulation site, consistent with our hypothesis that the underlying functional brain architecture guides information flow after stimulation. Furthermore, we observed changes in cortical excitability over time as measured by changes in amplitude of the TBS evoked responses both within stimulation burst trains and across burst trains. The degree of change in cortical excitability was modulated by anatomical location, proximity of the stimulating electrode to white matter, and current amplitude.

CONCLUSIONS:

These results indicate that direct cortical TBS produces neural effects that can be measured over time and correlate with baseline biophysical parameters. Thus, personalizing stimulation parameters might be critical to predictably maximize our ability to alter disease-relevant brain networks.
244 The Inaugural “Century” of Mixed Reality in Cranial Surgery: Virtual Reality Rehearsal/Augmented Reality Guidance and Its Learning Curve in the First Single-Surgeon, 100-Case Series
Authors: Jean Walter C. , Piper Keaton , Saez-Alegre Miguel
Published: March 2024

INTRODUCTION:

Virtual reality (VR) and augmented reality (AR), together called Mixed reality (MxR) gaining importance in Neurosurgery as it helps to select apporaches and identify key anatomic landmarks intraoperatively.

METHODS:

The first 100 consecutive cases of a single surgeon for which MxR was intended for use were retrospectivaly analyzed for specific contributions to the opeation. Seventeen cases in the study cohort were matched with historical non-MxR cases for comparison of outcome parameters. The cases in which MxR failed were plotted over time to determine the nature of the “learning curve.”

RESULTS:

The nadir of the blue line is at case 44. The inflection point of the trend line (black) occurred at approximately case 63.This provides some evidence of proficiency acquisition in between. MxR helped to limit the size of the opening in 44 cases, enhanced precise placement of the craniotomy in 64 cases, increased the guidance efficiency to target or marker in 58 cases, and protected anti-targets from surgical incursion in 12 cases. Cases where MxR had above-expectation performances will be highlighted. Comparing MxR cases with matching non-MxR, the average EBL (106.8 mL vs. 142.4 mL), LOS (5.4 d vs. 8.2 d) and surgery duration (218.4 mins. 252.8 min) were all smaller for the MxR group. However, no statistically significant differences were found for all three comparisons.

CONCLUSIONS:

MxR enhances surgical planning and can supplant probe-and-monitor navigation for efficient intraoperative guidance without additional time for surgery or hospitalization
245 Linking Cervical Spinal Cord White Matter Magnetization Transfer Ratio to NIH Toolbox Based Analyses of Motor Function in Degenerative Cervical Myelopathy
Authors: Muhammad Fauziyya , Weber Kenneth Arnold , Rohan Michael , Haynes Grace , Khan Ali Fahim , Hameed Sanaa , Mohammadi Esmaeil , Omini Michael , Smith Zachary Adam
Published: March 2024

INTRODUCTION:

Traditional spine imaging technique present disparity between degenerative cervical myelopathy (DCM) disease severity and prognosis. Advancement in spine neuroimaging has unveiled key changes that enhance our understanding of DCM pathogenesis. We investigated region- and tract-specific SC white matter (WM) damage and their relationship to motor deficit in DCM.

METHODS:

A cohort of 20 DCM and 23 age-matched HC participants were recruited in a cross-sectional study. We utilized a consensus MT-imaging protocol, Spinal cord Toolbox, and objective motor assessment tool battery to assess the extent of WM injury and functional deficits in DCM. The SC WM region- and tract-based MTR were calculated in three different ROIs: maximum compressed level (MCL), caudal uncompressed level (C7), and central region of compression.

RESULTS:

DCM patients demonstrated significant functional deficits compared to HC in motor assessments. DCM exhibited reduced MTR measures denoting WM injury in the anterior region of the SC and within selected motor tracts in the ROIs. MTR values in reticulospinal, vestibulospinal, and lateral corticospinal tracts were significantly associated with dexterity and grip strength measures.

