bluuebunny/crossref_metadata_2025 huggingface dataset:
292 Intraoperative Confocal Laser Endomicroscopy During 5-ALA Guided Glioma Surgery: Significant Considerations for Resection at the Tumor Margins
Authors: Abramov Irakliy , Xu Yuan , Mignucci-Jiménez Giancarlo , Hartke Joelle Nicole , Belykh Evgenii , Porter Randall , Sanai Nader , Smith Kris A. , Eschbacher Jennifer , Preul Mark C.
Published: March 2024

INTRODUCTION:

Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) has proven effective in aiding the detection of glioma marginal zones and enhancing maximal safe resection. FDA-cleared confocal laser endomicroscopy is another imaging modality for intraoperative brain tissue discrimination on cellular level that could improve visualization at the glioma margin.

METHODS:

5-ALA wide-field imaging and CLE were used in 9 patients with gliomas (6 enhancing, 3 non-enhancing). CLE imaging was enhanced by the use of a telesurgical pathology software platform to enable real-time conversation between neurosurgeons and pathologists located remotely. CLE was used for imaging tumor regions subjectively regarded as tumor margins under normal visualization with the operative microscope. After CLE imaging, 5-ALA wide-field imaging was performed in the same regions. A tissue was harvested at imaging locations, and interpretations of CLE and 5-ALA wide-field imaging were compared to permanent histological sections.

RESULTS:

Overall, 20 deep and superficial margin regions of interest (ROI) were imaged with CLE and 5-ALA imaging. Most of the ROIs interpreted by the neuropathologist as infiltrative glioma based on CLE imaging lacked 5-ALA-induced fluorescence. Permanent histological sections from the corresponding regions were concordant with the interpretation of CLE images in 15 of 20 (75%) ROIs and with the interpretation of 5-ALA imaging in 11 of 20 (55%) ROIs. Sensitivity/specificity of CLE and 5-ALA for interpretation of tumor margins were 79%/67%, and 50%/67%, respectively. Positive/negative predictive values for CLE and 5-ALA were 85%/57%, and 78%/37%, respectively.

CONCLUSIONS:

Conventional intraoperative understanding of tumor margins based on wide-field fluorescence could underestimate the invasiveness of gliomas. The ongoing study demonstrates that CLE shows higher accuracy in detecting regions with infiltrating tumor than intraoperative 5-ALA imaging.
305 Extracellular Vesicular mRNA and miRNA Biomarkers in Patients With Glioblastoma
Authors: Huntoon Kristin , Hong Li , Zhnag Jingjing , Kim Betty Y.S. , Jiang Wen , Lee James , Reategui Eduardo
Published: March 2024

INTRODUCTION:

Glioblastoma (GBM) is a highly lethal primary brain cancer that is resistant to conventional immunotherapies. However, currently, there is a lack of reliable biomarkers for clinical practice. Extracellular vesicles (EVs) present in biofluids are a potential biomarker for GBM diagnosis.

METHODS:

EVs from cell culture medium, healthy donor and GBM patient serum were purified using tangential flow filtration (TFF). Morphology, size, and numbers of EVs were characterized by TEM and qNano, respectively. EVs from healthy donor and GBM patient serum were compared against other cancer EV samples using bulk mRNA and miRNA sequencing analysis. Selected mRNA and miRNA name are not mentioned due to patents being drafted. mRNA and miRNA expression in EVs were quantified by a fluorescent nucleic acid detection method using a biochip platform at a single-EV level. Fluorescence images were recorded using high-resolution total internal reflection fluorescence (TIRF) microscopy.

RESULTS:

From bulk mRNA and miRNA sequencing and bioinformatics analysis, three miRNA and two mRNA were selected as potential candidate biomarkers for GBM. Subsequently, EVs from the serum of GBM patients (n = 39) were evaluated through our biochip platform. mRNA and miRNA expression of these biomarkers were positive in single EVs, for which we detected colocalization of protein/RNAs or multiple RNAs in subpopulations of EVs. Our platform was benchmarked with a standard PCR method showing 100X more sensitivity. Moreover, levels of expression of the different RNAs were compared to a cohort of serum from healthy donors (n=20), and showing significant differences between the two groups.

CONCLUSIONS:

Our non-invasive biochip assay outperformed qRT-PCR for EV RNA detection. Selected mRNAs and miRNAs in subpopulations of EVs could be used as potential GBM biomarkers.
308 Improvement in Cranial Nerve Neuropathies Following Treatment of Intracranial Aneurysms With Flow Diverters: Institutional Outcomes and Meta-analysis of Literature
Authors: Sujijantarat Nanthiya , Antonios Joseph Paul , Koo Andrew B. , Haynes Joseph , Renedo Daniela , Hebert Ryan Matthew , Sheth Kevin , King Joseph , Christian Matouk Charles
Published: March 2024

INTRODUCTION:

Cranial nerve (CN) neuropathies are rare presenting symptoms of intracranial aneurysms. Ophthalmological outcomes for symptomatic aneurysms treated with flow diversion are not well established.

METHODS:

We conducted a retrospective review of our institutional database for patients with intracranial aneurysms presenting with CN neuropathies who underwent treatment with flow diversion between 2015 and 2023. Systematic review of the literature was performed using Medline, EMBASE, Cochrane, and manual citation searches. Random effects meta-analysis was used.

