bluuebunny/crossref_metadata_2025 huggingface dataset:
356 Intraoperative Robotic Planning Software is Accurate at Predicting Postoperative Lumbar Lordosis After Anterior Column Reconstruction
Authors: Shah Vaibhavi , Haider Ghani , Stienen Martin N. , Veeravagu Anand
Published: March 2023

INTRODUCTION:

Re-establishment of lumbar lordosis with spine deformity surgery is considered a pre-requisite for long term positive results with less biomechanical loading on the adjacent segments, reducing the likelihood of developing adjacent segment disease. The pre-operative planning softwares of robotic systems now allow the surgeon to plan a patient-specific surgical plan and are also able to predict the degree of lumbar lordosis following the instrumentation surgery based on pre-operative imaging by using vertebral segmentation.

METHODS:

We conducted a retrospective review of patients aged 18 or older who underwent pedicle screw spinal instrumentation using the Mazor X Robot (Medtronic Inc., Minneapolis, MN, USA), performed by one surgeon over a five-year period. The robotic guidance software (Mazor X-Align, Medtronic Inc., Minneapolis, MN, USA) was used to calculate the predicted lumbar lordosis based on pre-operative imaging. Wilcoxon Rank test was used to compare the predicted angles to the observed lumbar lordosis on post-operative radiographs.

RESULTS:

A total of 15 patients (46.6% female) with a mean age of 61.5 ± 10.9 years were identified, who underwent posterior lumbo-sacral spinal fusion with the robotic system using both percutaneous and open approach. Instrumentation was done across a mean of 3.27 levels per case and 11 patients (73.3%) underwent anterior column reconstruction prior to posterior fixation without the need for an intra-operative CT spin. There was no statistical difference between the predicted and the actual post-operative lumbar lordosis (p-value: 0.334) while there was a significant statistical difference between the pre-operative and post-operative angles (p-value: 0.02).

CONCLUSIONS:

Our study suggests that the intraoperative robotic planning software of the Mazor X system is accurate at predicting postoperative lumbar lordosis which can be useful and help guide surgical decision making and planning.
360 Assessment of Pedicle Screw Placement Accuracy Utilizing a Novel Augmented Reality and Artificial Intelligence Surgical Guidance System
Authors: Luciano Cristian , Cornwall Bryan , Malone Hani , St. Clair Selvon , Parfeniuk Katya , Trzmiel Michal , Siemionow Krzysztof
Published: March 2023

INTRODUCTION:

The integration of artificial intelligence (AI) and augmented reality (AR) technologies in spine navigation has the potential to minimize pedicle screw misplacement, decrease radiation exposure, and improve procedural efficiency, addressing some of the challenges associated with spinal instrumentation.

METHODS:

Sixty lumbosacral pedicle screws were placed by 4 Orthopedics surgeons in 6 cadavers using the AR/AI surgical navigation system. Two CT intraoperative scans (before and after screw placement) of the cadaveric specimens were obtained for the study to measure the 3D positional and angular discrepancies between virtual and real screws. The validation procedure consisted of 3 steps: (1) automatic registration and 3D coordinate transformation, where the preop CT scan was aligned with the postop scan to determine the virtual screw 3D positions and orientations in postop scan; (2) analysis of the postop scan to determine the real screw 3D positions and orientations as they appeared in the scan volume; (3) automatic comparison between the 3D positions and orientations of the virtual and real screws.

RESULTS:

A one-sample t-test statistical analysis yielded a mean positional error of 2.16 mm ± 1.00 mm (99% CI: 1.81-2.49 mm), and a mean angular error of 1.49± 0.73° (99% CI: 1.25-1.74°). These results were independent of anatomical level, side, and surgeon.

CONCLUSIONS:

This study indicates that this AR/AI surgical guidance system provides mean positional and angular errors lower than 3.0 mm and 3.0° respectively, thus complying with FDA-required regulatory acceptance criteria. The system was FDA-cleared as a US 510k Orthopedic Stereotaxic Instrument.
376 From Core to Margin: Intratumoral Differences in Cancer Hallmarks Depend on Spatial Localization of Cells in Glioblastoma
Authors: Suarez-Meade Paola , Figueredo Luisa F. , Roberts Mckinley , Brooks Mieu , Zarco Natanael , Guerrero-Cazares Hugo , Chaichana Kaisorn L. , Schiapparelli Paula , Quinones-Hinojosa Alfredo
Published: March 2023

INTRODUCTION:

Glioblastoma (GBM) carries a dismal prognosis due to its invasive nature. Studies show that GBMs have transcriptionally heterogeneous cell populations within the same tumor. However, information regarding the biological behavior of different intratumoral populations has never been demonstrated in vitro.

METHODS:

GBM patients who underwent resective surgery were consented for research. MRI-guided images were registered during resection to localize the area where samples were obtained. Two GBM cell lines were established from the same patient for each case: margin and core cell line. Proliferation, migration, and stemness experiments were performed in vitro and intracranial implantation of tumors was then carried out to evaluate tumor behavior in vivo.

RESULTS:

10 cell lines from 5 patients were established from the margin and the core. There were no differences in cell proliferation. Sphere area and limiting dilution assay (p < 0.01) show that cells derived from the margin have greater stemness capabilities. Cells from the margin have higher migratory abilities in transwell migration assay (p < 0.01 in 4/5 patients) and in real-time cell invasion monitoring (p < 0.01). Trend which was later noted in sphere invasion assay. In vivo studies demonstrate that both cell populations were capable of tumor engraftment with no differences in tumor growth by bioluminescence (p > 0.05). Nonetheless, tumors from the marginal area demonstrated a more diffuse phenotype and greater extension when compared core-derived tumors on histopathology .