CONCLUSIONS:

Our methodology enables precise mapping of ROIs within the SC allowing us to demonstrate an association between tract-specific WM damage and functional motor deficits in DCM patients. Additionally, the observation of decreased MTR measures in seemingly uncompressed SC regions indicates the pathophysiology of DCM that may provide insight into the varying presentations of DCM. Identification of specific WM injury may help better understand DCM deficits that can be targeted for effective interventions to improve patient outcomes
247 Novel Automated Active Irrigation With Drainage Leads to Significantly Faster Hematoma Clearance and Lower Catheter-related Infections Compared to Passive Drainage Alone for cSDHA Propensity Score-matched Comparative Study with Volumetric Analysis
Authors: Baig Ammad , Hess Ryan M. , Khan Asham , Cappuzzo Justin Mark , Hashmi Eisa , Bregy Amade , Kuo Cathleen , Nyabuto Elizabeth , Goyal Aditya , Davies Jason , Levy Elad I. , Siddiqui Adnan Hussain
Published: March 2024

INTRODUCTION:

Passive drainage post-surgical evacuation of symptomatic chronic subdural hematoma (cSDH) is currently standard of care. High rates of infection, drain occlusion, and recurrence are associated complications.

METHODS:

A prospectively maintained database was retrospectively searched for consecutive patients presenting with cSDH. One-to-one PSM of covariates (including baseline comorbidities and presentation hematoma volume) in active and passive irrigation groups was performed to adjust for treatment selection bias. Rates of hematoma clearance, catheter-related occlusion, and infection; number of revisions; and length of hospital stay were recorded.

RESULTS:

This study included 55 patients: active continuous irrigation-drainage-21 (21 post-PSM); passive drainage-34 (21 post-PSM). For PSM groups, a significantly higher rate of hematoma clearance was obtained in the active irrigation-drainage group (0.5±0.4 vs. 0.4±0.5 ml/day in the passive drainage group; odds ratio [OR] = 1.291 (confidence interval [CI]:1.062-1.570, P = 0.002) and a significantly lower rate of catheter-related infections (OR = 0.051; CI: 0.004-0.697, P = 0.039). A non-significantly lower hematoma expansion rate at discharge was noted in the active irrigation-drainage group (4.8% vs. 23.8%; OR = 0.127; P = 0.186). No statistical difference in all-cause in-hospital mortality or discharge GCS score was observed between groups.

CONCLUSIONS:

Active and automated continuous irrigation plus drainage following cSDH surgical evacuation results in faster hematoma clearance and led to favorable clinical outcomes and low complication and revision rates compared to passive irrigation.
251 A Comparison of Neurosurgical Intervention and In-hospital Mortality in Patients With Intracranial Gunshot Wounds From Long Guns Versus Handguns: A Propensity-matched National Database Analysis
Authors: Jiang Sam Han , Neves Teresa , Hewins Bryson , Chiu Ryan Guan , Marotta Dario Alfredo , Mehta Ankit Indravadan
Published: March 2024

INTRODUCTION:

Intracranial gunshot wounds (IC-GSW) are an understudied cause of mortality with indications for neurosurgical intervention. Historically, handguns have accounted for the majority of IC-GSW, but incidents involving long guns (rifles/shotguns) are rising. A comparison of neurosurgical intervention and in-hospital mortality by firearm type has yet to be fully explored.

METHODS:

The National Trauma Data Bank was queried from 2017-2019 for patients with IC-GSW presenting to a hospital with signs of life. Propensity score matching was performed between LG and HG groups based on demographics, comorbidities, Glasgow Coma Scale (GCS), and insurance type. Group differences were compared using paired Student’s t-tests and Pearson’s chi-square tests. A logistic regression model was developed to identify predictors of mortality.

RESULTS:

A total of 6,585 patients met inclusion criteria. Following one-to-one propensity score matching, 510 patients were identified and compared in each group. Seventy percent of patients with IC-GSW arrived with a GCS < 8 (68.43% LG vs. 72.16% HG, p=0.19). Rates of neurosurgical intervention were similar between the LG and HG groups (20.49% vs. 23.53%, p = 0.26), however LG patients had a lower rate of in-hospital mortality (34.51% vs. 42.55%, p < 0.01). Neurosurgical wound debridement (OR = 0.46, p<0.001), foreign body removal (OR = 0.44, p < 0.001), craniectomy (OR = 0.48, p < 0.001), and ventriculostomy (OR = 0.58, p < 0.01) were associated with lower odds of mortality.