RESULTS:

Twelve out of 136 studies were included in this meta-analysis, totaling 261 patients. The results were combined with our institutional data. The pooled rate of improvement in any CN neuropathies following flow diversion was 76% (95% CI, 67%-84%, n = 272). Patients presenting with CNII deficits were less likely to improve following treatment compared to other CN neuropathies (pooled OR [pOR] 0.32, 95% CI, 0.16-0.63, n = 224). The pooled rate of clinical improvement was 53% in CNII deficits (95% CI, 42%-65%, n = 80) and 80% in other CN deficits (95% CI, 71%-88%, n = 106). Intervention within one month of presentation was associated with improvement (pOR 6.53, 95% CI, 1.34-31.81, n = 33). Adjunctive coiling did not demonstrate effect on the improvement rate (pOR 0.38, 95% CI, 0.07-2.13, n = 31). Near total occlusion (Raymond Roy Occlusion Classification of 1 or 2, or O'Kelly-Marotta scale of C or D) was associated with symptomatic improvement (pOR 5.29, 95% CI, 1.66-16.90, n = 118), but not total occlusion (pOR 2.83, 95% CI, 0.97-8.23, n = 118).

CONCLUSIONS:

Flow diversion improves CN outcomes in patients with symptomatic intracranial aneurysms. These results support the theory that CN neuropathies depend more on the pulsatility of the aneurysm sac rather than mass effect. The inferior rate of improvement in CNII deficits compared to other CN symptoms may imply an additional, more irreversible mechanism contributing to CNII visual deficits.
309 High Glutamine Associated With the Risk of Stroke by Inducing Endothelial to Mesenchymal Transition Through ITGB4 MAPK-ERK Smad in Moyamoya Disease
Authors: Yang Yi , Ge Peicong , Zhao Jizong , He Qiheng
Published: March 2024

INTRODUCTION:

Previous studies have suggested potential association between glutamine and stroke. The role of glutamine in moyamoya disease (MMD) manifestation and pathological process remains unknown.

METHODS:

A prospective cohort of 360 adult MMD patients between September 2020 to December 2021 was established. Human brain microvascular endothelial cells (HBMECs) were utilized for rt-qPCR, western blot, immunofluorescence, and functional assays including CCK8, Edu for proliferation and wound healing for migration. HBMECs were transfected with ITGB4 adenovirus, ITGB4 siRNA or Smad4 siRNA to explore the downstream alterations. Atorvastatin was used to treat HBMECs and the mechanism was explored. Finally, the expression of ITGB4 was validated in databases and immunofluorescence staining of superficial temporal artery in MMD patients.

RESULTS:

After fully adjusted, the risk of stroke increased with each increment of glutamine level (OR = 1.599, 95% CI = 1.071 – 2.387, p = 0.022). Consistently, compared with patients in the lower tertiles of serum glutamine levels, a significantly higher risk of complete stroke was found in those in highest glutamine tertile (OR = 2.752, 95% CI = 1.556 – 4.868, p = 0.001). After treated with glutamine, HBMECs showed increased proliferation, migration, and endothelial-mesenchymal transition (EndMT) which was reversed by ITGB4 knockdown. In ITGB4-transfected HBMECs, MAPK-ERK-TGF-β/BMP pathway was activated and Smad4 knockdown could reverse the EndMT. Atorvastatin alleviated the EndMT by inhibiting Smad2/3 phosphorylation in ITGB4-transfected HBMECs. The upregulated ITGB4 expression was validated in the superficial temporal artery of MMD patients.

CONCLUSIONS:

High glutamine was independently associated with the risk of stroke in MMD. Glutamine promotes the proliferation, migration, and EndMT by ITGB4 through MAPK-ERK-TGFβ/BMP-Smad pathway. Atorvastatin could alleviate the EndMT by inhibiting Smad2/3 phosphorylation and promoting Smad4 ubiquitination and thus may be a potential drug for MMD patients.
310 The Derivo 2 Heal Embolization Device in the Treatment of Ruptured and Unruptured Intracranial Aneurysms: A Retrospective Multicenter Analysis
Authors: Nordmeyer Hannes , Schwab Roland , Behme Daniel
Published: March 2024

INTRODUCTION:

The Derivo 2 Flow diverter has been previously described for the treatment of intracranial aneurysms. To overcome the risk of in-stent thrombosis and thrombo-embolism as a well-known risk of intracranial flow diverter implantation, the device was modified by adding an antithrombogenic fibrin-heparin coating. The fibrin network aims at surface passivation, reduction of inflammatory reactions and building a scaffold for endothelial cells. The covalently bound heparin reduces the thrombogenicity by locally reducing platelet activation and inhibtion of the coagulation cascade.

METHODS:

We perform a retrospective multicenter, single-arm trial at seven neurovascular centers. Patients treated with the D2H for unruptured or ruptured intracranial aneurysms are included in the study. The primary endpoint is angiographic aneurysm occlusion at six months as assessed by the O’Kelly-Marotta (OKM) grading scale. Clinical outcome is evaluated after intervention and at six months with major morbidity defined as modified Rankin Scale scores (mRS) of 3-5.

RESULTS:

Between October 2021 and March 2023 56 patients with ruptured and unruptered intracranial aneurysms were treated with the D2H embolization device and included in our analysis. All patients were subjected to the regular antiplatelet pre- and post-treatment medication as per standard of care in the respective institutions with no deviations being reported. No differences in terms of technical device properties were observed. By the time of the conference, data evaluation will be completed and clinical as well as safety results including angiographic follow-up will be available.

CONCLUSIONS:

The Derivo 2 heal Flow Diverter is a promising antithrombogenic coated device for the treatment of ruptured and unruptured intracranial aneurysms. Early post-interventional and long-term results will provide further insight into the effect of antithrombogenicity and endothelial healing.
313 Development and Validation of a Scoring System for Hemorrhage Risk in Brain Arteriovenous Malformations
Authors: Chen Xiaolin
Published: March 2024

INTRODUCTION:

The dilemma between natural rupture risk and adverse outcomes of intervention is of major concern for patients with unruptured arteriovenous malformations (AVMs). The existing risk score for AVM rupture includes factors that are controversial and lacks prospective validation.

