bluuebunny/crossref_metadata_2025_split huggingface dataset:
Petrosal Approach for Giant Retrochiasmatic Craniopharyngioma: 2-Dimensional Operative Video
Authors: Erkmen Kadir , Aboud Emad , Al-Mefty Ossama 
Published: May 2021

Abstract
Microsurgical resection of craniopharyngiomas poses significant challenges, which are amplified with tumors in the retrochiasmatic location and larger size. Traditional pterional trans-sylvian, subfrontal translamia terminalis, or interhemispheric approaches provide narrow surgical corridors with obstructed visualization of the tumor by the prefixed chiasm and slit optic carotid window.
1–5
The superior extension of the tumor compressing the hypothalamus and third ventricle are likewise inaccessible. Dissection through these approaches requires crossing and manipulation of the already compromised optic apparatus with surgical instruments. Finally, the basilar artery and its perforating branches are often adherent to the posterior aspect of the tumor, and are invisible.
Endonasal endoscopic techniques have been utilized as a surgical approach that accesses the tumor without crossing the optic apparatus; however, these approaches have a significant risk of cerebrospinal fluid leakage and require dissection of the basilar artery and hypothalamus from long distances with lengthy instruments.
6–9
Frequently, the surgeon achieves only partial removal.
The petrosal approach is ideal for tumors in the retrochiasmatic location.
10–13
Advantages include unhindered access to the retrochiasmatic space without crossing the optic nerve and chiasm. The angle of approach allows visualization superiorly to the hypothalamus. Additionally, the approach shortens the distance to the tumor, allowing for delicate bimanual dissection of the tumor, especially at the basilar artery and hypothalamic interfaces.
This video demonstrates three cases of retrochiasmatic craniopharyngioma resection through the petrosal approach, highlighting these advantages to optimize patient outcome. The patients and guardians consented for the surgery, photography, and publication of the patient's image.
Figures from Al-Mefty et al
11
used with permission from the Journal of Neurosurgery Publishing Group.
Additional figures republished from Al-Mefty et al.
12
“The petrosal approach for the resection of retrochiasmatic craniopharyngiomas,” Neurosurgery, 2008, volume 62, issue 5 Suppl 2 (ONS), ONS331-ONS336, by permission of the Congress of Neurological Surgeons.
Surgical Treatment of Bilateral Optic Nerve Sheath Meningioma: 2-Dimensional Operative Video
Authors: Rassi Marcio S , Al-Mefty Ossama 
Published: May 2021

Abstract
Even though intracranial meningiomas commonly invade the optic canals, true optic nerve sheath meningiomas are extremely rare. They are insidious lesions that frequently grow in 4 stages, leading to progressive visual loss.
1–4

Frequently, management includes observation for asymptomatic patients, and fractioned stereotactic radiotherapy with progressive visual loss.
1,3
However, surgery is avoided due to the risk of perioperative visual loss.
2–4

However, many of these cases present in the early stage of tumor growth, where an arachnoidal plane is still present, and vision can be saved by microsurgical tumor resection.
2
Here we present the case of a 33-yr-old female presenting with a 3-wk history of blurred vision. Neuroimaging depicted an enhancing lesion along both optic nerves consistent with bilateral optic nerve sheath meningioma. Neuroophthalmological examination showed inferior cut of visual field bilaterally, more extensive on the left eye. Acuity was 20/20 on both eyes.
Microsurgical resection of the tumor was performed through left supraorbital craniotomy, with the goal of eliminating intracranial extension and stabilizing visual function.
5
The optic canal was unroofed with diamond bit drill under copious irrigation. A remarkable improvement of her visual field was observed with maintenance of acuity at 20/20 on follow-up. As the patient is attempting pregnancy, she is closely monitored without radiation.
Surgery can be offered as a primary treatment of optic nerve sheath meningiomas, especially in early stages, with likely preservation and, in some cases, improvement of visual function.
6