CONCLUSIONS:

Patients with IC-GSW often present to the hospital in critical neurologic condition. Neurosurgical intervention is associated with lower odds of in-hospital mortality. Though both groups undergo neurosurgery at similar rates, patients with LG IC-GSW have a lower mortality rate. This study identifies a subset of patients who may particularly benefit from neurosurgery. Further research is needed to quantify the rationale behind these findings.
252 Chronic Subdural Hematoma Drainage Under Local Versus General Anesthesia: Systematic Review and Meta-analysis
Authors: Liu Eva , Zhou Amy , Tilbury Natalie , Radic Julia
Published: March 2024

INTRODUCTION:

Chronic subdural hematoma (CSDH) is one of the most encountered conditions seen in neurosurgery. Although mainstay treatment of cSDH has been burr hole drainage, no consensus yet exists on optimal anesthetic technique for surgical treatment between general (GA) and local (LA) anesthesia.

METHODS:

A search was conducted in MEDLINE (1946 to November 11, 2022), Embase (1974 to November 11, 2022), and PubMed (up to November 11, 2022). We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to systematically screen studies.

RESULTS:

Our literature search identified 521 studies, out of which 20 were included. There were a total of 1750 patients in the LA group and 699 patients in the GA group. Our meta-analysis found that the LA group had significant shorter operative time (mean difference -29.28 minutes, p <0.0001), length of admission (Mean difference -1.58 days, 95% CI = -2.40 to -0.76 days, p = 0.0002), and postoperative complications rate (odds ratio 0.38, 95% CI = 0.25 to 0.59, p < 0.0001) compared to GA. There was no significant difference between the two groups in revision rate (odds ratio 2.71, 95% CI 0.89 to 8.25, p = 0.08) and mortality rate (odds ratio 1.23, 95% CI 0.63 to 2.43, p = 0.55).

CONCLUSIONS:

In this meta-analysis, LA shows benefits in shorter operative time, shorter admission length, and fewer postoperative complications. This makes local anesthesia a less invasive alternative to general anesthesia especially in elderly patients.
253 Tissue Partial Pressure of Oxygen During Spreading Depolarization in Malignant Stroke is Associated With Outcome
Authors: Hecht Nils , Haddad Daisy , Schumm Leoni , Dömer Patrick , Meinert Franziska , Major Sebastian , Lemâle Coline , Dreier Jens , Vajkoczy Peter , Woitzik Johannes
Published: March 2024

INTRODUCTION:

Spreading depolarization (SD) describes a propagating neuronal mass depolarization within the cerebral cortex that likely represents a relevant mechanism of secondary lesion progression.

METHODS:

This prospective observational study included 25 patients with MHS that underwent decompressive hemicraniectomy (DC) followed by subdural placement of an electrocorticography (ECoG) strip electrode and cortical implantation of a PtiO2 probe within in the periinfarct tissue. Continuous ECoG and PtiO2 recordings were obtained at bedside for five days and analyzed for the occurrence of SD and SD-associated PtiO2 changes, as well as their association with clinical outcome at 6 months.

RESULTS:

The overall simultaneous ECoG and PtiO2 recording time was 2603 hours, during which 796 SDs were detected. The overall SD duration and SD frequency did not correlate with outcome. During the observation period, the overall PtiO2baseline changed significantly with an almost linear increase that reached a peak around 100 hours (*p=0.0055), followed by a PtiO2 drop until the end of the monitoring period (*p = 0.0048). Accordingly, low baseline PtiO2 (<15 mmHg) was mainly noted during the first 24 hours but did not correlate with outcome (p = 0.916). Conversely, 20 out of 25 patients showed SD-associated PtiO2 changes in 363 out of 796 SDs (45.6%), which were categorized as biphasic (222), hypoxic (119) and hyperoxic (22). Among these SD-associated PtiO2 responses, a high occurrence rate, biphasic response pattern and high amplitude correlated significantly with favorable outcome (mRS 1-3) at 6 months.