METHODS:

This prognostic study developed a prediction model derived from a single-center cohort (derivation cohort) and validated in a multicenter external validation cohort and a conservative treatment validation cohort. Patients were recruited from a nationwide multicenter prospective collaboration registry in China. A total of 4135 patients were enrolled. 3962 patients were included (3585 in the derivation cohort and 377 in the multicenter external validation cohort); 1028 patients from the derivation cohort who had time-to-event data and prerupture imaging results were included in the conservative treatment validation cohort.

RESULTS:

Four risk factors were used to develop the scoring system: ventricular system involvement, venous aneurysm, deep location, and exclusively deep drainage (VALE). The VALE scoring system performed well in all 3 cohorts, with areas under the receiver operating characteristic curve of 0.77 (95% CI, 0.75-0.78) in the derivation cohort, 0.85 (95% CI, 0.81-0.89) in the multicenter external validation cohort, and 0.73 (95% CI, 0.65-0.81) in the conservative treatment validation cohort. The 10-year hemorrhage-free rate was 95.5% (95% CI, 87.1%-100%) in the low-risk group, 92.8% (95% CI, 88.8%-97.0%) in the moderate-risk group, and 75.8% (95% CI, 65.1%-88.3%) in the high-risk group; the model discrimination was significant when comparing these rates between the high-risk group and the low- and moderate-risk groups (p < .001 for both comparisons).

CONCLUSIONS:

In this prognostic study, the VALE scoring system was developed to distinguish rupture risk among patients with AVMs. The stratification of unruptured AVMs may enable patients with low risk of rupture to avoid unnecessary interventions.
317 Automated Diffusion Tensor Tractography: Quantitative Tract Counts Predict 90-Day Change in Motor Function by Baseline Deficit in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy
Authors: Jaquish Rigel , Abraham Benjamin , Spivak Sarah , Tobin Matthew Kyle , Troja Weston C. , Bohnstedt Bradley N.
Published: March 2024

INTRODUCTION:

Ischemic stroke causes persistent motor deficits in roughly half of survivors. Although mechanical thrombectomy (MT) optimizes stroke outcomes, not all patients improve. Commercially available diffusion tensor tractography (DTT) software increases access to robust tractometric software. Automation and seamless clinical integration of diffusion tensor imaging (DTI) and tractography protocols standardizes data acquisition in high-throughput and high-resolution manners.

METHODS:

Between June 2020 and 2021, a total of 28 patients with M1 and M2 ischemic strokes underwent a standardized DTT protocol following MT. Patients were stratified by their baseline deficits, defined as the averaged upper and lower extremity motor testing scores at the time of initial presentation (MTS severe = 0, intermediate = 0.5–3.5, and mild = 4+). Multivariable linear regression analysis included demographics, clinical characteristics, and tractometrics of the lesioned CST with MTS at 90-days as the outcome.

RESULTS:

There were 12 patients with severe, 12 with intermediate, and 4 with mild baseline deficits. Stratification by baseline deficits revealed no significant difference between mean effected tract counts (5.20, 5.08, and 5.78 in the severe, intermediate, and mild groups, respectively, p = 0.377). When controlling for demographics and clinical characteristics, baseline deficits (β = -0.838, SE = 0.913, p < 0.001) and effected mean tract count (β = 1.755, SE = 0.407, p = 0.001) of the CST significantly predicted the change in MTS at 90-day follow-up (adjusted R2 = 0.727 p = 0.002).

CONCLUSIONS:

Our study suggests automated tractometrics predict the change in motor function at 90 days when controlling for the patient’s baseline motor deficit. Although larger cohort studies should be conducted, commercially available DTI software could yield novel avenues into rehabilitation optimization for post-stroke patients with persistent motor deficits.
318 Profiling Long RNA Transcriptome From Circulating Extracellular Vesicles in Subarachnoid Hemorrhage for Biomarker Discovery
Authors: Batool Syeda , Escobedo Ana , Hsia Tiffaney , Khanna Sirena , Ekanayake Emil , Gamblin Austin , McLellan Rachel , Carter Bob S. , Patel Aman B. , Balaj Leonora
Published: March 2024

INTRODUCTION:

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with a high mortality rate and permanent neurological deficits following acute brain injury. Previous studies have aimed at investigating CNS specific biomarkers that can predict the outcomes following aSAH. Liquid biopsy represents a promising minimally invasive approach for biomarker discovery using biofluids (plasma, CSF).

METHODS:

CSF was collected from patients (n = 10) during in-hospital stay at multiple time points via the external ventricular drain and EV RNA was sequenced using Oxford Nanopore Technologies.

RESULTS:

We detected different biotypes in EV RNA with minimal rRNA contamination (protein coding; 58.4%, pseudogene; 23.1%, LncRNA; 10%, rRNA; 1.7%). This is the first study reporting presence of long (>500 bp) RNA transcripts in CSF derived EVs. Approximately, 80% of the sequenced reads were up to 500 bp long and 20% reads 500-10,000 bp long. Principal Component Analysis demonstrated distinct clustering of samples based on location (anterior vs. posterior circulation) and type of aneurysm (saccular, dissecting, bilobed). A set of protein coding genes (S100A9, EEF1A1, SCARNA1, DMTN) were found to be differentially enriched in patients who developed cerebral vasospasm (n = 6). Furthermore, for each patient there was a unique population of biomarkers upregulated in acute (HBB, COX2) vs. chronic (SEPTIN7, PDK4) immune response following aSAH. Preliminary findings reveal potential candidate biomarkers providing insight into the pathogenesis and prognosis.