CONCLUSIONS:

There is a large degree of behavioral heterogeneity between cells from the tumor core versus the margin. GBM cells from the margin have higher migration and stemness properties when compared to their core counterparts in vitro; suggesting that peripheral cells carry more aggressive phenotypes that could be responsible for treatment resistance and tumor recurrence
408 Racial Disparities in Long-Term Functional Outcome After Traumatic Brain Injury: An Update
Authors: Bah Momodou , Eden Sonia Veronica , Chen Alex , Simo Leticia , Tummala Shalini , Mahas Rachel
Published: March 2023

INTRODUCTION:

Racial disparities in outcomes have been reported in various medical conditions and in patients with traumatic brain injury (TBI). Despite equal access to acute rehabilitation, blacks had significantly worse long-term functional outcomes after TBI than non-Hispanic whites (NHWs). Much effort has been placed on raising awareness, improving access to care, expanding research, and on closing racial disparity gaps in healthcare.

METHODS:

Patients followed and tracked in the Southeastern Michigan Traumatic Brain Injury System (SEMTBIS) database were inquired, including 95 non-Hispanic whites (NHWs) and 97 blacks. Severe TBI was defined as Abbreviated Injury Scale [AIS] score of 3–5. Patients from February 2010 to December 2019 were included. Long-term outcomes were measured by 1) the percentage of patients discharged to home, and 2) the Glasgow Outcome Scale-Extended (GOSE) score after 1 year. Student’s T-test was used for numeric data analysis. Chi-square was used for categorical data comparison.

RESULTS:

There were no significant differences in initial TBI severity between non-Hispanic whites (NHWs) and blacks, measured by the admission Glasgow Coma Scale (GCS), the percentage of people who had midline shift >5 mm on brain CT, the number of days from injury to date out of posttraumatic amnesia, and of days from injury to following commands. More NHWs were discharged to low acuity facilities (80% versus 58.8%, P = 0.0014). A higher percentage of NHWs had an upper good recovery score, which is a GOSE score of 8 (23.1% versus 9.3%, P = 0.074) after 1-year follow-up.

CONCLUSIONS:

Despite efforts to mitigate racial disparities in medical outcomes after TBI, the blacks in Southeastern Michigan continue to score lower than NHWs on their long-term functional outcomes at one-year follow-up.
419 Integration of Trainees with Mobility Impairment in Neurological Surgery
Authors: Lawrence Jesse D. , Konrad Peter , Sedney Cara L.
Published: March 2023

INTRODUCTION:

Increasing attention has been paid to diversity amongst neurosurgical trainees in recent years; but representation of individuals with mobility impairment within neurosurgical training has not been previously demonstrated.

METHODS:

A trainee with mobility impairment (JL) matriculated to neurosurgical residency in 2017 with programmatic and institutional support. Prior to matriculation he had independently developed standing wheelchairs and operating room protocols. Upon matriculation, a careful needs assessment was performed with the assistance of JL and the university ADA officer and accommodation recommendations were provided. These consisted of generally minor procedural or equipment alterations, including hand controls for surgical devices, cord covering mats in the operating rooms, minor changes to scrub stations and call room, parking access, etc. Minor iterative technique guidance was provided with respect to body mechanics and adaptive equipment which was not demonstrably different than that provided to other residents (eg left hand dominant residents).

RESULTS:

The trainee has successfully performed in all roles of neurosurgical residency, including the chief resident role, with no alteration of duties, expectations, or assignments. In regards to adaptive equipment, no one solution could be considered ideal for all situations. Specifically, operating room adaptations needed to optimize positioning and mobility while bedside adaptations needed to optimize ease of access and low profile.

CONCLUSIONS:

Integration and training of individuals with mobility impairment can be successful with minor procedural and equipment alterations, even in a small program with relatively limited resources. This experience demonstrates feasibility and provides a blueprint for other institutions and applicants with mobility impairment who desire to pursue neurosurgical training.
423 Trends in Utilization of Standardized Letters of Recommendation in the 2021-2022 Neurosurgery Application Process
Authors: Feldman Michael , Ortiz Alex , Roth Steven G. , Dambrino Robert J. , Yengo-Kahn Aaron Michael , Chitale Rohan V. , Chambless Lola Blackwell
Published: March 2023

INTRODUCTION:

Standardized LORs (SLORs) were introduced during the 2020-2021 neurosurgery residency application cycle, but suffered from poor inter-rater reliability and significant grade inflation. Changes were made to the SLOR template and utilization patterns in response to these shortcomings.

METHODS:

This cross-sectional study analyzed all SLORs submitted to a single neurosurgery residency program over the 2021-2022 cycle. Data from seven competency domains and the overall rating were recorded and stratified by academic category of letter writer. Inter-rater reliability was evaluated using Krippendorff’s Alpha. Frequency of letters written was evaluated using Kruskal-Wallis H Test.

RESULTS:

90% of SLORs rated applicants among the Top 25%, but there was a significant decrease in the usage of the “Top 1%” and “Top 2-5%” ratings from the prior application cycle. Inter-rater reliability was poor across all competencies. Writers who completed one SLOR rated applicants higher and had a narrower range than those who completed multiple SLORs.

