bluuebunny/crossref_metadata_2025_split huggingface dataset:
Operative Strategies for Aplastic Circle of Willis Arteries on CTA in Meningioma Surgery: A Case Report
Authors: Tabor Joanna K. , Pappajohn Alexandros F. , Lei Haoyi , O'Brien Joseph , Fulbright Robert K. , Morales-Valero Saul F. , Moliterno Jennifer 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Meningiomas frequently involve critical neurovascular structures. Preoperative imaging with computed tomography angiography (CTA) can help understand the relationship of tumor with neurovascular structures. Although CTA was useful in preoperative planning and less invasive, we present a unique case in which it mistakenly represents a hypoplastic anterior cerebral artery as aplastic and thus displays poor sensitivity in the Circle of Willis.

CLINICAL PRESENTATION:
A 66-year-old woman presented with new onset seizures and MRI demonstrated a sphenoid wing meningioma with tumor involvement of the internal carotid artery and right M1 artery. On preoperative CTA, a right A1 artery was not appreciated. However, a hypoplastic right A1 artery was identified during careful dissection guided by micro-Doppler and found to be encased within the tumor. All arteries were preserved, and a near-total resection was achieved with a small remnant of tumor at the supraclinoid internal carotid artery.

CONCLUSION:
Although CTAs can be useful in understanding vascular anatomy and its association with tumors, they are not ideal for providing information about hypoplastic arterial segments. Seemingly aplastic arteries on CTA may very well be present, albeit hypoplastic. While we recognize the usefulness of a less invasive modality of CTA to help guide surgical strategy, we underscore recognizing this potential pitfall and recommend the use of the microvascular Doppler during careful dissection when working within tumor in the location of a seemingly aplastic artery.
Second-Generation Wide-Field Visualization Devices for 5-ALA–Induced Fluorescence and Concepts for Validation in Neurosurgery—A Systematic Review
Authors: Özdemir Zeynep , Suero Molina Eric , Hellwig Sönke J. , Stepp Herbert , Stummer Walter 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Fluorescence-guided resection (FGR) of malignant gliomas with five-aminolevulinic acid (5-ALA) is an established method using surgical microscopes equipped with filter systems for observing fluorescence. Over the past decade, new technologies have been introduced for the same purpose, with available publications evaluating their clinical efficacy based on varying criteria. This study aims to review technologies and concepts of validation in the context of 5-ALA–mediated FGR.

METHODS:
A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was performed to identify devices capable of detecting 5-ALA–induced fluorescence. Articles found eligible for this review were analyzed, focusing on the methods of validation used for novel devices. A qualitative analysis is presented.

RESULTS:
Using predefined eligibility criteria, 22 studies were analyzed. Publications on the following visualization devices were reviewed: FL400 (Leica Microsystems), Aeos (Aesculap), BLUE400 and BLUE400 AR Filter System (Carl Zeiss Meditec AG), Endoscope with D-Light C (Karl Storz), Fiberscope N-4L (Machida), ORBEYE 4K 3D Digital Video Microscope (Olympus), and several customized surgical loupe systems. In many cases, validation seemed unstandardized, with inherent biases and limited reproducibility.

CONCLUSION:
This review illustrates the significance of device validation within the framework of FGR. It emphasizes the criticality of validating devices in accordance with established standard, i.e. the BLUE400 filter system, which was employed in the approval studies of 5-ALA. Furthermore, standardized concepts of validation are required to assess whether new devices are, in fact, a reliable or superior alternative in the field of FGR. Published guidelines should be considered when performing future studies.
Phase 1, Dose Escalation, Nonrandomized, Open-Label, Clinical Trial Evaluating the Safety and Preliminary Efficacy of Allogenic Adipose-Derived Mesenchymal Stem Cells for Recurrent Glioblastoma: A Clinical Trial Protocol
Authors: Ramos-Fresnedo Andres , Al-Kharboosh Rawan , Twohy Erin L. , Basil Aleeshba N. , Szymkiewicz Ewa C. , Zubair Abba C. , Trifiletti Daniel M. , Durand Nisha , Dickson Dennis W. , Middlebrooks Erik H. , Abarbanel David N. , Tzeng Stephany Y. , Almeida Joao Paulo , Chaichana Kaisorn L. , Green Jordan J. , Sherman Wendy J. , Quiñones-Hinojosa Alfredo 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Despite standard of care with maximal safe resection and chemoradiation, glioblastoma (GBM) is the most common and aggressive type of primary brain cancer. Surgical resection provides a window of opportunity to locally treat gliomas while the patient is recovering and before initiating concomitant chemoradiation. The objective was to assess the safety and establish the maximum tolerated dose of adipose-derived mesenchymal stem cells (AMSCs) for the treatment of recurrent GBM. Secondary objectives were to assess the toxicity profile and long-term survival outcomes of patients enrolled in the trial. In addition, biospecimens will be collected to explore the local and systemic responses to this therapy.