CONCLUSIONS:

SD-associated PtiO2 coupling in patients suffering hemispheric stroke appears to be associated with clinical outcome and could reflect the presence of viable and metabolically less impaired peri-infarct tissue.
257 Breaking the Mold: An International, Multicenter Study on Active and Continuous Irrigation With Cerebrospinal Fluid Exchange for Improving Outcomes in Cerebral Ventriculitis
Authors: Baig Ammad , Hess Ryan M. , Sprau Annelise , Kemeny Hanna , Nazari Pouya , Turner Ryan C. , Brandmeir Nicholas James , Jahromi Behnam Rezai , Jahromi Babak S. , Levy Elad I. , Siddiqui Adnan Hussain
Published: March 2024

INTRODUCTION:

Cerebral ventriculitis remains one of the most challenging neurosurgical conditions, with poor outcome and a long course of treatment and duration of hospital stay. Despite the current conventional management plans, i.e., using antibiotics in addition to CSF drainage, the outcome remains unsatisfactory in some cases, with no definitive therapeutic guidelines.

METHODS:

We conducted a multicenter, international, retrospective study of ventriculitis patients treated with a novel automated active irrigation, and drainage system. Data collected included patients’ demographics, comorbidities, admission Glasgow Coma Scale (GCS) score, and pre-hospital modified Rankin Scale (mRS). Catheter occlusions, infections, and shunt placement was recorded for outcome assessment, along with discharge mRS, and in-hospital mortality.

RESULTS:

Four centers (3 from U.S and 1 from Finland) contributed data for a total of 21 ventriculitis patients who had IRRAflow placement. Thirteen (61.9%) were males (mean age = 49.8 ± 14.87 years). The baseline median mRS was 1 and the median GCS at time of ventriculitis diagnosis was 13. Etiology of ventriculitis was iatrogenic in 12 (57.4%), and secondary to abscess in 9 (42.6%). No cases reported hemorrhage, or failure of IRRAflow placement. Antibiotics were administered in through the IRRAflow in 13 (61.9%) cases in addition to systemic dosing. Sixteen (76.19%) patients had significant clinical improvement and resolution of ventriculitis. Seven (33.33%) patients required shunt placement after resolution. There were 6 (28.6%) in-hospital mortalities reported.

CONCLUSIONS:

Use of active and continuous irrigation with drainage for continuous delivery of intraventricular irrigation fluid with antibiotics led to dramatically lower mortality when compared to literature (mortality approx. 70%). In our case series, it led to marked improvement in neurologic status, imaging findings, and CSF profiles making it technically feasible and safe treatment for ventriculitis.
258 Impact of Risk Stratified Antithrombotic Medication Resumption After Traumatic Brain Injury on Patient Outcomes
Authors: Kodvawala Raghad , Thomas Andrea , Yang George Liu , Cass Daryn Katherine , Gao Angela , Kruggel Andrew , Le Diana , Ngwenya Laura Benjamin
Published: March 2024

INTRODUCTION:

The incidence of traumatic brain injury (TBI) in patients on antithrombotic (AT) medications to prevent thromboembolic events is increasing. AT medications include antiplatelets and/or anticoagulants. While these medications are generally stopped in the setting of intracranial bleed, the optimal medication resumption time is uncertain. Both brief and prolonged suspension carry risk. In March 2021 we adjusted our institutional guidelines from restarting AT therapy at two weeks or more after TBI to resuming medications based on patient risk factors.

METHODS:

We performed a retrospective case-control study of data from the University of Cincinnati Level 1 Trauma Center neurotrauma registry between February 2017-November 2022. Patients on AT therapy presenting with intracranial hemorrhage and a Glasgow Coma Scale (GCS) score of 13-15 were included. The LR cohort included patients from February 2017-December 2019. The RSR cohort included patients from March 2021-November 2022. Demographics, injury variables, medication history, medication resumption, and thrombotic or hemorrhagic events up to 6 months after injury were collected. Groups were compared using t-tests for linear variables and Chi-Square for categorical variables with p < 0.05 denoted as significant.

RESULTS:

We identified 406 patients with 337 patients in the LR cohort and 69 patients in the RSR cohort. Early resumption (during hospitalization) occurred in 21.7% of the RSR cohort compared to 9.5% in the LR group. The difference in occurrence of thrombotic and hemorrhagic events between groups was not significant.