CONCLUSIONS:

There is an unmet need for inclusion of diagnostic and predictive biomarkers in clinical management of aSAH to decrease the overall mortality. In this study, we overcame challenges of analyzing low input RNA using a sensitive and optimized sequencing platform. Validation and testing in a larger study population offers new opportunities for biomarker discovery.
326 Factors Associated With the Maintenance of Cost-Effectiveness at 5 Years in Adult Spinal Deformity Corrective Surgery
Authors: Passias Peter G. , Mir Jamshaid M. , Dave Pooja , Tretiakov Peter S. , Smith Justin S. , Lafage Renaud , Gum Jeffrey Lynn , Line Breton G. , Diebo Bassel G. , Daniels Alan H. , Protopsaltis Themistocles , Hamilton D. Kojo
Published: March 2024

INTRODUCTION:

Substantial increase of costs in the surgical treatment of adult spinal deformity has given precedence to scrutinize the value it can provide hence cost-effectiveness (CE) is a vital analytical constituent. The analysis of factors associated with the durability of cost-effectiveness at 5 years has not been previously evaluated.

METHODS:

Adult spinal deformity (ASD) patients with baseline (BL) to 5-year (5Y) data were included. Cost calculation using PearlDiver database and CMS.gov definitions was used. Cost analysis was based on average DRG reimbursement rates. ODI was converted to SF-6D, with a 3% discount applied for residual decline in life expectancy. Cost per QALY gained at 2Y and 5Y was calculated. Threshold value for cost per QALY was $100,000. Patients that met 2Y (CE2+) were grouped based on meeting CE at 5Y(CE5+) or not(CE5-). Analysis based on meeting cost-effectiveness (CE) at 2Y and 5Y was conducted. Conditional-inference-tree (CIT) established cutoffs values for HRQLs.

RESULTS:

299 patients with 5Y data were included. Major and minor complication rates were 11% and 47% respectively, while 26% underwent reoperation by 5Y. The mean cost of surgery was $91,095 ± $47,003, utility-gain of 0.091 ± 0.086, and QALY of 0.171 ± 0.183, CE of $118,976 ± $208,323. 85.5% of the cohort met CE at 2Y, 79.2% at 5Y, whereas 59.6% met both. Frailty was comparable at baseline but was worse in CE5- at 2Y. CIT depicted 2Y ODI < 18 and SRS-22r > 3.3 (both p < 0.03) being associated with higher rates of C5+. Multivariable-regression depicted higher baseline CCI and pelvic tilt (PT) to be the strongest baseline predictors of not maintaining CE at 5Y (CCI OR: 1.821, p = 0.009) (PT OR: 1.079, p = .030).

CONCLUSIONS:

The majority that met cost-effectiveness at the 2 year went on to maintain it at 5 years. Lower baseline CCI and PT were strong predictive factors.
327 Sustained Improvement in Compliance With Use of Sequential Compression Devices in a Neurosurgery Patient Population of a Safety-Net Hospital
Authors: Windermere Sonora , Filippidis Aristotelis , Binello Emanuela
Published: March 2024

INTRODUCTION:

Sequential Compression Devices (SCDs) are utilized in perioperative patients given increased risks of deep venous thrombosis from mobility reductions and post-operative inflammatory responses. Additionally, mechanical prophylaxis is crucial in patients where chemical prophylaxis is contraindicated. Previous work has found SCD compliance far less than expected.

METHODS:

Across a 9-month period (August-April), we tracked which neurosurgical patients in stepdown units had SCDs on and properly functioning. When not on or properly functioning, we documented the missing element. Compliance was calculated daily as the percentage of patients who were SCD compliant out of all patients with SCD orders, then averaged over the month, for each month. Most common barriers to compliance were identified. Together with nursing management, we designed and implemented a best practice alert to facilitate nursing education and supply chain management, at month 3. The impact was tracked over the next six months, with a 4-months break from November-February.

RESULTS:

Compliance averaged 19.7% (n = 95) during August, and 38.4% (n = 131) in September. After implementation of the best practice nursing alert and supply chain upgrades, compliance was 48.8% (n = 150) in October, 41.2% (n = 104) in March, and 45.9% (n = 76) in April. Residual barriers to compliance included patient behavior and equipment issues. Compliance was significantly increased from baseline in August to October (z = 5.042). The significant difference was sustained through March (z = 3.402) and April (z = 3.730).

CONCLUSIONS:

While initial improvement was attributed to a Hawthorne effect, implementation of the best practice nursing alert likely facilitated the sustained improvement in SCD compliance despite the break in surveillance. SCD compliance nonetheless remained below 50%. Further study is warranted to address the remaining barriers, such as improving patient engagement and minimizing equipment malfunction.
335 Federal Research Funding Trends for Cerebrovascular Neurosurgeons: The Decline of the Cerebrovascular Surgeon-Scientist?
Authors: Pugazenthi Sangami , Srienc Anja I. , Cantu Luke , Huguenard Anna , Eskandar Emad N. , Mack William J. , Amin-Hanjani Sepideh , Vellimana Ananth K. , Zipfel Gregory J.
Published: March 2024

INTRODUCTION:

With the rise of endovascular neurosurgery, the number of cerebrovascular (CV) surgeons has grown. However, it is unclear whether the number of CV surgeon-scientists has concomitantly increased.

METHODS:

Publicly available data were collected on currently practicing academic CV surgeons in the US. Inflation-adjusted NIH funding between 2009-2021 was surveyed using NIH RePORTER. The K12 Neurosurgeon Career Development Program grant data were queried for CV-focused grants. Pearson R correlation was used for statistical analysis.

RESULTS:

From 2009-2021, NIH funding has increased: in total (p = 0.0318), to neurosurgeons (p < 0.0001), to CV research projects (p < 0.0001), and to CV surgeons (p = 0.0018). There has been an increase in the total number of CV surgeons (p < 0.0001), NIH-funded CV surgeons (p = 0.0034), and the percent of CV surgeons with NIH funding (p = 0.370). Additionally, active NIH grant dollars per CV surgeon (p = 0.0047) and number of NIH grants per CV surgeon (p = 0.0078) has increased. However, the percent of neurosurgeon-awarded NIH grants awarded specifically to CV surgeons has trended down over the past decade (p=0.3664). Analysis of early-career research grants showed a decline in the proportion of K12 applicants (p = 0.1840).