METHODS:
We will conduct a phase 1, dose-escalated, nonrandomized, open-label, clinical trial of patients with GBM who are undergoing surgical resection for recurrence. Up to 18 patients will receive intracavitary application of AMSCs encapsulated in fibrin glue during surgical resection. All patients will be followed for up to 5 years for safety and survival data. Adverse events will be recorded using the CTCAE V5.0.

EXPECTED OUTCOMES:
This study will explore the maximum tolerated dose of AMSCs along with the toxicity profile of this therapy in patients with recurrent GBM. In addition, preliminary long-term survival and progression-free survival outcome analysis will be used to power further randomized studies. Finally, cerebrospinal fluid and blood will be obtained throughout the treatment period to investigate circulating molecular and inflammatory tumoral/stem cell markers and explore the mechanism of action of the therapeutic intervention.

DISCUSSION:
This prospective translational study will determine the initial safety and toxicity profile of local delivery of AMSCs for recurrent GBM. It will also provide additional survival metrics for future randomized trials.
Removal of Spinal Calcified Meningiomas With Piezosurgery: Technical Note on a New Application of a Known Device
Authors: Rispoli Rossella , Pizzolitto Stefano , Cappelletto Barbara 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Ossified spinal meningiomas are a rare form of spinal tumor. The removal in narrow surgical space is challenging because of their hard consistency and strong adhesion to the neural tissue. These meningiomas are often located in the upper thoracic spine, and sometimes, even the identification of the correct intraoperative level is difficult.

CLINICAL PRESENTATION:
We describe the clinical findings, surgical strategies, and histological findings of a patient with a thoracic ossified meningioma.

DISCUSSION:
We discuss the technical points, safety, and efficacy of the piezosurgery device in reducing the calcified mass.

CONCLUSION:
The device has the potential to reduce the operating time and enhance surgical safety when removing ossified meningiomas.
A Case of Sellar Arachnoid Cyst Operated Using the Endoscopic Supraorbital Keyhole Approach
Authors: Yamashiro Kei , Higashiguchi Saeko , Wakako Akira , Omi Tatsuo , Hayakawa Motoharu , Hirose Yuichi 
Published: November 2024

BACKGROUND AND IMPORTANCE:
In recent years, sellar arachnoid cysts (ACs) have been increasingly treated using an endoscopic transnasal approach. It is important to connect the subarachnoid space with the AC to prevent recurrence; however, a high frequency of postoperative cerebrospinal fluid (CSF) leakage has been reported with the endoscopic transnasal approach, and the suitability of the endoscopic transnasal approach for treating sellar ACs is questionable to begin with.

CLINICAL PRESENTATION:
A man in his 40s underwent surgery for a sellar AC compressing the optic chiasm. The normal pituitary gland was compressed dorsally by the cyst, and an endoscopic supraorbital keyhole approach was adopted to reduce the risk of postoperative CSF leakage. A small incision was made in the right eyebrow, and a small craniotomy was performed. A rigid scope was used to approach the cyst and incise the arachnoid membrane of the prechiasmatic cistern and the anterior wall of the cyst. Postoperatively, the cyst shrank, and the preoperative visual field defects improved. The duration of the endoscopic manipulation was approximately 40 minutes.

DISCUSSION:
The endoscopic supraorbital keyhole approach eliminates the need to incise the dura mater of the anterior skull base and reduces the risk of CSF leakage compared with the transnasal approach. In addition, cumbersome dural reconstruction using fat and fascia is not required during the supraorbital keyhole approach, which reduces operation time.