CONCLUSIONS:

Changes in the format and subsequent utilization patterns of SLORs have slightly decreased grade inflation; however, inter-rater reliability remains poor. The most wide-ranging evaluators submitted the highest number of SLORs, suggesting that future evaluation and usage of SLORs should emphasize letter-writer characteristics and numbers of SLORs written. Overall, SLORs have been well and broadly accepted with subtle improvements in the second year of utilization.
425 Intraoperative Surveillance of the Vertebral Artery Using Indocyanine Green Angiography and Doppler Sonography in Craniovertebral Junction Surgeries
Authors: Lee Dong Hoon
Published: March 2023

INTRODUCTION:

The surgical approach for craniovertebral junction (CVJ) procedures may be complicated for many reasons due to sensitive relationships involved in the surrounding neurovascular structures and complex biomechanical issues.

METHODS:

In total, 344 consecutive patients enrolled who underwent CVJ surgery. Surgery was performed without intraoperative VA monitoring tools in 262 cases (control group) and with VA monitoring tools in 82 cases (monitoring group). The authors compared the incidence of VAI between groups. The procedure times of ICG angiography, change of VA flow velocity measured by Doppler sonography, and complication were investigated.

RESULTS:

There were 4 VAI cases in the control group, and the incidence of VAI was 1.5%. Meanwhile, there were no VAI cases in the monitoring group. The procedure time of ICG angiography was less than 5 minutes (mean [±SD] 4.6 ± 2.1 minutes) and VA flow velocity was 11.2 ± 4.5 cm/sec. The combined use of ICG angiography and Doppler sonography was useful not only to monitor VA patency but also to assess the quality of blood flow during CVJ surgery, especially in the high-risk group of patients.

CONCLUSIONS:

The combined use of ICG angiography and Doppler sonography enables real-time intraoperative monitoring of the VA by detecting blood flow and flow velocity. As the arteries get closer, they provide auditory and visual feedback to the surgeon. This real-time image guidance could be a useful tool, especially for high-risk patients and inexperienced surgeons, to avoid iatrogenic VAI during any CVJ surgery.
439 Percutaneous Electrical Nerve Stimulator for Treatment of Chronic Spinal Pain
Authors: Bindal Shriya , Bindal Maya , Lall Maureen
Published: March 2023

INTRODUCTION:

The percutaneous electrical nerve stimulator (PENS) is a relatively new device for the treatment of chronic spinal pain. This programmable device is worn for a recommended 10 to 12 days on the external ear, stimulating the auricular vagus nerve. It is postulated to release endorphins and relieve pain. There is minimal literature on the use of PENS as an adjunct to pain management in patients with chronic spinal pain.

METHODS:

Patients who had the PENS placed for chronic refractory spinal pain were included in the study. All patients failed multiple forms of treatment such as physical therapy, epidural steroid injections, and medication.

RESULTS:

In 2021, 114 patients had the PENS placed. The mean patient follow-up was 34.9 weeks. 67 patients (58.7%) felt pain relief due to the PENS. In patients with neck pain, the mean Neck Disability Index scores decreased from 43.8% to 25.4%, and the mean Numerical Rating Scores (NRS) decreased from 7.9 to 3.9. In patients with low back pain, the mean Oswestry Disability Index scores decreased from 47.6% to 33.5%, and the mean NRS scores decreased from 7.9 to 5.1. The rate of improvement in patients with neck pain (71.9%) was significantly greater (p-value <0.02) than in patients with back pain (56.4%). Interestingly, 33.3% of patients who responded to treatment remained improved at one year follow-up.

CONCLUSIONS:

Our study shows that a significant number of patients experienced reduced pain and disability as a result of treatment with the PENS. Patients with neck pain responded better than patients with low back pain. Many patients in this difficult patient population experienced durable relief, lasting over one year. Our study suggests that the PENS may be a useful adjunct in the management of patients with chronic spinal pain.
450 A Shared Cortical Language Network for Multimodal Naming
Authors: Snyder Kathryn , Forseth Kiefer , Tandon Nitin
Published: March 2023

INTRODUCTION:

Surgical resections for epilepsy or neoplasms often result in naming deficits. While various brain regions are hypothesized to support separable processes, the language network and its functional mapping to naming remain unclear. However, such knowledge could improve the localization of critical brain regions to preserve language function.

METHODS:

Data were obtained from epilepsy patients who underwent invasive electrophysiology. Recordings were acquired during three cued-naming tasks using pictures (n = 120), auditory descriptions (n = 82), and orthographic descriptions (n = 68). High-gamma power (65-115Hz) was used to measure activity, and group-level activity was estimated using surface-based mixed-effects multilevel analysis.

RESULTS:

Analyses showed left-lateralized heteromodal activity in the inferior frontal gyrus (IFG), the middle fusiform gyrus (mFus), and the intraparietal sulcus (IPS) following sensory processing. Activation of mFus peaked 150ms before stimulus offset for auditory (15.2%, p < 10-6) and orthographic (21.4%, p < 10-6) naming and 350ms after picture onset (39.0%, p < 10-6) for visual naming. IPS activation peaked just before stimulus offset for auditory (38.1%, p = 7.7*10-5) and orthographic (27.5%, p = 0.008) naming and 450ms following picture onset (43.0%, p < 10-6) for visual naming. IFG activation peaked just before stimulus offset for auditory (30.1%, p < 10-6) and orthographic (40.1%, p = 10-6) naming and 500ms after picture onset (36.4%, p < 10-6) for visual naming. The left posterior middle temporal gyrus (pMTG) showed heteromodal activity for auditory and orthographic but not visual stimuli with peak activation occurring before convergence of all tasks 250ms before stimulus offset (auditory = 34.1%, p < 10-6;orthographic = 25.5%, p = 0.0035).