CONCLUSIONS:

Resuming antithrombotic medications after a TBI based on risk stratification criteria allows earlier resumption of medication with no associated increase in thrombotic or hemorrhagic events.
259 Ultra-early (8 Hours) Surgery for Thoracic Spinal Cord Injuries: A Systematic Review and Meta-analysis
Authors: Bhimani Abhiraj D. , Carr Matthew Thomas , Al-Sharshahi Zahraa Fadhil , Hickman Zachary L. , Margetis Konstantinos D.
Published: March 2024

INTRODUCTION:

The impact of the timing of surgery on neurological recovery in thoracic spinal cord injuries (tSCI) is still a subject of discussion. Accumulating evidence is supporting early decompression (<24 hours) following tSCI. However, the potential advantages of earlier decompression remain uncertain.

METHODS:

A search was conducted in the electronic databases Medline, Embase, Scopus, and Web of Science from their inception until May 2022 for human studies. Groups were stratified into ultra-early (surgery within 8 hours of injury) vs control group operated >8 hours of injury. The authors included the study data from their institutional case series of thoracolumbar spinal cord injury from 2015-2018. An arm-based meta-analysis was performed on all studies using the R Studio. For studies that qualified, a contrast-based meta-analysis was also performed with standardized mean difference (SMD). Outcomes were reported as effect size, treatment effect, and effect difference, all with 95% confidence intervals (CI).

RESULTS:

133 patients were included from 5 studies. 76 (57.1%) underwent decompression = 8 hrs, while 57 (42.9%) underwent decompression >8 hours from injury. Quantitative analysis using the SMD model showed a significant difference in mean AIS improvement in the ultra-early group [Effect size 1.15 (0.62-1.67), p < 0.0001]. On arm-based meta-analysis, a statistically significant treatment effect was found for ultra-early arm [1.25 (0.91-1.67)], while >8 hour arm did not show significance [0.30 (-0.08-0.71)]. There was a statistically significant effect difference between two arms [0.96(0.49-1.48)].

CONCLUSIONS:

This study observed a significant improvement in mean AIS score in patients undergoing decompression within 8 hours of tSCI. Given the scanty literature regarding ultra-early decompression of tSCI, this study solidifies the need to further explore the role of early interventions for tSCIs to improve patient outcomes.
263 Radiographic Structural Changes in Brain Anatomy of Pediatric Fetal Versus Postnatal Myelomeningocele Repair Patients
Authors: Desai Shivani , Woolard Alice , Guimaraes Carolina , Hung Sheng-Che , Quinsey Carolyn
Published: March 2024

INTRODUCTION:

Postnatally repaired myelomeningocele (MMC) patients have twice the risk of needing shunt treatment for hydrocephalus compared to fetally repaired patients, however it is unknown why exactly this occurs as well as what structural brain changes may be predictive of hydrocephalus. We radiographically characterized anatomic changes in fetally vs postnatally treated infants to understand early developmental anatomy.

METHODS:

MRIs were characterized by two board-certified neuroradiologists for the following variables: 1) The ratio of ventricular-to-subarachnoid space (VSAR) using bifrontal (BF), left frontal lobe thickness (LV), and extra-axial (EA) spaces as parameters. 2) The ratio of 2 planes within the lateral ventricle (LVR). These ratios, elongation of the choroid plexus glomus and body, and Chiari were measured.

RESULTS:

54 MMC repair patients met criteria, yielding 109 MRIs. In the one-to-three month time frame, VSAR at BF and LV parameters in addition to LVR were all significantly different in the fetally repaired group (n = 14) compared to the postnatally repaired group (n = 13, p<0.05). VSAR was not significantly different in early life. Chiari was significantly different in the early life and one-to-three month time between fetal and postnatal repair cohorts (p < 0.05).

CONCLUSIONS:

Fetally and postnatally repaired MMC brain MRIs were examined by two neuroradiologists to characterize differences in early brain development. This study identified significant differences in the ventricular to subarachnoid space ratio during the one-to-three month time point between fetally and postnatally repaired patients. We suspect that subarachnoid anatomy may be predictive of the need for surgical treatment of hydrocephalus.
265 Inpatient Outcomes in Pediatric Patients With Non-accidental Versus Accidental Head Trauma: National Trauma Data Bank Analysis
Authors: Nosova Kristin , Kern Ashley , Deaver Courtney , Russell Rachel , Bauer Isabel L. , Pico Annie , Bates Bryan , He Jack , Keric Natasha , Nakaji Peter , Bina Robert Wagner
Published: March 2024

INTRODUCTION:

Non-accidental trauma (NAT) is a leading cause of pediatric traumatic brain injury (TBI). Recent studies suggest NAT results in worse outcomes than accidental TBI, independent of severity of the injury and interventions.