CONCLUSION:
The endoscopic supraorbital keyhole approach may be more suitable than the transnasal approach for surgery of sellar ACs.
The Role of Intraoperative MRI in Resection of High-Grade Glioma Using 5-ALA: A Single-Center Case Series
Authors: Zakaria Rasheed , Suki Dima , Weinberg Jeffrey S. , Prabhu Sujit S. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Outcomes in high-grade glioma (HGG) remain poor despite maximal safe tumor resection. Although intraoperative MRI (iMRI) or 5-aminolevulinic acid (5-ALA) individually has demonstrated clinical benefit, their combined use has not been evaluated extensively. We sought to evaluate the benefit of combined use of iMRI and 5-ALA in patients with HGG who underwent craniotomy and tumor resection.

METHODS:
We identified 54 patients who underwent 5-ALA–guided resection of intracranial HGG. iMRI was used in 33 cases. Intraoperative ultrasound and frameless neuronavigation with tractography were used for all cases. Using standard MRI sequences, the extent of resection (EOR) of T1-weighted contrast-enhancing (T1WCE) tumor and fluid-attenuated inversion-recovery (FLAIR) signal tumor were calculated.

RESULTS:
There were no significant differences in EOR of T1WCE tumor, volume of residual T1WCE tumor, and volume of residual FLAIR signal abnormality between the 5-ALA and iMRI + 5-ALA groups. Although the number of patients with complete resection did not differ significantly, more patients in the iMRI + 5-ALA group achieved resection of >53.21% of the FLAIR signal abnormality (20/31 vs 5/21, Pearson χ2, P = .004), which is known to be a predictor of improved prognosis. No significant differences in overall survival or progression-free survival between the groups and no association between EOR and clinical outcomes were observed, which may be due to the size of this study. There was no difference in new neurological deficit between the groups at 30 days after surgery.

CONCLUSION:
Surgery with 5-ALA alone is as effective as surgery with 5-ALA and iMRI at achieving maximal safe resection, when combined with adjuncts. Our findings suggest that the role and interaction of these technologies needs to be further studied in larger, prospective studies to understand whether their utility is complementary or additive, particularly their influence on EOR of FLAIR signal abnormality and subsequent clinical outcomes.
Improving Quality Metrics in Neurosurgery: A Spinal Surgery 3-Year Case Review
Authors: Feller Christina Nicoll , Bodenbach Erin M. , Kolinski Julie M. , Sinson Grant P. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Despite the known importance of accurate clinical documentation as a companion to quality patient care, this is not often prioritized in practice and leads to a variety of downstream consequences. Inaccurate documentation leads to missed opportunities in full, accurate coding. In turn, it also negatively influences hospital and physician quality ranking, medical center profiling, and revenue captured. The aim of this study is to highlight the opportunity for continuous improvement in clinical documentation and the significance accurate clinical documentation has on outcome measures, such as expected length of stay (eLOS).

METHODS:
A single-center retrospective chart review took place for patients undergoing spinal surgery from 2019 to 2021. Based on Vizient's diagnosis-related group risk model for eLOS, 192 charts spanning 10 unique diagnosis-related groups were reviewed to identify ICD-10 diagnosis and procedure codes that were not coded or not clearly documented by a physician. A new eLOS for each patient was recalculated with the addition of the newly identified variables and then compared with the original eLOS.

RESULTS:
Overall, there was a significant difference between the original eLOS and new eLOS when the newly identified variables were added (P < .001). Of 192 patient charts, 89.5% had at least one new variable contributing to eLOS, with an average of 2.60 (0, 12) new variables. This resulted in an average increase in eLOS of 2.869 days (−0.160, 35.129). Compared with the observed LOS, the new eLOS was significantly different (P < .001), whereas the original LOS was not (P = .5661).

CONCLUSION:
Incomplete documentation and coding can misrepresent the quality of patient care provided and the complexity of their cases. This represents an opportunity for improvement for both the clinicians, clinical documentation improvement specialists, and coders to improve quality metrics and hospital rankings.
Internal Carotid Artery Injury in Endoscopic Endonasal Surgery: The Value of Intraoperative Magnetic Resonance Imaging
Authors: Ajlan Abdulrazag , Babateen Emad M. , Alqurashi Ashwag 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Internal carotid artery (ICA) injury is a devastating complication of endoscopic endonasal surgery. We report a case of completely resected clival chordoma using endoscopic endonasal surgery despite intraoperative ICA injury. Intraoperative MRI (iMRI) was used to localize the bleeding site, confirm resection degree and ICA patency distal to the injury site, and rule out intraoperative ischemia.