CONCLUSIONS:

These results reveal a heteromodal network of IFG, mFus, and IPS supporting lexical access. Our findings also implicate the role of pMTG in phonological access. Altogether, this work characterizes the roles of key regions within language networks, which could influence surgical approaches to minimize postoperative language deficits.
494 Comparison of Disc Height Restoration and Subsidence Rates Between Static Versus Expandable Titanium Cages for Lateral Lumbar Interbody Fusion
Authors: Ashayeri Kimberly , Neifert Sean N. , Frempong-Boadu Anthony , Protopsaltis Themistocles , Lau Darryl
Published: March 2023

INTRODUCTION:

It has been shown that expandable cages for transforaminal lumbar interbody fusion (TLIF) are associated with increased rates of subsidence. However, as lateral lumbar interbody fusion (LLIF) cages offer substantially larger footprints, this may offset the risks.

METHODS:

A retrospective review was performed of a consecutive adult patients undergoing LLIF with either static or expandable cages from 2013-2021. Demographics and surgical details were collected. Posterior disc height (PDH), subsidence, and fusions status were compared between patients with static and expandable cages. Follow-up were reported at minimum 6-months and 1-year.

RESULTS:

A total of 120 patients had 173 cages implanted: 96 patients with 143 static cages vs. 24 patients with 30 expandable cages. Mean age was 63.4 and 62.4% were male. There were no significant differences in age, gender, BMI, smoking, or osteoporosis. Overall, PDH was significantly increased following LLIF (4.1 v 7.4 mm, p < 0.001). Static and expandable cage types had similar magnitude (3.7 v 3.3 mm, p = 0.311) and percentage (89.0% v 121.5%, p = 0.127) change in PDH, respectively. Overall incidence of cage subsidence at 6-months and 1-year was 6.9% and 10.4% respectively. There was no significant difference in subsidence rates between cage types at 6 months (7.0% v 6.7%, p = 0.949) and 1-year (11.2 v 6.7%, p = 0.461). Radiographic evidence of fusion was present in 92.7% of cases at 1-year, and both cage types achieved similar fusion rates as well (92.2% v 95.6%, p = 0.555).

CONCLUSIONS:

LLIF static and expandable cages offer similar PDH restoration depending on surgical goals. Expandable cages seem to be less prone to subsidence than smaller TLIF cage counterparts and offer similar fusion rates to static cages. Larger cohort studies are warranted to further validate these findings which are ongoing.
500 Non-Verbal Memory Decline is Greater Following Anterior Temporal Lobectomy Than Mesial Temporal Laser Ablation in Non-Dominant Temporal Lobe Epilepsy
Authors: Hulse Kyle , Grannan Benjamin , Kang Jin , Kim Michelle , Tsai Jeff , Hakimian Shahin , Hauptman Jason Scott , Ojemann Jeffrey G. , Ko Andrew Lin
Published: March 2023

INTRODUCTION:

Although it has been shown for dominant temporal lobe epilepsy that stereotactic laser amygdalohippocampectomy (SLAH) results in less verbal memory decline than anterior temporal lobectomy (ATL), the relative cognitive effects of these surgeries in non-dominant temporal lobe epilepsy have not been directly studied.

METHODS:

A retrospective review of SLAH or ATL surgeries at the University of Washington from 2014 to 2020 was conducted. Hemisphere dominance was determined using WADA testing or functional MRI. Patients that received non-dominant SLAH or ATL and pre- and post-operative neuropsychological testing were analyzed. A composite non-verbal visuospatial memory variable was created using Z-score normalization of the Visual Reproduction (VR) and Rey Complex Figure Test (RCFT) tasks. The Rey Auditory Verbal Learning Test (RAVLT) was used for verbal memory analysis. Paired t-test analysis was used to compare cognitive score distributions. Two-way ANOVA was used to assess the effects of seizure freedom (Engel score 1) and surgical intervention factors on cognitive improvement.

RESULTS:

Pre- and post-operative neuropsychological testing was available for 26 patients (14 SLAH, 12 ATL). Non-verbal visuospatial memory significantly decreased after ATL (mean -0.18 to -0.82, p = 0.025, n = 11) but not after SLAH (mean -0.55 to -0.57, p = 0.96, n = 14). There were no observed changes in verbal memory after ATL (mean -0.41 to -0.07, p = 0.22, n = 11) or SLAH (mean -0.13 to 0.-42, p = 0.26, n = 13). Seizure freedom was a significant factor in explaining non-verbal memory improvement, even when modeled with surgical intervention interaction term (ANOVA, p = 0.04).

CONCLUSIONS:

Patients undergoing non-dominant ATL experience a greater reduction in visuospatial memory metrics compared to patients undergoing SLAH. Independent of surgery type, seizure freedom is associated with improved non-verbal memory outcome.
504 Safety and Efficacy of Brain-Responsive Neurostimulation Treatment With Depth Leads Placed in the Neocortex
Authors: Purger David Arnold , Parker Jonathon J. , Sadeghzadeh Sina , Mirro Emily , Karakis Ioannis , Gross Robert E. , Wu Chengyuan , Drees Cornelia , Raslan Ahmed M.T. , Ernst Lia , Nerison Caleb , Sather Michael D. , Jobst Barbara , Aronson Joshua P. , Halpern Casey H.
Published: March 2023

INTRODUCTION:

Responsive neurostimulation (RNS) is efficacious in treating medically refractory epilepsy arising from neocortical foci. During clinical trials, most patients with neocortical seizure foci received cortical strip leads, perhaps due to intracranial monitoring with subdural grids/strips. Stereo-electroencephalography (sEEG) has become more widely utilized since the trials, resulting in increased placement of neocortical RNS depth leads. This is also an appealing approach when dural adhesions make strip lead implantation difficult.