The patient consented to the procedure and the use of image.
Images at 1:46 and 3:48 reprinted from Al-Mefty O, Operative Atlas of Meningiomas. 1998: Raven Press; Philadelphia, PA, with permission from LWW.
Image at 2:57 reprinted from Rassi et al
2
; © Anil Can, 2018, used with permission.
Image at 9:27 in public domain/age.
Interhemispheric Precuneus Retrosplenial Transfalcine Approach for Falcotentorial Meningiomas: Anatomic Study and Clinical Series
Authors: Celtikci Emrah , Nunez Maximiliano , Liu James K , Gardner Paul A , Cohen-Gadol Aaron A , Fernandez-Miranda Juan C 
Published: April 2021

Abstract

BACKGROUND
Falcotentorial meningiomas are surgically challenging. Currently accepted approaches include occipital interhemispheric and supracerebellar infratentorial approaches, which have documented drawbacks.

OBJECTIVE
To propose an alternative approach to the posterior tentorial incisural space, the interhemispheric precuneus retrosplenial transfalcine approach (IPRTA).

METHODS
A total of 6 colored-silicone-injected adult cadaveric heads were dissected. We measured the interval between bridging veins and studied computed tomography venography scans of 20 subjects to confirm the feasibility of the IPRTA. Bony landmarks, the region's bridging veins, and the anterior and posterior borders of the approach were identified. The surgical corridor widths (veins’ interval) and lengths were compared between alternative midline approaches. We also reviewed 4 consecutive clinical cases using this approach.

RESULTS
The IPRTA provides the shortest distance to the anterior and posterior limits of the posterior tentorial incisura. Moreover, it is the only approach that provides direct visualization of the anterior and posterior limits of falcotentorial junction meningiomas. In all specimens and patients, a minimum 30-mm interval between the anterior and posterior parietal veins was found in at least one of the hemispheres. Tumor removal was successful in all 4 patients but resulted in mild paresthesia in the lower extremities of 2 patients and temporary foot drop in 1 patient.

CONCLUSION
The IPRTA offers the shortest and most direct corridor for falcotentorial meningiomas and provides excellent visualization of most of the critical structures in the region. Detailed preoperative evaluation of the deep and superficial venous structures is recommended.
Microsurgical Anatomy of the Endoscopy-Assisted Retrosigmoid Intradural Suprameatal Approach to the Meckel's Cave
Authors: Xu Yuanzhi , Hendricks Benjamin K , Nunez Maximiliano Alberto , Mohyeldin Ahmed , Fernandez-Miranda Juan C , Cohen-Gadol Aaron A 
Published: April 2021

Abstract

BACKGROUND
Understanding the microsurgical anatomical features of the endoscopy-assisted retrosigmoid intradural suprameatal approach (RISA) is critical for surgeons treating petroclival tumors or lesions in the cerebellopontine region that extend into Meckel's cave.

OBJECTIVE
To evaluate increased exposure for Meckel's cave in the RISA and assess the surgical landmarks for this approach.

METHODS
A standard retrosigmoid craniotomy to the cerebellopontine region was performed in 4 cadaveric specimens (8 hemispheres) with microscope-assisted endoscopy. The length and depth of the drilling region from the suprameatal tubercle to the petrous apex were analyzed. After opening Meckel's cave and mobilizing the trigeminal root completely, the landmarks for this approach were investigated.

RESULTS
The endoscopy-assisted RISA facilitates mobilization of the trigeminal root and enhances surgical exposure in the region of Meckel's cave and the petrous apex with increases of 10.1 ± 1.3 mm in depth, 21.4 ± 3.2 mm in length, and 6.4 ± 0.6 mm in height. The posterior and superior semicircular canals, internal auditory canal, superior petrous sinus, and internal carotid artery (petrous segment) served as important landmarks for this approach. One case illustration is presented to describe the application of this approach.