METHODS:

Patients under 18 years old diagnosed with head trauma with or without NAT during 2019-2021 were identified in the NTDB. The predictor variables were demographics; previously validated prognostic factors , including motor score, verbal score, pupillary score, pupillary reactivity, image findings; neurosurgical interventions including EVD, ICPM, PbO2 monitoring; length of stay, and number of ventilated days. Data evaluation and univariate analysis were performed using summary statistics, t-tests, chi-square tests, and non-parametric tests. Mortality, length of ICU stay and complication rates were modeled using a multivariate logistic regression model. Outcomes were controlled for age, race, sex, and teaching vs nonteaching hospital.

RESULTS:

A total of 90,607 pediatric TBI events were identified in the database, 1721 (1.90%) cases with NAT. NAT was observed most often in 0-2 year-olds (64.78%), followed by 2-5 year-olds (22.66%), 6-10 and 15-18 year-olds (0.09% each), then 11-14 year-olds (0.07%). Patients with NAT had longer ICU stays (6.18 vs 4.93 days, p < 0.0001) and ventilator days, despite similar injury severity scores (p < 0.0001). In-hospital mortality was 30% more likely if NAT was the MOI (LR 1.3046, p < 0.001).

CONCLUSIONS:

Pediatric TBI patients with NAT have worse inpatient outcomes than similar patients with accidental injuries. Accurate diagnosis and better prognostication scales specific to patients with non-accidental trauma may lead to improved management and resource allocations for these sicker patients.
267 Risk Factors Associated With Baclofen Pump Infection in Children Translated Into Health-Care Costs: A Retrospective Analysis From the Children's Hospital of Pittsburgh Experience From 2009-2020
Authors: Fernandez-de Thomas Ricardo Jose , Huq Sakibul , Thambireddy Swetha , Adida Samuel , Kellogg Robert
Published: March 2024

INTRODUCTION:

Intrathecal baclofen infusion is often used as a therapy for spasticity in children and adults, with pediatric cases more associated with infections. Infection leads to the need for pump explantation and is associated with a significantly increased hospitalization cost.

METHODS:

We retrospectively reviewed demographic, clinical, and economic data for children who underwent surgery for intrathecal baclofen pumps at a single institution from 2009-2020. Bivariable analyses (chi-squared tests) were conducted to compare differences in clinical characteristics between patients with surgical site infection and those without. Mann-Whitney tests were performed to compare total charges per patient between patients who had an infection versus those who did not.

RESULTS:

A total of 199 patients undergoing 442 surgeries were included. The cohort was 64% male and 84% Caucasian, with a mean age of 13.3 years. The most common indication for placement was cerebral palsy. Infection occurred in 28 patients (14% infection rate). The most common organisms were methicillin-resistant and methicillin-sensitive staph aureus. The pump model, access site, and the number of surgeons scrubbed were not associated with infection. Total hospital charges (for all surgeries) were significantly higher for patients with an infection versus those who did not ($231,762 vs. $187,028, p=0.0078), with an average charge increase of $44,734 associated with surgical site infection.

CONCLUSIONS:

In our single-center series, the most common indication for baclofen pump placement was cerebral palsy, with an infection rate of 14%, close to other rates reported in the literature. Total hospital charges were higher for patients with an associated surgical site infection than those without one.
271 A Retrospective, Chart Review Study of the Efficacy and Safety of the RNS System in Pediatric Populations for Medically Refractory Focal Epilepsy
Authors: Lin Christine , Kim-McManus Olivia , Sattar Shifteh , Rismanchi Neggy , Ravindra Vijay , Gonda David D.
Published: March 2024

INTRODUCTION:

The Responsive Neurostimulation System (RNS) (NeuroPace, Mountain View) is a direct intracranial neurostimulator that is FDA-approved for adults with medically refractory focal epilepsy. There currently exists limited data regarding its efficacy and safety in pediatric populations.