METHODS:

We conducted retrospective chart review of adult patients with refractory epilepsy at seven institutions who underwent placement and connection of at least one RNS depth lead in the neocortex.

RESULTS:

61 neocortical depth leads were connected to the RNS neurostimulator in 53 patients. 33 patients had additional depth leads in a non-neocortical focus, and 12 had an additional neocortical strip lead. Median follow-up was 2.2 years (range: 0.4 – 5.2 years). Median clinical seizure reduction in seizures was 63% at 1 y and 75% at last follow-up. 12 patients (23%) were seizure-free at last follow-up; a majority of these (83%) were seizure-free for >6 mo, with five patients seizure-free for >1 y. There were two (3.8%) scalp infections. One patient (1.9%) had each of the following: chemical meningitis, epidural hematoma, post-surgical status epilepticus (resolved with stimulation), new-onset non-epileptic seizures, and stimulation-related nausea (resolved with programming).

CONCLUSIONS:

Our multicenter series of 53 patients with neocortical-onset epilepsy treated with neocortical RNS depth leads demonstrated 75% median seizure reduction at 2 y of follow-up with a similar safety profile to placement of deep brain electrodes for movement disorders. Neocortical depth leads may be preferred with the RNS system following sEEG evaluation and/or if strip placement poses increased surgical risk.
511 Regional Patterns of Decreased Grey-Matter Volume are Associated with Non-Response to Temporary CSF Drainage in iNPH
Authors: Lang Stefan T. , Dimond Dennis , Isaacs Albert M. , Dronyk Jarred , Hamilton Mark G.
Published: March 2023

INTRODUCTION:

Temporary drainage of cerebrospinal fluid (CSF) by lumbar puncture or lumbar drain has a high predictive value for identifying patients with idiopathic normal pressure hydrocephalus (iNPH) who will benefit from shunt insertion. However, it is unclear what differentiates responders from non-responders. One hypothesis is that there are patterns of reduced grey-matter volume (GMV) that predispose patients to a poor response.

METHODS:

Subjects included 132 patients with iNPH who underwent testing with temporary CSF drainage and who had undergone structural MRI between 2013 and 2021. Subjects were classified as responders or non-responders to temporary CSF drainage based on clinical examination and standardized measures of cognition (MoCA) and gait velocity. Demographic and clinical variables were examined between groups. Group differences in GMV were assessed using VBM while adjusting for age, sex, and total intracranial volume.

RESULTS:

There were 87 responders and 45 non-responders. There were no differences in age, sex, baseline gait velocity, CSF volume, or white-matter T2 hyperintensity volume. Non-responders had higher baseline MoCA scores and were more likely to have received lumbar puncture vs extended lumbar drainage. Responders had greater increases in MoCA and gait velocity scores. Non-responders demonstrated decreased GMV in the right supplementary motor area and in the right posterior parietal cortex as compared to responders.

CONCLUSIONS:

Decreased GMV in the supplementary motor area and posterior parietal cortex may identify patients with suspected iNPH likely to experience a negative response following temporary CSF drainage. These patients may have limited capacity for recovery due to atrophy in these regions known to be important for motor and cognitive integration.
560 Mechanical Thrombectomy Versus Best Medical Therapy for Medium Vessel Occlusions: A Cost-Effective Analysis Using Local Get with the Guidelines Registry Data
Authors: Lim Jaims , Monteiro Andre , Siddiqi Manhal , Kuo Cathleen , Baig Ammad , Khawar Wasiq , Davies Jason , Levy Elad I. , Siddiqui Adnan Hussain
Published: March 2023

INTRODUCTION:

Equipoise exists in regards to whether mechanical thrombectomy (MT) is superior to best medical management (BMM) in patients with acute ischemic stroke due to medium vessel occlusion (MeVO). While clinical outcome differences may not be statistically significant in prior series, MT for MeVO may still be cost-effective (CE).

METHODS:

The local Get with the Guidelines (GTWG) registry data was queued. Patients with MeVO documented on CTA presenting with NIHSS >5 and treated with MT or BMM within 12 hours from symptom onset were included. Rates of each mRS outcomes was collected. Stroke cost data was derived from previous stroke literature including costs associated with imaging done at admission (non-contrast CT, CT Angiography, and CT perfusion), MRI 24 hours post-stroke, perfusion maps software, intravenous alteplase, physician and personnel costs, and thrombectomy. Costs associated with each mRS from presentation to 90-days and post-90 day care were collected. Utilizing the clinical data from GTWG registry and costs from the literature, TreeAge Pro was used to generate cost-effectiveness ratios (CE-ratio).

RESULTS:

Both the MT and BMM groups were similar in age, comorbidities, NIHSS and time to presentation. MT was found to be more cost-effective (CE-ratio 93,500) compared to BMM (CE-ratio 101,496. MT was more costly (total cumulative cost $59,840) than BMM (total cumulative cost $51,763). MT and BMM respectively had an effectiveness score of 0.64 and 0.51.

CONCLUSIONS:

This is one of the first CE studies comparing MT and BMM in acute ischemic strokes due to MeVO. We demonstrate based on GTWG data and costs in the literature that MT is more CE than BMM.
625 The Impact of the Mexico-San Diego Border Wall Extension on Spinal Injuries
Authors: Tenorio Alexander , Brandel Michael G. , Produturi Gautam , McCann Carson , Costantini Todd , Doucet Jay , Ciacci Joseph D.
Published: March 2023

INTRODUCTION:

San Diego, California has one of the busiest international land borders in the world, and its unauthorized crossing is a contentious issue. The recent border height extension along the San Diego-Mexico border has led to a new set of physical risks to unauthorized individuals traversing the wall.