CONCLUSION
The RISA is suitable mainly for lesions in the posterior fossa that extend into Meckel's cave. The endoscopy-assisted reach optimizes accessibility to the petrous apex region, obviates the need for extensive drilling, and decreases the risk of internal carotid artery injury. Better realization and recognition of microsurgical landmarks and parameters of this approach are crucial for successful outcomes.
Stenting in High-Grade Internal Carotid Artery Stenosis: 2-Dimensional Operative Video
Authors: Kaye Joel M , Mejia-Munne Juan C , Grossman Aaron W , Shirani Peyman , Smith Matthew S , Prestigiacomo Charles J 
Published: April 2021

Abstract
Carotid artery stenosis is implicated in up to 40% of all ischemic strokes. Accordingly, symptomatic, high-grade carotid artery stenosis portends an especially high risk of future stroke. Intervention via open or endovascular approaches drastically reduces this risk. Under the appropriate conditions, carotid artery stenting serves as a safe and effective alternative to carotid endarterectomy. We present the case of a 57-yr-old male with symptomatic, high-grade stenosis of his right internal carotid artery, for whom a history of radiation to the head and neck represented a relative contraindication to carotid endarterectomy, and thus endovascular treatment with angioplasty and stenting was performed. Informed consent was obtained prior to the procedure. Intraprocedurally, stent delivery past the area of stenosis proved somewhat challenging. However, by employing several nuanced maneuvers, we utilized our guiding catheter in a nonconventional manner in order to successfully perform the procedure. As the field of neuroendovascular surgery evolves, each case provides us unique lessons, which in turn expands our interventional capabilities and adds to the armamentarium of neuroendovascular techniques. We present this surgical video both as a means to provide a general overview of carotid artery stenting, and to share a lesson learned through the implementation of an interesting technical nuance.
Medial Acoustic Tumors: Special Considerations: 2-Dimensional Operative Video
Authors: Almefty Rami O , Essayed Walid Ibn , Al-Mefty Ossama 
Published: April 2021

Abstract
Medial acoustic tumors are a rare distinct type of vestibular schwannoma having distinguished clinical and radiological features.
1
Originating medially in the cerebellopontine angle without extending into the lateral internal auditory meatus, they are frequently giant in size at presentation in younger patients with a relatively preserved hearing, while they have other neurological deficits from cerebellar or brainstem compression and associated hydrocephalus. Imaging typically shows a cystic tumor with local mass effect and an internal auditory canal filled with cerebrospinal fluid.
1,2
Surgical resection of theses schwannoma is particularly challenging not only due to their size and hypervascularity, but also given their particular arachnoidal rearrangement inducing marked adherence to the brainstem and facial nerve.
2

The treatment is surgical resection, despite, however, their giant size hearing preservation should be sought and is attainable.
1–5
Transmastoid approach with squeletonization and reflection of the transverse sigmoid sinus provides lateral exposure avoiding cerebellar retraction.
6
In this report, we demonstrate the specific surgical considerations applied to the resection of a giant medial acoustic tumor in a 40-yr-old patient presenting with ataxia, vertigo, facial paresthesia, and intact hearing. The patient agreed to the surgery and photography.
Image at 1:44 © Ossama Al-Mefty, used with permission; Image at 8:21 from Dunn et al,
2
used with permission from JNSPG.
Radical Resection of a Giant Epidermoid Tumor Associated With Miniature Chordoma Utilizing a Combined Endoscopic-Microscopic Technique: 2-Dimensional Operative Video
Authors: Tavanaiepour Daryoush , Abolfotoh Mohammad , Essayed Walid Ibn , Al-Mefty Ossama 
Published: April 2021