METHODS:

A retrospective chart review was conducted of pediatric patients treated with the RNS System between January 1, 2019 and December 31, 2021 at Rady Children’s Hospital for at least one year. Data collected included percent change in median disabling seizure frequency from baseline at years 1, 2, and 3, as well as device-related serious adverse events.

RESULTS:

Twenty patients with medically refractory focal epilepsy were identified who had been treated with the RNS System for at least one year. Median duration of follow-up was 24 months (interquartile range [IQR]: 15-35 months) The median percent reduction in disabling seizures was 29% (N = 20, IQR = 0-84%) at 1 year, 53% (N = 12, IQR = -5-81%) at 2 years, and 67% (N = 4, IQR = 25-100%) at 3 years. 40% of patients reported a >90% reduction in median disabling seizure frequency, and 25% were seizure-free at last follow-up. Reductions in median seizure frequency were comparable based on patient age, age at seizure onset, neuroimaging findings, and prior intracranial monitoring. Zero patients experienced implant site infections. One patient (5%) required lead revision, and another patient (5%) had a spontaneous intraparenchymal hemorrhage at the generator site 2 years after implantation that resolved with expectant management. Neither of these events were associated with long-lasting neurological complications.

CONCLUSIONS:

The RNS System is a safe and efficacious treatment for pediatric patients with medically refractory focal epilepsy.
279 Does Surgical Treatment of Lumbar Spondylolisthesis Impact Self-care and Functional Independence? Five-Year Analysis of the Quality Outcomes Database
Authors: Le Vivian , DiDomenico Joseph D. , Johnson Sarah , Bisson Erica Fay , Bydon Mohamad , Kai-Hong Chan Andrew , Glassman Steven D. , Foley Kevin T. , Potts Eric A. , Shaffrey Christopher I. , Shaffrey Mark Edwin , Coric Domagoj , Wang Michael Y. , Knightly John J. , Park Paul , Fu Kai-Ming G. , Virk Michael S. , Slotkin Jonathan , Asher Anthony L. , Kerezoudis Panagiotis , Guan Jian , Michalopoulos Giorgos , Chou Dean , Haid Regis W. , Mummaneni Praveen V. , Uribe Juan S. , Turner Jay D.
Published: March 2024

INTRODUCTION:

Lumbar spondylolisthesis may have an impact on patients’ ability to care for oneself and maintain functional independence. Surgical treatment is associated with improvement in patient function but the impact on self-care is not well understood.

METHODS:

This is a retrospective analysis of the multicenter, prospectively collected Quality Outcomes Database (QOD). Patients with surgically treated grade I lumbar spondylolisthesis with five years of follow-up were included. Patient reported outcomes (PROs) were recorded. Patients were grouped into baseline dependent or independent cohorts based on the Personal Care component of the ODI (0-2=independent; ³3=dependent). Minimum clinically important difference (MCID) was defined as a 30% reduction from baseline disability.

RESULTS:

Of the 602 patients, 535 (89%) were independent and 67 (11%) were dependent at baseline with mean age of 63 and 59, respectively (p = 0.01). 479 patients (80%) reported 60-month follow up Personal Care scores, with 59% reporting improvement and 41% having worse or no improvement. At 60-month follow-up, 87.5% of dependent patients had gained lasting independence. Dependent and independent cohorts met 5-year MCIDs at similar rates. Baseline dependence was universally associated with worse pre-operative PROs (p < 0.01). 60-month improvement in personal care was associated with greater satisfaction and rates of MCID for all PROs (p < 0.01). 60-month improvement in personal care was positively associated with surgical treatment including arthrodesis versus motion-preserving surgery (OR = 1.17, 95%CI 1.04-1.32, p = 0.01).

CONCLUSIONS:

Dependent patients with lumbar spondylolisthesis achieve very high rates of independence (87.5%) which is durable through 5 years of follow-up. The dependent cohort represented only 11% of the cohort and was significantly younger at baseline. Spondylolisthesis patients treated with arthrodesis are more likely to improve their long-term self-care and independence.
280 Are We Getting Better at Treating Adult Cervical Deformity? Complication Rate Trends Analysis in Adult Cervical Deformity Over 10 Years
Authors: Mir Jamshaid M. , Dave Pooja , Tretiakov Peter S. , Das Ankita , Kurland David B. , Robertson Djani , Janjua Burhan , Jankowski Patrick Patryk , Passias Peter G.
Published: March 2024

INTRODUCTION:

Adult cervical deformity patients can have significant impact on quality of life. Realignment surgery has proven to be effective in a select group of these patients, however despite advancements in the field, complications are not uncommon. Evaluation of outcomes overtime can be insightful on aspects that surgeons have been improving on and those that remain to be a nuance.