METHODS:

In this retrospective cohort study, patients who presented to the UC San Diego Trauma Center between 2016 and 2021 were considered. Two different cohorts were compared: pre-height extension (Jan 2016-May 2018), and post-height extension (January 2020-December 2021). Demographics, clinical data (fracture morphology, operative intervention, concurrent injuries, length of stay), and hospital costs were collected. Spinal injuries were normalized using Customs and Border Protection (CBP) apprehensions to adjust for changing migration rates. Statistical analysis was completed with Stata MP Version 14.1 (Stata Corp LP).

RESULTS:

A total of 114 patients met inclusion criteria: 12 in the pre-height extension period, and 102 in the post-height extension period. The increase in spine injuries per month (0.8 to 4.25) and operative spine injuries per month (0.3 to 1.7) were statistically significant (P < 0.001). Concurrent extremity injuries were also significantly increased (8.3 vs. 43.1%, p = 0.02). The severity of injuries and economic costs were reflected in median length of stay (6 vs. 9 days; p = 0.006) and median total hospital charges ($150,914 to $293,798; p < 0.001).

CONCLUSIONS:

The data support that the San Diego-Mexico border wall extension is correlated with more frequent, severe, and costly spinal injuries. These findings advocate for reevaluating our current border wall infrastructure as this represents a humanitarian and public health crisis.
660 Intraoperative O-C2 and O-EA Angular Measurements for Achieving Optimal Alignment During Posterior Fossa Decompression and Occipitocervical Fusion for Complex Chiari Malformation
Authors: Han Rachael , Chae John Kyungjun , Garton Andrew L.A. , Medary Branden , Navarro-Ramirez Rodrigo , Hussain Ibrahim , Hartl Roger , Greenfield Jeffrey P.
Published: March 2023

INTRODUCTION:

Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications such as dysphagia and neck pain. Achieving neutral craniocervical alignment intraoperatively can be challenging in patients with Chiari malformation (CM) with craniocervical instability (CCI) undergoing posterior fossa decompression (PFD) and OCF because the head must be flexed for optimal PFD and subsequently extended to neutral for OCF.

METHODS:

We retrospectively reviewed patients with CM 1 and 1.5 who underwent PFD and OCF. Patient demographics, preoperative presentation, XR morphometrics, operative details, postoperative complications, and clinical outcomes were analyzed.

RESULTS:

Out of 39 patients (mean age 24.6 years, range 3-51, 76.9% female), 37 patients did not require revision surgery after PFD and OCF. In this non-revision cohort, O-C2a (13.5 ± 10.4° vs. 17.5 ± 10.1°, P = .047) and nPAS (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = .007) increased significantly after surgery. In 2 patients who required revision due to postoperative dysphagia, these measurements acutely decreased after initial surgery (mean difference -16.6° in O-C2a and -12.8° in O-EAa), and revision surgery restored the morphometrics back to baseline. Applying these observations, we now intraoperatively measure these fluoroscopic morphometrics and ensure neutral craniocervical alignment using the Mayfield head clamp locking mechanism prior to hardware placement.

CONCLUSIONS:

Utilizing fluoroscopic morphometrics pre- and intra-operatively can guide surgeons in appropriate positioning during combined PFD and OCF. With neutral rotatory fixation, single-axis flexion/extension of the head during each stage of the surgery with the Mayfield head clamp locking mechanism facilitates positioning in conjunction with these fluoroscopic-based measurements.
677 Do Flare-Ups in Systemic Disease Activity Correlate to Cervical Deformity in Patients With Rheumatoid Arthritis?
Authors: Lebouille-Veldman Anna , Spenkelink Dylan , Vleggeert-Lankamp C.L.A.
Published: March 2023

INTRODUCTION:

Following the introduction of biological DMARDs in Rheumatoid Arthritis (RA) treatment, cervical spine deformity seems to be less prevalent in those patients. It seems that this vast decline in patients with Atlanto-axial Subluxation (AAS), Subaxial Subluxation (SAS) or Vertical Subluxation (VS) is correlated to better control of systemic disease activity (DAS). The aim of the current study is to correlate the frequency of flare-ups in DAS to cervical spine deformity.

METHODS:

272 RA patients were included and cervical deformity (AAS and/or SAS) was observed in 108 patients. 84 (31%) patients were in remission at 10 years FU and 206 (75%) of patients reached remission at least once during 10 years FU. Patients with cervical spine deformity at 10 years had less flare-ups (1.26) in DAS than patients without cervical spine deformity (1.58; 95% CI: 0.013-0.627).

RESULTS:

So, even though the BeSt Trial was designed to optimize treatment, 40% of the patients still developed RA-associated cervical spine deformity. However, remarkably, patients with more flares had less cervical deformity. This may be explained by the treatment regimen that anti-inflammatory medication is augmented upon measuring a systemic flare-up.

CONCLUSIONS:

This raises the hypothesis that RA medication treatment regimes should not be solely aimed at DAS values, as they are currently defined, in order to avoid cervical deformity in RA in the long term.
765 Outcome of Chronic Subdural Hematoma Management in Patients on Long Term Antiplatelet Therapy—A Propensity Score Matched Analysis
Authors: Salih Mira , Salem Mohamed M. , Ravina Kristine , Stippler Martina , Papavassiliou Efstathios , Alterman Ron L. , Thomas Ajith , Moore Justin M. , Ogilvy Christopher S.
Published: March 2023

INTRODUCTION:

Chronic subdural hematomas (cSDH) are particularly common in frail older adults given their increased risk of falls, and the fact that they often have conditions that require antithrombotic agents, such as antiplatelets.