CONCLUSIONS:

Our data show that there are more CV surgeons than ever, and there has been a proportional increase in number of NIH-funded CV surgeons. However, there are fewer early-career neurosurgeons pursuing CV-focused projects, and the proportion of neurosurgeon-awarded NIH grants given to CV surgeons has trended down. These findings suggest a declining trend in CV surgeons pursuing research careers.
336 Understanding the Unique Challenges Faced by Homeless Patients With Acute Traumatic Neurosurgical Injuries
Authors: Cole Kyril Lynn , Findlay Matt , Earl Emma , Sherrod Brandon , Cutler Christopher , Nguyen Sarah Elizabeth , Grandhi Ramesh , Menacho Sarah Tamara
Published: March 2024

INTRODUCTION:

Homelessness is associated with high risk of acute neurotraumatic injury in the ∼600 000 Americans affected on any given night.

METHODS:

Adults hospitalized for acute neurotraumatic injuries between January 1, 2015, and December 31, 2020, were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, inhospital characteristics, discharge dispositions, readmissions, and adjusted readmission risk.

RESULTS:

Of 1308 patients, 8.5% (n = 111) were homeless on admission to neurointensive care. Compared with nonhomeless individuals, homeless patients were younger (P = .004), predominantly male (P = .003), and less frail (P = .003) but had similar presenting Glasgow Coma Scale scores (P = .85), neurointensive care unit stay time (P = .15), neurosurgical interventions (P = .27), and in-hospital mortality (P = .17). Nevertheless, homeless patients had longer hospital stays (11.8 vs 10.0 days, P = .02), more unplanned readmissions (15.3% vs 4.8%, P < .001), and more complications while hospitalized (54.1% vs 35.8%, P = .01), particularly myocardial infarctions (9.0% vs 1.3%, P < .001). Homeless patients were mainly discharged to their previous living situation (46.8%). Readmissions were primarily for acute-on-chronic intracranial hematomas (4.5%). Homelessness was an independent predictor of 30-day unplanned readmissions (odds ratio 2.41 [95% CI 1.33-4.38, P = .004]).

CONCLUSIONS:

Homeless individuals experience longer hospital stays, more inpatient complications such as myocardial infarction, and more unplanned readmissions after discharge compared with their housed counterparts. These findings combined with limited discharge options in the homeless population indicate that better guidance is needed to improve the postoperative disposition and long-term care of this vulnerable patient population.
339 Gender Concordance and Publication Productivity Within Neurosurgical Focus: A Ten-Year Review
Authors: Roy Joanna , Segura Aaron , Rumalla Kavelin , Estes Emily Marie , Iqbal Javed , Asjad Muhammad , Sidebottom Rachel , Schmidt Meic H. , Bowers Christian Andrew
Published: March 2024

INTRODUCTION:

The “glass ceiling” phenomenon describes how female representation in leadership positions has remained stagnant despite an increase in the number of trainees. Mentorship from female role models has been hypothesized to influence academic productivity. To our knowledge, trends in gender representation among editorial boards of neurosurgical journals remain undescribed. Neurosurgical Focus publishes monthly issues which are peer-reviewed by an invited group of topic editors based on their expertise in the field.

METHODS:

Publicly available data were collected from the Journal of Neurosurgery: Focus website from January 2013 to December 2022. Themes were dichotomized into technical or non-technical themes. Female gender concordant publications were defined as publications having females in both first and senior authorship. Gender was assessed using pronouns based on authors’ university profile and an artificial intelligence platform in case of ambiguity. Odds ratios (ORs) were calculated using Chi-squared and Fisher’s exact test.

RESULTS:

The number of female editors and gender concordant authors increased over time (P < 0.05). Women accounted for =50% of the editorial board on non-technical themes relevant to education and gender diversity. Having a female senior author was associated with higher publication productivity for original research and review articles among female authors (OR = 13.73, 95% CI = 1.74-394.31, P < 0.05). The odds of having female gender concordant publications were higher with a female editor (OR = 4.05, 95% CI= 1.38-12.92, P < 0.01).

CONCLUSIONS:

Mentorship and representation among editorial boards play a crucial role in enhancing academic productivity among women. This paper provides evidence that Neurosurgical Focus increased female gender concordant publications by increasing female editors over time because of their efforts to increase female representation. Initiatives to increase female representation and mentorship will help overcome the glass ceiling phenomenon.
340 Effect of Worker's Compensation Status on Pain, Disability, Quality of Life, and Return to Work After Lumbar Spine Surgery: A One-Year Propensity-Matched Analysis
Authors: Hani Ummey , Monk Steve Hubert , Pfortmiller Deborah , Stanley Gerry , Kim Paul Keetae , Bohl Michael , Holland Christopher Michael , McGirt Matthew J.
Published: March 2024

INTRODUCTION:

Compensation and litigation have been shown to adversely impact prognoses in a vast range of health conditions. Low back pain (LBP) is currently the most frequent reason for workers' compensation (WC) claims.

METHODS:

Complete datasets for patients who underwent 1 to 4-level lumbar spinal fusion or decompression alone were retrospectively mined from the National Quality Outcomes Database (QOD), which included one-year patient-reported outcomes (PROs) from over 200 hospital systems collected from 2012-2021. Population demographics, perioperative safety, facility utilization, patient satisfaction, disability, pain, EuroQol-5D (EQ-5D) quality-of-life, and return-to-work rates were compared between cohorts for both subgroups. Statistical significance was set at p < 0.05.

