bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of stereotactic radiosurgery for cerebral dural arteriovenous fistulas in a multicenter international consortium
Authors: Starke Robert M. , McCarthy David J. , Chen Ching-Jen , Kano Hideyuki , McShane Brendan , Lee John , Mathieu David , Vasas Lucas T. , Kaufmann Anthony M. , Wang Wei Gang , Grills Inga S. , Patibandla Mohana Rao , Cifarelli Christopher P. , Paisan Gabriella , Vargo John A. , Chytka Tomas , Janouskova Ladislava , Feliciano Caleb E. , Rodriguez-Mercado Rafael , Tonetti Daniel A. , Lunsford L. Dade , Sheehan Jason P. 
Published: February 2019

OBJECTIVEIn this multicenter study, the authors reviewed the results obtained in patients who underwent Gamma Knife radiosurgery (GKRS) for dural arteriovenous fistulas (dAVFs) and determined predictors of outcome.METHODSData from a cohort of 114 patients who underwent GKRS for cerebral dAVFs were compiled from the International Gamma Knife Research Foundation. Favorable outcome was defined as dAVF obliteration and no posttreatment hemorrhage or permanent symptomatic radiation-induced complications. Patient and dAVF characteristics were assessed to determine predictors of outcome in a multivariate logistic regression analysis; dAVF-free obliteration was calculated in a competing-risk survival analysis; and Youden indices were used to determine optimal radiosurgical dose.RESULTSA mean margin dose of 21.8 Gy was delivered. The mean follow-up duration was 4 years (range 0.5–18 years). The overall obliteration rate was 68.4%. The postradiosurgery actuarial rates of obliteration at 3, 5, 7, and 10 years were 41.3%, 61.1%, 70.1%, and 82.0%, respectively. Post-GRKS hemorrhage occurred in 4 patients (annual risk of 0.9%). Radiation-induced imaging changes occurred in 10.4% of patients; 5.2% were symptomatic, and 3.5% had permanent deficits. Favorable outcome was achieved in 63.2% of patients. Patients with middle fossa and tentorial dAVFs (OR 2.4, p = 0.048) and those receiving a margin dose greater than 23 Gy (OR 2.6, p = 0.030) were less likely to achieve a favorable outcome. Commonly used grading scales (e.g., Borden and Cognard) were not predictive of outcome. Female sex (OR 1.7, p = 0.03), absent venous ectasia (OR 3.4, p < 0.001), and cavernous carotid location (OR 2.1, p = 0.019) were predictors of GKRS-induced dAVF obliteration.CONCLUSIONSGKRS for cerebral dAVFs achieved obliteration and avoided permanent complications in the majority of patients. Those with cavernous carotid location and no venous ectasia were more likely to have fistula obliteration following radiosurgery. Commonly used grading scales were not reliable predictors of outcome following radiosurgery.
High expression of survivin independently correlates with tumor progression and mortality in patients with skull base chordomas
Authors: Ma Junpeng , Tian Kaibing , Du Jiang , Wu Zhen , Wang Liang , Zhang Junting 
Published: February 2019

OBJECTIVEThe object of this study was to clarify the expression characteristics and prognostic value of survivin in skull base chordomas.METHODSIn this retrospective study, the authors measured the expression of survivin at the mRNA level in 81 samples from 71 patients diagnosed with skull base chordomas at their hospital in the period from July 2005 to January 2015. Clinical data collection, follow-up, and survival analyses were performed, and correlations were analyzed.RESULTSOf the 71 patients, 50 had primary chordomas with a mean survivin expression level of 1.09; the other 21 patients had recurrent chordomas with a mean survivin expression level of 2.57, which was 2.36 times higher than the level in the primary chordoma patients (p < 0.001, Mann-Whitney U-test). In addition, an analysis of 18 paired samples derived from 9 patients showed that the expression level of survivin was 2.62 times higher in recurrent tumors than in primary tumors (p = 0.002, paired t-test). The Spearman rank correlation coefficient method showed that the expression level of survivin was positively correlated with the mean ratio of tumor signal intensity to the signal intensity of surrounding brainstem on T1-weighted sequences (RT1; rs = 0.274, p = 0.021) and was negatively correlated with the mean ratio of tumor signal intensity to the signal intensity of surrounding brainstem on T2-weighted sequences (RT2; rs = −0.389, p = 0.001). A multivariate Cox proportional-hazards model suggested that pathology (p = 0.041), survivin expression level (p = 0.018), preoperative Karnofsky Performance Status (KPS; p = 0.012), and treatment history (p = 0.009) were independent prognostic factors for tumor progression. Survivin expression level (p = 0.008), preoperative KPS (p = 0.019), tumor diameter (p = 0.027), and intraoperative blood loss (p = 0.015) were independent prognostic factors for death.CONCLUSIONSSurvivin expression level and preoperative KPS were independent significant prognostic factors for tumor progression and death in skull base chordoma patients. Recurrent skull base chordomas and chordomas with high RT1 and low RT2 were likely to have high survivin expression. Other independent risk factors related to tumor progression included conventional pathology and treatment history, whereas additional mortality-related risk factors included larger tumor diameter and greater intraoperative blood loss.
Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry
Authors: Sheehan Jason P. , Grills Inga , Chiang Veronica L. , Dong Huamei , Berg Arthur , Warnick Ronald E. , Kondziolka Douglas , Kavanagh Brian 
Published: February 2019