METHODS:

Patients who underwent surgical management for subdural hematoma (SDH) at our institution between January 2006 and June 2021 were identified. Propensity score matched analysis was used to make a balance in patients on antiplatelets before procedure vs those who were not on antiplatelets and patients on antiplatelets post-procedure vs those who were not. Length of hospitalization, peri-procedural complications, reintervention rate during the same admission, rebleeding risk and reintervention rates after discharge were compared.

RESULTS:

In total, 180 patients were on long-term antiplatelets before procedure, while 286 were not. After matching, 57 pairs were included in analysis. Post-procedure, 76 patients were started on long-term antiplatelets, the rest were not. Then 44 patients in each group were included in the analysis after matching. Comparing the pre-procedure antiplatelet group with non-antiplatelet group, no significant differences were found in length of hospitalization (7.9 ± 5.5 vs 9.2 ± 7.7, p = 0.28), procedural complications (3.5% vs 5.3%, p = 0.65), or reintervention during the same admission (10.5% vs 3.5%, p=0.14). In the comparison of post-procedure antiplatelet group and non-antiplatelet group, no significant differences were seen in recurrence rate (9.1% vs 13.6%, p = 0.5) or reintervention rate after discharge (4.5% vs 4.5%, p = 1).

CONCLUSIONS:

Being on long-term antiplatelets before cSDH procedures does not affect length of hospitalization, peri-procedural complications or reintervention during the same admission. Similarly, long-term antiplatelets after cSDH procedure does not increase rebleeding risk or reintervention rate. Our data suggest that similar management protocols can be applied to both groups of patients, and it is safe to restart antiplatelet agents in the setting of a chronic subdural hematoma (cSDH).
840 Dorsolateral Prefrontal Cortex Beta Power Dynamics Underlying Verbal Working Memory Encoding in Parkinson’s Disease
Authors: Paulo Danika Lea , Qian Helen , Subramanian Deeptha , Johnson Graham Walter , Bick Sarah KB
Published: March 2023

INTRODUCTION:

Cognitive impairment (CI) is the most frequent nonmotor symptom in Parkinson’s Disease (PD) and is associated with deficits in executive functions such as working memory (Kehagia et al, 2010). Previous studies have demonstrated that caudate and DLPFC beta power underlie learning and working memory (Bick et al, 2019). Decreased dopamine in motor cortico-striato-thalamo-cortical (CSTC) circuits results in increased beta power and PD motor symptoms (Lapidus et al, 2014). Analogous changes in cognitive CSTC circuits, including the dorsolateral prefrontal cortex (DLPFC), may contribute to PD CI and be a target for neuromodulation. Better understanding of anatomic structures and neurophysiologic changes associated with working memory deficits is needed to develop potential neuromodulatory treatment strategies for PD CI.

METHODS:

Thirteen PD and ten ET patients who underwent deep brain stimulation in 2021 at Vanderbilt University Medical Center were consented and included in this analysis. Intraoperative local field potential recordings were obtained from the DLPFC during a 2-back verbal memory task with performance feedback (Owen et al, 2005). Signals were sampled at 1000Hz, Butterworth band pass filtered, de-meaned and averaged across patients. Average beta power differences 500-1000 msec following image onset were analyzed for correct and incorrect trials for PD and ET patients.

RESULTS:

PD patients exhibited significantly lower mean beta power compared to ET patients for correct trials (p = 0.0305, Wilcoxon rank-sum test).

CONCLUSIONS:

Neurophysiologic patterns underlying working memory encoding deficits in PD patients may reflect underlying dopaminergic dysfunction in cognitive CSTC circuits that result in CI. Structures within this circuit may be implicated in PD memory impairment and may serve as potential secondary targets for neuromodulation to improve working memory in patients with comorbid CI.
875 The Role of Frailty in Geriatric Cranial Neurosurgery for Primary Central Nervous System Neoplasms
Authors: Shahrestani Shane , Brown Nolan James , Ransom Seth C. , Ballatori Alexander , Ton Andy , Chen Xiao , Singh Rohin , Gendreau Julian , Sahyouni Ronald
Published: March 2023

INTRODUCTION:

Frailty is a clinical state of increased vulnerability due to age-associated decline and has been well established as a perioperative risk factor. Yet, literature describing the effects of frailty on short- and long-term complications in geriatric patients is limited.

METHODS:

The authors conducted a retrospective cohort study between 2010 and 2017 by using the Nationwide Readmission Database. Demographics and frailty were queried at primary admission, and readmissions were analyzed at 30-, 90-, and 180-day intervals. Nearest-neighbor propensity score matching for demographics was implemented to identify nonfrail control patients with similar diagnoses and procedures. The analysis used Welch two-sample t-tests for continuous variables and chi-square test with odds ratios.

RESULTS:

A total of 6713 frail patients and 6629 nonfrail patients were identified at primary admission. At primary admission, frail geriatric patients undergoing cranial neurosurgery had increased odds of developing acute posthemorrhagic anemia (OR 1.56, 95% CI 1.23-1.98; p = 0.00020); acute infection (OR 3.16, 95% CI 1.70-6.36; p = 0.00022); acute kidney injury (OR 1.32, 95% CI 1.07-1.62; p = 0.0088); urinary tract infection prior to discharge (OR 1.97, 95% CI 1.71-2.29; p < 0.0001); acute postoperative cerebral infarction (OR 1.57, 95% CI 1.17-2.11; p = 0.0026); and mortality (OR 1.64, 95% CI 1.22-2.24; p = 0.0012) compared to nonfrail geriatric patients receiving the same procedure. In addition, frail patients had a significantly increased inpatient length of stay (p < 0.0001) and all-payer hospital cost (p < 0.0001) compared to nonfrail patients at primary admission.