METHODS:

Adult Cervical Deformity(ACD) patients with a minimum 2-year follow-up and less than 10 levels fused were included. Patients were stratified into quartiles by date of surgery, with the middle two quartiles being merged to form three categories: Early(E), Middle(M), Recent(R). ANCOVA was used to assess complication rates and PROMs amongst tertiles controlling for age, gender, osteoporosis, CCI, mFI, TS-CL, cSVA, and levels fused. Multivariate analyses were used to assess differences in surgical, radiographic, and clinical outcomes over time.

RESULTS:

570 patients were included. Age, CCI, and mFI were highest in R cohort. No difference at baseline in Ames modifiers amongst cohorts. Controlled analysis depicted lowest rates of complications in R (E: 62.5%, M: 72.7%, R: 45.5%). Major complication rates decreased from 59.8% in E to 15.0% in last cohort. Rates of DJK decreased from M to R (39.6% to 12.7%, p = .011), with rate of DJF being lowest in R and highest in M (20% in M, 12% in E, 6.7% in R, p = 0.046). Reoperation rates decreased from 18.8% in E to 12.4% in R. Neurological complications decreased as well from 38.5% in E to 2.1% in R (p = 0.044). Cardiopulmonary complication rates decreased from 24.8% in M to 3.5% in R.

CONCLUSIONS:

Complication rates decreased over a 10 year period amongst cases, despite having higher age, frailty, comorbidities, mJOA, and no difference in baseline deformity between early and recent cases.
281 Does Smoking Status Affect Achievement of Satisfaction and Minimum Clinically Important Difference in Outcomes in Patients With Cervical Myelopathy at 24 Months? 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:

It is not clear whether smoking impacts patient-reported outcomes (PROs) in patients with cervical spondylotic myelopathy (CSM).

METHODS:

This was an analysis of the prospective Quality Outcomes Database CSM module. Patients of age = 18 years diagnosed with primary CSM who underwent elective surgery were included. PROs (VAS neck and arm pain, NDI, mJOA, EQ-5D, and NASS patient satisfaction) were collected at baseline and 24 months.

RESULTS:

Of the 1,141 patients with CSM, 202 (17.7%) were smokers and 939 (82.3%) were non-smokers. Compared to the non-smokers, smokers were younger (56.3 ± 11.3 vs 61.5 ± 11.7, p<0.01) and had lower BMI (29.3 ± 6.8 vs 30.3 ± 6.3, p=0.04). A higher number of smokers had depression, anxiety, and COPD (all p<0.01). At baseline, smokers had worse pain (neck: 6.0 ± 3.2 vs 5.1 ± 3.3; arm: 5.7 ± 3.2 vs 4.7 ± 3.5), disability (NDI: 45.2 ± 20.0 vs 37.1 ± 20.6), myelopathy (mJOA: 11.5 ± 2.9 vs 12.2 ± 2.8), and quality of life (EQ-5D: 0.51 ± 0.23 vs 0.57 ± 0.22) (all p < 0.01). At 24-month follow-up, a higher proportion of smokers achieved MCID in mJOA (69.4% vs 56.6%, p < 0.01) compared to non-smokers. Otherwise, there was no significant difference in the PROs at 24-month follow-up between the two groups (all p > 0.05). The two groups were also similarly satisfied (NASS 1-2: smoker 81.2% vs non-smoker 84.6%, p = 0.29) 24 months after surgery.

CONCLUSIONS:

Despite smokers having worse baseline characteristics in terms of comorbidities and outcomes of interest, both smokers and non-smokers experienced improvement in all the PROs and achieved similar rates of MCID and satisfaction. Although smoking continues to be an important risk factor for poor surgical outcome, it may not have significant impact on PROs and satisfaction in this patient population.