Abstract
Epidermoid tumors arise from misplaced squamous epithelium and enlarge through the accumulation of desquamated cell debris.
1
Notwithstanding the prevailing conservative attitudes to minimize morbidity, optimal treatment consists of total removal of the capsule
2,3
; therefore, giant and multicompartmental tumors are particularly challenging. The utilization of simultaneous endoscopic microscopic techniques by tandem endoscopic and microscopic dissection to overcome the shortcomings of both modalities, markedly enhances the ability of radical removal,
4
thus eliminating or at least long-delaying inevitable recurrences with subsequent accumulated morbidity. The transmastoid approach by skeletonizing and reflexing the transverse-sigmoid sinus offers wide exposure of the cerebellopontine angle avoiding cerebellar retraction and allowing 4-hands dissection.
5
The patient is a 17-yr-old male with a giant epidermoid tumor in the cerebellopontine angle, extending through the incisura. The patient underwent surgical resection with maximum pursuit of the epithelial capsule. After removing the epidermoid tumor, a miniature intra and extradural midclival tumor was encountered and removed with a proven pathology of chordoma. Patient did well postoperatively with relief of his hemifacial spasms. Patient consented for surgery and photograph publication.
Image at 1:23, ©1997, O. Al-Mefty, used with permission. All rights reserved.
Decentralizing diabetes care from tertiary to primary care: how many persons with diabetes can be down-referred to primary care settings?
Authors: Olickal Jeby Jose , Suryanarayana B S , Chinnakali Palanivel , Saya Ganesh Kumar , Ganapathy Kalaiselvan , Vivekanandhan T , Subramanian Sadhana , Subrahmanyam D K S 
Published: April 2021

Abstract

Background
In a cohort of persons with diabetes (PWDs) seeking care at a tertiary care center, we aimed to determine the proportion of PWDs eligible and willing for down referral to primary health centers (PHCs).

Methods
We conducted a cross-sectional analytical study among PWDs on treatment for at least 1 year. PWDs with stable blood sugar, no history of cardiovascular events and proliferative retinopathy were considered as ‘eligible’ for primary care management.

Results
Of the total 1002 PWDs, mean (SD) age was 56 (12) years; 62% were male and 81% were from rural areas. About half (49%) of them were on insulin, and 52% had comorbidities. In total, 45.6% (95% CI: 42.3–48.8%) were eligible to be managed at PHCs. Among those who were eligible, 46.6% were willing to go back to PHCs. Males (APR = 1.16), people with diabetes for more than 10 years (APR = 1.23), and the presence of comorbidities (APR = 1.13) were significantly associated with unwillingness. Quality of medicines (46%) and poor facilities (40%) at PHCs were the main reasons for unwillingness.

Conclusions
About half of the PWDs availing care at tertiary hospitals can be managed at primary care settings; of those, only half were willing to receive care at PHCs.
The value priorities of consumer innovators
Authors: Søndergaard Helle Alsted , Thøgersen John 
Published: May 2021

AbstractContributing to the understanding of drivers for innovation, we report the first study of the value base of consumer innovation. Based on a survey with representative samples across ten European countries (N ≈ 10,000), about 5 per cent of participants are engaged in innovation activities in their leisure time, which is in line with earlier, single-country studies. The study confirms that consumer innovation is significantly related to personal value priorities and as expected, consumer innovators give higher priority to openness-to-change values than non-innovators. More surprisingly, consumer innovators are less motivated by hedonistic goals (fun and enjoyment) and more by concern for other people and society (i.e. self-transcendence values) than non-innovators. This adds an important dimension to existing knowledge and understanding of what motivates consumer innovation, helps differentiate consumer innovators from other consumers, and offers important input to the development of policies for facilitating or supporting consumer innovation.
041 Alteration of Threat-Related Information Processing During Extended Sleep Deprivation
Authors: Alger Sara , Hughes John , Balkin Thomas , Doty Tracy Jill 
Published: May 2021

Abstract

Introduction
Threat-related information is preferentially processed, facilitating quick and efficient responses. However, the impact of extended sleep deprivation on perception of and response to threatening information is not well known. Sleep loss may increase amygdalar activity and negative mood, potentially facilitating threat processing. However, it also reduces cognitive function, possibly impairing ability to respond. The present study assessed the extent to which extended sleep deprivation modulates threat processing using a threat expectation paradigm.