CONCLUSIONS:

Frailty may significantly increase the risks of short-term acute complications in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. Long-term analysis revealed no significant difference in complications between frail and nonfrail patients.
RNA therapeutics
Authors: Hastings Michelle L. , Krainer Adrian R.
Published: March 2023

“RNA therapeutics” refers to a disease treatment or drug that utilizes RNA as a component. In this context, RNA may be the direct target of a small-molecule drug or RNA itself may be the drug, designed to bind to a protein, or to mimic or target another RNA. RNA has gained attention in the drug-development world, as recent clinical successes and breakthrough technologies have revolutionized the drug-like qualities of the molecule or its usefulness as a drug target. In this special issue ofRNA, we gathered expert perspectives on the past, present, and future of the field, to serve as a primer and also a challenge to the broad scientific community to incorporate RNA into their experimental design and problem-solving process, and to imagine and realize the potential of RNA as a therapeutic drug or target.
The identification of high-performing antibodies for Secreted frizzled-related protein 1 (sFRP-1) for use in Western Blot and immunoprecipitation
Authors: Ayoubi Riham , Southern Kathleen , Laflamme Carl ,   NeuroSGC/YCharOS collaborative group
Published: March 2023

Secreted frizzled-related protein 1 (sFRP-1) is a secreted protein, belonging to the secreted glycoprotein SFRP family. As a modulator of the Wnt/β-catenin signalling pathway, sFRP-1 has implications in human cancers and neurologic diseases. If the community had access to well-characterized anti-sFRP-1  antibodies, the reproducibility of sFRP-1 research would be enhanced. In this study, we characterized 11  sFRP-1 commercial antibodies for Western Blot and immunoprecipitation, using a standardized experimental protocol based on comparing read-outs in knockout cell lines and isogenic parental controls. We identified many well-performing antibodies and encourage readers to use this report as a guide to select the most appropriate antibody for their specific needs.
Women's knowledge, attitudes and access to vaccines in pregnancy: A South Auckland study
Authors: Priday Adrienne , Clemons Janine , Krishnan Teresa , Gillard-Tito Stacey , McAra-Couper Judith
Published: March 2023

Background: In Aotearoa New Zealand pertussis and influenza vaccinations are available free-of-charge during pregnancy, although uptake varies between District Health Board areas. Aims: This study was designed to assess the knowledge of, attitudes towards, and infrastructural access to, these vaccines for birthing people in an area of Auckland (Counties Manukau) where uptake has been low. Methods: A mixed methods research design was used involving interviews (n = 7), two focus groups (n = 9) and a paper-based survey (n = 121). Interviews and focus groups were semi-structured and analysed using thematic analysis. The survey comprised of a 20-item Likert scale. Findings: Participants displayed support for maternal vaccinations. Concerns remain regarding potential adverse effects. Awareness of the existence of vaccines in pregnancy is not universal, and 36% of survey participants were unaware that the vaccines are free-of-charge. Appreciation was expressed for trusted healthcare relationships within which people feel supported to make decisions about maternal vaccination, and for immunisation services that are easily accessible. Conclusion: The research contributes to growing evidence on the significance of health professionals providing information about immunisation in pregnancy. Also highlighted is the importance of: culturally safe knowledge sharing; information being tailored to meet individual needs; and continuity of health and maternity care to facilitate that.
A CRITICAL DISCOURSE ANALYSIS OF MAINSTREAM COLLEGE STUDENT LEADERSHIP DEVELOPMENT MODELS
Authors: Irwin Lauren N. , Posselt Julie R.
Published: March 2023

Developing leaders for a diverse democracy is an increasingly important aim of higher education and social justice is ever more a goal of leadership education efforts. Accordingly, it is important to explore how dominant leadership models, as blueprints for student leadership development, account for and may unwittingly reinforce systems of domination, like racism. This critical discourse analysis, rooted in racialization and color-evasiveness, examines three prominent college student leadership development models to examine how leaders and leadership are racialized. We find that all three leadership texts frame leaders and leadership in color-evasive ways. Specifically, the texts’ discourses reveal three mechanisms for evading race in leadership: focusing on individual identities, emphasizing universality, and centering collaboration. Implications for race in leadership development, the social construction of leadership more broadly, and future scholarship are discussed.
WHAT ARE WE MISSING? Problems with using generational cohorts in leadership research and suggestions for a better direction.
Authors: Brachle Benjamin , McElravy L.J.
Published: March 2023

The rising costs of recruiting and hiring workers and the seismic shift of age demographics in the United States workforce has created much stir around the concept of generational cohorts. Although much has been done by researchers and practitioners alike to attempt a better understanding of each generational group’s leadership preferences, confusing and contradictory results has attracted much criticism. This critique has inspired efforts to look at the concept of leadership and followership preference through an alternative lifespan developmental lens. Because leadership influences are inherently social influences, a person’s overall lifespan development level may potentially provide a deeper perspicacity of the phenomenon than examining it from the more conventional generational cohort perspective. However, specific research into this area is lacking. This paper adds to the literature by uncovering what we are missing in research and practice when we look at age-related leadership phenomena solely from a generational cohort perspective. A review of the contradicting literature on generational cohorts and leadership is offered. Next, specific lifespan developmental theories are examined, and propositions and implications of such research are extended.