CLINICAL PRESENTATION:
A 16-year-old girl presented with right-sided facial paresthesia and was diagnosed with a large, invasive skull base lytic lesion centered in the clivus. The patient's neurological examination was normal, except for decreased sensation on the right side of the face. During tumor resection, massive bleeding occurred from the ICA paraclival segment, which was by applying direct pressure using hemostatic agents. Partial tumor resection, no clear signs of ischemic injury, and a patent flow distal to the ICA injury site were observed using iMRI. These findings helped in the decision to proceed with surgery and complete gross total resection. Postoperative angiography immediately performed after surgery revealed a pseudoaneurysm that was successfully embolized with coils. After discharge with no new neurological deficits, the postoperative imaging showed complete resection and no evidence of ischemic stroke in the injured ICA distribution.

CONCLUSION:
Although not commonly used to detect skull base lesions, iMRI was valuable in our chordoma case and enabled the surgical team to proceed with a complete surgical resection. It provided real-time evaluation of the injury and possible complications. Thus, iMRI should be considered for high-risk skull base ICA injuries.
Application of Delta T1 Maps for Quantitative and Objective Assessment of Extent of Resection and Survival Prediction in Glioblastoma
Authors: Laing Brandon R. , Prah Melissa A. , Best Benjamin J. , Krucoff Max O. , Mueller Wade M. , Schmainda Kathleen M. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Gross-total resection and low residual tumor volume (RTV) have been associated with increased survival in glioblastoma. Largely because of the subjectivity involved, the determination of gross-total resection and RTV remains difficult in the postoperative setting. In response, the objective of this study is to evaluate the clinical efficacy of an easy-to-use MRI metric, called delta T1 (dT1), to quantify the extent of resection (EOR) and RTV, in comparison with radiologist impression, to predict overall survival (OS) in patients with glioblastoma.

METHODS:
Fifty-nine patients who underwent resection of glioblastoma were retrospectively identified. dT1 images, automatically created from the difference between calibrated post- and precontrast T1-weighted images, were used to quantify EOR and RTV. Kaplan–Meier survival estimates were determined for EOR categories, an RTV cutoff of 5 cm3 and radiologist interpretation of EOR. Multivariate Cox proportional hazard regression analysis was used to evaluate RTV and EOR along with effects related to sex, Karnofsky Performance Scale, O[6]-methylaguanine-DNA methyltransferase (MGMT), and age on OS.

RESULTS:
Kaplan–Meier analysis revealed a statistically significant difference in median OS for a dT1-determined RTV cutoff of 5 cm3 (P = .0024, hazard ratio = 2.18 [1.232-3.856]), but not for radiological impression (P = .666) or dT1-determined EOR (P = .0803), which was limited to a comparison between partial and subtotal resections. Furthermore, when covariates were accounted for in multivariate Cox regression, significant differences in OS were retained for dT1-determined RTV. In addition, a significantly strong yet short-term effect of MGMT methylation status on OS was revealed for each RTV and EOR model.

CONCLUSION:
The utility of dT1 maps to quantify EOR and RTV in glioblastoma and predict survival suggests an emerging role for dT1s with relevance for intraoperative MRI, neuronavigation, and postoperative disease surveillance.
Machine Learning–Driven Prognostication in Traumatic Subdural Hematoma: Development of a Predictive Web Application
Authors: Karabacak Mert , Margetis Konstantinos 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Our focus was on creating an array of machine learning (ML) models to predict unfavorable in-hospital outcomes after acute traumatic subdural hematoma (atSDH). Our subsequent aim was to deploy these models in an accessible web application, showcasing their practical value.

METHODS:
Data from the American College of Surgeons Trauma Quality Program database were used to identify patients with atSDH. In-hospital mortality was the primary outcome of interest. Secondary outcomes were (1) nonhome discharges, (2) prolonged length of stay (LOS), (3) prolonged length of stay in the intensive care unit (ICU-LOS), and (4) major complications. Feature selection was performed with least absolute shrinkage and selection operator algorithm. Five ML algorithms, including TabPFN, TabNET, XGBoost, LightGBM, and Random Forest, were used along with the Optuna optimization library for hyperparameter tuning.