Methods
Twenty-one participants underwent one baseline night of sleep followed by 62hrs total sleep deprivation (TSD) and one recovery night of sleep (12hrs). Threat expectation task performance was assessed at baseline, at multiple time points during TSD, and following recovery sleep. To control for circadian influence, performance at three 1100 sessions (baseline, 52hrs into TSD, and recovery) were compared. The threat expectation task involved determining whether a presented face was fearful (i.e., signaled threat) or neutral. Faces were presented at three expectation levels: 80%, 50%, and 20% chance of viewing a fearful face.

Results
Overall, responses were faster (F=9.77, p=0.001) and more accurate (F=11.48, p=0.001) when the type of face (fearful or neutral) was expected. Accuracy significantly decreased over TSD (t=7.71, p&lt;0.001) and recovered following subsequent sleep. Fear bias was calculated for accuracy (accuracy for fearful face minus neutral face). Under conditions of high expectation (80%) of viewing a fearful face, fear bias increased across TSD (t=-1.95, p=0.07). Although accuracy to both fearful and neutral faces significantly declined across TSD (both p&lt;0.001), decline for neutral faces was greater, thus increasing fear bias. Importantly, the increased bias toward fear was still evident compared to baseline following a 12-hour recovery sleep opportunity, (t=-1.93, p=0.07).

Conclusion
Extended sleep deprivation, common in operational environments where there is also high expectation of encountering threat, impairs cognitive control and is thought to enhance amygdala activity. These data show that, consequently, cognitive resources become biased toward biologically adaptive behaviors (i.e., threat processing) at the expense of attending and responding more broadly to all stimuli. This behavior is not reversed with a single extended sleep opportunity.

Support (if any)
Department of Defense Military Operational Medicine Research Program (MOMRP)
043 Sleep Restriction Affects Memory in Healthy Adults: Preliminary Findings
Authors: Zimmerman Molly , Hale Christiane , Brickman Adam , Yeung Lok-Kin , Cochran Justin , St-Onge Marie-Pierre 
Published: May 2021

Abstract

Introduction
Sleep loss has a range of detrimental effects on cognitive ability. However, few studies have examined the impact of sleep restriction on neuropsychological function using an experimental design. The goal of this study was to examine the extent to which maintained insufficient sleep affects cognition in healthy adults compared to habitual adequate sleep.

Methods
This study used a randomized, crossover, outpatient sleep restriction design. Adults who regularly slept at least 7 h/night, verified by 2 weeks of screening with actigraphy, completed 2 phases of 6 weeks each: habitual sleep (&gt;7 h of sleep/night) or sleep restriction (habitual sleep minus 1.5 h) separated by a 6-week washout period. During the sleep restriction phase, participants were asked to delay their bedtime by 1.5 hours/night while maintaining their habitual wake time. Neuropsychological function was evaluated with the NIH Toolbox Cognition Battery at baseline (week 0) and endpoint (week 6) of each intervention phase. The NIH Toolbox evaluates a range of cognitive abilities, including attention, executive functioning, and working memory. General linear models with post hoc paired t-tests were used to assess demographically-adjusted test scores prior to and following each sleep condition.

Results
At the time of analyses, 16 participants were enrolled (age 34.5□14.5 years, 9 women), 10 of whom had completed study procedures. An interaction between sleep condition and testing session revealed that individuals performed worse on List Sorting, a working memory test, after sleep restriction but improved slightly after habitual sleep (p&lt;0.001). While not statistically reliable, the pattern of test results was similar on the other tests of processing speed, executive function, and attention.

Conclusion
In these preliminary results from this randomized experimental study, we demonstrated that sleep restriction has a negative impact while stable habitual adequate sleep has a positive impact on working memory, or the ability to temporarily hold information in mind while executing task demands. This finding contributes to our understanding of the complex interplay between different aspects of sleep quality (i.e., both sleep restriction as well as the maintenance of stable sleep patterns) on cognition and underscores the importance of routine sleep screening as part of medical evaluations.
Support (if any):