RESULTS:

29,652 patients were included: Laminectomy (16,939 non-WC, 615 WC); Fusion (11,767 non-WC, 331 WC). WC patients were more frequently male, minority race, younger, less educated, more frequently a smoker, healthier ASA grade, with greater baseline VAS and ODI scores (p < 0.001). One-year postoperative improvements in VAS, ODI, QALY, return to work rates, and satisfaction were all significantly worse for WC vs non-WC patients for both procedures. After adjusting for baseline differences via propensity matching, WC vs non-WC patients continued to demonstrate worse 3- and 12-month VAS and ODI, reduced 12-month QALY-gain, and delayed return to work after both procedure types.

CONCLUSIONS:

WC status was associated with significantly greater residual disability and pain post-operatively, lower quality of life, and delayed return to work. Utilizing resources to identify the negative influences on outcomes for WC patients may be of value in preoperative optimization and could yield better outcomes in these patients.
341 Racial Disparities in Incidence, Treatment, and Survival in Adult Brain Metastases: A 10-Year National Database Analysis
Authors: Jiang Sam Han , Sri Bhaskara Mounika Lalitha , Deysher Daniel , Souter John Robert , Sadeh Morteza , Mehta Ankit Indravadan
Published: March 2024

INTRODUCTION:

Brain metastases are the most common central nervous system tumors in the United States. It is imperative to understand how prognosis and survival varies demographically to ensure equitable care for vulnerable populations and reduce financial burdens on the healthcare system.

METHODS:

Using the Surveillance, Epidemiology, and End Result Program (SEER) database, adults with non-primary brain metastases between 2010 and 2019 were identified. The primary outcome measure was all-cause mortality within 5 years. Chi-squared tests of independence and one way analyses of variance were used to compare group differences between White, Black, Asian/Pacific Islander (A/PI), and American Indian/Alaskan Native patients. A Cox proportional hazards model was developed to evaluate the risk of death within 5 years.

RESULTS:

A total of 65,154 patient records were identified following exclusion based on age (>84 years or <18 years), missing race data, and missing survival data. The incidence of brain metastases increased from 2.53 per 100,000 adults in 2010 to 2.71 per 100,000 in 2019. A/PI patients had the highest population-adjusted incidence, highest population proportion of high income, the longest time from diagnosis to treatment, lowest rate of radiation refusal, and highest rate of chemotherapy treatment. Subsequently, A/PI patients had the highest 5-year survival rate compared to White and Black patients (9.05% vs. 4.15% vs. 3.23% respectively, p < 0.001). Chemotherapy (OR = 0.44) and surgery (OR = 0.51) were the strongest protective factors against death while being widowed (OR = 1.15) and having primary lung cancer (OR = 1.14) strongest risk factors.

CONCLUSIONS:

A/PI patients also have a significant survival advantage compared to White, Black, and AI/AN patients, potentially due to higher rates of radiation and chemotherapy treatment. Patients of other races are recommended treatment at lower rates than A/PI patients, suggesting a discrepancy in services offered to these patients.
345 Analysis of the Caribbean Neurosurgery Workforce: Scope of Practice, Challenges and Ways Forward
Authors: Rolle Myron , Williams Ashley , Boeykens Annegien , Garba Deen L. , McLellan Rachel , Francis Michael , Santos Rubio Ellianne Dos
Published: March 2024

INTRODUCTION:

There are close to 45 neurosurgeons for 16 million people in the Caribbean Community (CARICOM) region. The aim of our study is to understand the current scope of practice for neurosurgical providers in the Caribbean, as very sparse information has been published.

METHODS:

This study surveyed neurosurgeons within Caribbean and CARICOM countries online using qualitative and quantitative methods via Qualtrics.

RESULTS:

Of 38 countries within the Caribbean, 26 (68%) were surveyed of which 18 (69%) replied. In total 61 neurosurgeons were identified, with a majority of general neurosurgeons (56%). Remarkably, the majority of countries failed to meet the threshold workforce density for safe health care - either expressed by FTE neurosurgeons or neurosurgical centers. Most neurosurgical practices denied receiving or sending medical referrals. If otherwise, most referrals took longer than 8 hours without significant difference regarding the destination. Lastly, challenges confronting neurosurgical advancement were found in: technology and equipment (40%), trained personnel (31%), hospital or medical center infrastructure (14%), neurosurgical education and training (44%).

CONCLUSIONS:

To our knowledge, this is the first comprehensive qualitative and quantitative study exploring the current status of the Caribbean neurosurgery workforce, the challenges and the potential ways forward. Arming the local providers with improved resources and support would only serve to add value to the region thus making excellent patient care the standard for a region in need of just that.
347 Short-Term Pain Outcomes and Pain Medication Utilization Among Urine Toxicology-Identified Opioid and Marijuana Users Following Elective Spine Surgery
Authors: Singh Manjot , Bajaj Ankush , Shlimak Anna , Kanekar Samika , Rampichini Margherita , Gokaslan Ziya L. , Scarfo Keith-Austin , Leary Owen P. , Guglielmo Maria
Published: March 2024

INTRODUCTION:

Postoperative pain outcomes may be influenced by preoperative substance use, which is often underreported due to associated stigma.

METHODS:

Patients undergoing elective spinal surgery between September 2020 and May 2022 were recruited for this prospective cohort study. Detailed chart review was completed to collect demographic, urine toxicology, VAS, and pain medication regimen data. Comparisons between self-reported and urine toxicology-identified substance use, pre- and post-operative VAS ratings, and postoperative pain medication use were made using χ2 tests, student’s t-tests, and logistic regression, respectively. Models were adjusted for age, sex, and race.