RESULTS:
There were 104 055 patients included in the analysis for the outcome mortality, 82 988 for the outcome nonhome discharges, 104 207 for the outcome prolonged LOS, 62 543 for the outcome prolonged ICU-LOS, and 100 241 for the outcome major complications. The models with the highest area under receiver operating characteristic curve (AUROC) values included TabPFN for mortality and major complications, and LightGBM for nonhome discharges, prolonged LOS, and ICU-LOS. The TabPFN model for the primary outcome of our study, in-hospital mortality, showed an AUROC of 0.934. The models with the highest AUROC values were integrated into an application to predict the outcomes of interest.

CONCLUSION:
Our findings show that ML tools aid in predicting various outcomes for patients with atSDH. We developed a web application that has the potential to integrate the developed models into clinical practice.
Clinical Characteristics and Outcome of Patients With Intraoperative Aneurysm Rupture: A Retrospective Cohort Study From Nepal
Authors: Sharma Mohan R. , Bohara Sandeep , Shrestha Dipendra K. , Joshi Deepak R. , Singh Shreejana , Lamsal Ritesh , Acharya Subhash P. , Kafle Prakash , Pradhanang Amit B. , Sedain Gopal , Farrokhi Farrokh , Grant Gerald A. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Intraoperative aneurysm rupture (IAR) is a significant complication during microsurgical clipping of cerebral aneurysms. The timing of rupture during surgery, morphology of the aneurysm, and strategies to mitigate risk are the key factors that influence the outcome.

METHODS:
Consecutive patients with the diagnosis of ruptured cerebral aneurysms were retrospectively reviewed at a single University Hospital in Kathmandu, Nepal. Variables analyzed included age, sex, presenting symptoms, Hunt and Hess grades, the location of aneurysms, the timing of surgery, and intraoperative rupture status. Outcomes were assessed at 6 months after surgery.

RESULTS:
A total of 199 patients with 231 ruptured cerebral aneurysms from July 2014 to December 2022 were reviewed. Surgery was performed within 3 days in 60 (30.1%) patients. Twenty aneurysms ruptured intraoperatively in 20 patients (10% per patient and 8.6% per aneurysm). Patients with IAR were significantly younger (mean age 52 years) than those without IAR (mean age 58 years) (P < .001, 95% CI: 3.72-8.28). There was no difference in IAR rate in early vs late surgery. Anterior communicating artery complex aneurysms were noted as the most common. However, posterior inferior cerebellar and posterior cerebral artery aneurysms had the highest IAR rate, albeit with the smallest total number. Rupture during dissection was noted in 10 (50%) and during clipping in 9 (45%) procedures. Strategies for handling IAR included direct definitive clip application in 9, temporary clip-aided permanent clipping in 8, and trapping of the parent vessel in 1 patient. Although postoperative complications were significantly higher in the IAR group (P < .000129), the neurological outcomes using the modified Rankin scale in 6 months were similar (P = .877).

CONCLUSION:
The demographic and clinical characteristics and rates of IAR in our patient population are similar to those in the contemporary literature. In patients with IAR, the outcome is not worse than those without IAR.
Reversal of Middle Cerebral Artery Stenosis by Minimally Invasive Intracerebral Hematoma Evacuation
Authors: Senol Yigit Can , Asghariahmadabad Mona , Haddad Alexander , Smith Wade S. , Savastano Luis E. 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Acute intracerebral hematomas are known to induce significant mass effects within the brain, leading to critical complications such as cerebral midline shift, herniation, and increased intracranial pressure. The timing and efficacy of intracerebral hematoma evacuation remain subjects of ongoing debate in current literature.

CLINICAL PRESENTATION:
In our case report, we present a 74-year-old female patient diagnosed with basal ganglia hematoma. The resultant mass effect from the intracerebral hematoma led to middle cerebral artery (MCA) stenosis. Notably, early-stage minimally invasive hematoma evacuation was pivotal in facilitating successful revascularization of the MCA.

CONCLUSION:
Our case underscores the significance of prompt identification and management of MCA stenosis arising from intracerebral hematoma. Early intervention through minimally invasive hematoma evacuation proved instrumental in achieving successful MCA revascularization. These findings emphasize the critical role of timely interventions in mitigating potential complications associated with intracerebral hematoma.