RESULTS:

Among 111 participants (mean age 58 years, 59% female, 95% with >1 comorbidity), urine toxicology overestimated drug use (47% vs 16%, p < 0.001) and underestimated alcohol use (16% vs 56%, p < 0.001) at preoperative baseline relative to patient reports. Two-weeks postoperatively, participants on preoperative opioids as determined by urine toxicology reported no significant improvements in pain from baseline (6.67 preop vs 5.92 postop, p = 0.288) unlike non-users (6.56 preop vs 4.61 postop, p < 0.001). They also had worse postoperative VAS (5.92 vs 4.61, p = 0.030) and heavier reliance on opioid medications (OR = 3.09, 95% CI = 1.21-7.89, p = 0.019). Conversely, participants on preoperative marijuana reported similar improvements in pain from baseline (users: 6.88 preop vs 4.36 postop, p = 0.001; non-users: 6.49 preop vs 5.07 postop, p = 0.001), similar postoperative pain (4.36 vs 5.07, p = 0.238), and similar postoperative reliance on opioid medications (OR = 0.96, 95% CI = 0.38-2.44, p = 0.928).

CONCLUSIONS:

While urine toxicology-identified preoperative opioid use was associated with poor postoperative pain relief and continued reliance on postoperative opioids for pain management following elective spinal surgery, preoperative marijuana use was not. Preoperative marijuana use, hence, should not delay or be a contraindication to elective spinal surgery.
353 Comparison of Brain Diffusion-Weighted Imaging of Cerebral Pain Regions Using DTI and MAP to Clinical Scores of Pain in Chronic Low Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation
Authors: Ashok Arjun Balaji , Oghli Yazan Shamli , Ailes Isaiah , Syed Mashaal , Kang KiChang , Naghizadehkashani Sara , Fayed Islam , Matias Caio M. , Mohamed Feroze , Krisa Laura , Alizadeh Mahdi
Published: March 2024

INTRODUCTION:

Thoracic spinal cord stimulation (SCS) may be an effective treatment option for patients with chronic low back pain (cLBP), and pain levels can be assessed using subjective clinical scores. The use of diffusion-derived imaging of brain regions involved in pain has yet to be studied.

METHODS:

DTI and MAP data was gathered from five cLBP patients (4 M, 1F) post-tSCS scanned at a 3.0T scanner. Four DTI measures and four MAP measures were extracted and registered against a pain-ROI atlas. The following clinical pain scores were assessed in the same five patients: Numerical Pain Rating Scale (NPRS), Visual Analogue Scale (VAS), Central Sensitization Inventory (CSI), Oswestry Disability Index (ODI), Pain Catastrophizing Scale (PCS), Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS). The associations between clinical scores and pain ROIs were investigated using linear regression.

RESULTS:

Within these eight measures, 16 significant linear associations were found between pain ROIs and clinical pain scores. The regions involved are areas of the cerebrum and thalamus involved in pain perception and processing: the secondary somatosensory cortex, the ventral posterolateral and mediodorsal nuclei of the thalamus, and the anterior long, anterior inferior, and middle short gyri of the insula.

CONCLUSIONS:

Diffusion-derived imaging, using DTI and AMURA/MAP techniques, shows microstructural changes in brain regions involved in pain with significant linear associations with clinical pain scores. As a result, diffusion-derived indices show potential to be used as a complementary quantitative measure to assess pain in cLBP patients receiving tSCS.
354 Feasibility and Clinical Imaging of Pain States Based on Multi-Delay Arterial Spin Labeling in Chronic Low Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation
Authors: Oghli Yazan Shamli , Ashok Arjun Balaji , Ailes Isaiah , Syed Mashaal , Fayed Islam , Matias Caio M. , Mohamed Feroze , Talekar Kiran , Feeko Kristofer , Krisa Laura , Alizadeh Mahdi
Published: March 2024

INTRODUCTION:

Multi-delay, pseudo-continuous arterial spin labelling (PCASL) is a novel technique capable of perfusion imaging without contrast. It overcomes the limitation of a low signal-to-noise ratio of pulsed-ASL, and multiple post-label delays allow it to account for and measure arterial transit time (ATT). This makes it a suitable tool for the perfusion assessment. To date, there have been no studies to assess changes in ASL-measured perfusion in chronic low-back pain (cLBP) patients treated with thoracic spinal cord stimulation (tSCS).

METHODS:

PCASL data was acquired in five patients post-tSCS and five healthy subjects. ATT was estimated using weighted delays from multiple delay times, and it was used to calculate cerebral blood flow (CBF) and cerebral blood volume (CBV). Maps were normalized into MNI space and smoothed. Averaged values of ATT, CBF and CBV from pain ROI atlas were extracted and compared between cLBP and healthy control groups. Statistics comparing perfusion changes between patients and healthy subjects were conducted after Box-Cox transformation of data using Wilcoxon rank sum.

RESULTS:

Our results demonstrated the feasibility of MRI scanning with ASL sequence in patients with SCS. Specific absorption rates ranged from 0.031–0.042W/kg. Wilcoxon test indicated that ATT was significantly greater in cLBP patients within the supplementary motor area, posterior short gyrus, and the orbitofrontal cortex. There were no significant differences in patients and controls in CBF or CBV.

CONCLUSIONS:

Rate of perfusion as indexed by PCASL-derived ATT is reduced in cLBP treated with SCS patients in regions associated with pain processing, cognition, and motor planning. Insignificant results in CBF and CBV measures are likely due to low sample size of patients.
355 Risk Factors for Intrathecal Baclofen Pump Implantation Infections: A Retrospective Database Analysis
Authors: Wilding Hannah Eloise , Sciscent Bao Yue , Hallan David , Harbaugh Thaddeus , Bhanja Debarati , Rizk Elias Boulos
Published: March 2024

INTRODUCTION:

Baclofen, a GABAB receptor agonist, can be delivered via intrathecal baclofen (ITB) pumps for patients with intractable spasticity. Prior literature has shown infection rates ranging between 10-30%.

METHODS:

A multi-institutional de-identified database TriNetX was queried to identify patients with: 1) implantation of ITB pump + infection within 6 months or 2) implantation of ITB pump without infection within 6 months. Two populations were analyzed: only pediatric patients, then patients of all ages. Characteristics were compared using log-rank tests and independent-sample t-tests.

RESULTS:

1,880 patients were identified in the pediatric cohort, of which 236 (12.6%) developed infection. 13,936 patients of all ages were identified, of which 1955 (14.0%) developed infection. In pediatric patients who developed infection, there were higher rates of diagnoses of overweight and obesity, malnutrition, and hypokalemia; the prevalence of diabetes was also higher, but this analysis was limited by small sample size. In patients of all ages, all medical diagnoses assessed were significantly more prevalent in patients with infection. Erythrocyte sedimentation rates and platelets were significantly higher in all patients with an infection. Additionally, the number of emergency department visits within 6 months was significantly higher in the infection group for pediatric (t = 3.571, p = 0.0004) and all-age (t = 7.882, p < 0.0001) patients.

CONCLUSIONS:

This study suggests that patients with certain comorbidities are at increased risk for infection post-ITB implantation. Since prevalence of diabetes, abnormal coagulation profile, tracheostomy, and B-vitamin deficiency remained significantly different between infection vs. no-infection cohorts as sample size increased with the addition of adults, these diagnoses should be considered when calculating the infection risk of ITB pump. Studies are underway to investigate the time of highest infection risk post-ITB implantation and the optimal time for ITB reimplantation after removal for infection.
356 Nervus Intermedius Sectioning for the Treatment of Geniculate Neuralgia: A Single-Surgeon Case Series
Authors: Ren Alexander Liang , Wu Janet , Hall Jennifer , Zhang Michael , Kim Lily H. , Xu Risheng , Lim Michael
Published: March 2024

INTRODUCTION:

Geniculate neuralgia (GN) is a rare pain condition involving the nervus intermedius (NI), a branch of the facial nerve. The current standard for surgical intervention consists of a retrosigmoid craniotomy with sectioning of the NI. However, few case reports/series exist detailing the outcomes of GN surgical treatment.

METHODS:

We reviewed patient charts involving craniotomies for GN performed by a single surgeon between November 2020 and December 2022.

RESULTS:

Three patients underwent two craniotomies for GN. GN patients were largely female (91.30%) and White, non-Hispanic/Latino (78.26%). Nearly all GN patients had a concurrent diagnosis of trigeminal neuralgia (n = 22, 95.65%) and some also had a concurrent diagnosis of glossopharyngeal neuralgia (n = 9, 39.13%). Vascular contact with cranial nerves VII and VIII was reported in four procedures. 22 procedures (84.62%) resulted in profound pain relief, with BNI pain score decreasing from 5 to 1 between pre-op and latest follow-up. No patients experienced unexpected hearing loss compared to baseline at latest follow-up. One patient experienced facial paralysis on the side of surgery and two patients experienced some form of vestibular dysfunction at latest follow-up. Of 26 total procedures, 20 included NI sectioning. Initial craniotomies in which the NI was sectioned (n = 18) resolved GN pain 88.89% of the time whereas craniotomies without NI sectioning (n = 5) resolved GN pain 60% of the time.

CONCLUSIONS:

NI sectioning is an effective means of achieving GN pain relief. Post-operative complications including unexpected hearing loss, facial paralysis, and vestibular dysfunction were infrequently observed in our series.
358 Quantifying Cognitive and Affective Dysfunction in Chiari Malformation Type I Patients With the Cerebellar Cognitive Affective Syndrome Scale and the Cerebellar Neuropsychiatric Rating Scale
Authors: Shao Belinda , Wirth Lella , Ma Kevin , Sayied Shanzeh , Kozel Olivia , Nieves Natalie Amaral , Klinge Petra Margarete , Trask Christine
Published: March 2024

INTRODUCTION:

Cognitive and affective dysfunction in Chiari Malformation Type I (CM1) patients are well-documented, but often rely on extensive neuropsychological tests.

METHODS:

Symptomatic CM1 patients considering surgical decompression were assessed by a board-certified neuropsychologist using the 105-point CNRS (N = 87) and the 10-task CCAS (N = 23), as well as a full neuropsychological battery (N = 24: Wechsler Full Scale IQ, Digit Span, Coding; WRAML Finger Windows; DKEFS Trail Making; verbal list learning; Grooved Pegboard). Descriptive and correlative measures were computed.

RESULTS:

The study included 66 adults and 21 children. A neuropsychological battery revealed impairment in 29% of patients on 1 test, 12.8% on 2 tests, and 20.8% on 3 or more tests. The CCAS indicated 26% with "possible CCAS" (1 task), 27% with "probable CCAS" (2 tasks), and 18% with "definite CCAS" (3 or more tasks). The median CNRS composite score was 31.0 (IQR: 18.5, 49.0), with positive and negative symptom sub-scores of 18.0 (10.0, 26.5) and 14.0 (7.5, 23.5), respectively. Moderate correlation with the neuropsychological battery was found between impairment detected by CCAS (Spearman rank coefficient ρ = 0.67, p = 0.002) and CNRS (ρ = 0.56, p = 0.003).

CONCLUSIONS:

A high prevalence of cognitive and affective impairments in pre-operative CM1 patients was observed by all three testing batteries. In this first report of CNRS and CCAS usage in CM1 patients, increased CNRS and CCAS impairment correlated with impairment on standard neuropsychological testing. These tools show promise for future studies CM1, providing a more concise alternative to traditional testing for cognitive and affective dysfunction.