OBJECTIVEStereotactic radiosurgery (SRS) is increasingly used for the treatment of brain metastasis. To date, most studies have focused on survival, radiological response, or surrogate quality endpoints such as Karnofsky Performance Scale status or neurocognitive indices. The current study prospectively evaluated pre-procedural factors impacting quality of life in brain metastasis patients undergoing SRS.METHODSUsing a national, cloud-based platform, patients undergoing SRS for brain metastasis were accrued to the registry. Quality of life prior to SRS was assessed using the 5-level EQ-5D (EQ5D-L) validated tool; additionally, patient and treatment attributes were collected. Patient quality of life was assessed as part of routine follow-up after SRS. Factors predicting a difference in the aggregate EQ5D-L score or the subscores were evaluated. Pre-SRS covariates impacting changes in EQ5D-L were statistically evaluated. Statistical analyses were conducted using multivariate linear regression models.RESULTSEQ5D-L results were available for 116 patients. EQ5D-L improvement (average of 0.387) was noted in patients treated with earlier SRS (p = 0.000175). Worsening overall EQ5D-L (average of 0.052 per lesion) was associated with an increased number of brain metastases at the time of initial presentation (p = 0.0399). Male sex predicted a risk of worsening (average of 0.347) of the pain and discomfort subscore at last follow-up (p = 0.004205). Baseline subscores of pain/discomfort were not correlated with pain/discomfort subscores at follow-up (p = 0.604), whereas baseline subscores of anxiety/depression were strongly positively correlated with the anxiety/depression follow-up subscores (p = 0.0039).CONCLUSIONSAfter SRS, quality of life was likely to improve in patients treated early with SRS and worsen in those with a greater number of brain metastases. Sex differences appear to exist regarding pain and discomfort worsening after SRS. Those with high levels of anxiety and depression at SRS may benefit from medical treatment as this particular quality of life factor generally remains unchanged after SRS.
International practice variation in postoperative imaging of chronic subdural hematoma patients
Authors: Hulsbergen Alexander F. C. , Yan Sandra C. , Stopa Brittany M. , DiRisio Aislyn , Senders Joeky T. , van Essen Max J. , van der Burgt Stéphanie M. E. , Smith Timothy R. , Gormley William B. , Broekman Marike L. D. 
Published: February 2019

OBJECTIVEThe value of CT scanning after burr hole surgery in chronic subdural hematoma (CSDH) patients is unclear, and practice differs between countries. At the Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, neurosurgeons frequently order routine postoperative CT scans, while the University Medical Center Utrecht (UMCU) in the Netherlands does not have this policy. The aim of this study was to compare the use of postoperative CT scans in CSDH patients between these hospitals and to evaluate whether there are differences in clinical outcomes.METHODSThe authors collected data from both centers for 391 age- and sex-matched CSDH patients treated with burr hole surgery between January 1, 2002, and July 1, 2016, and compared the number of postoperative scans up to 6 weeks after surgery, the need for re-intervention, and postoperative neurological condition.RESULTSBWH patients were postoperatively scanned a median of 4 times (interquartile range [IQR] 2–5), whereas UMCU patients underwent a median of 0 scans (IQR 0–1, p < 0.001). There was no significant difference in the number of re-operations (20 in the BWH vs 27 in the UMCU, p = 0.34). All re-interventions were preceded by clinical decline and no recurrences were detected on scans performed on asymptomatic patients. Patients’ neurological condition was not worse in the UMCU than in the BWH (p = 0.43).CONCLUSIONSWhile BWH patients underwent more scans than UMCU patients, there were no differences in clinical outcomes. The results of this study suggest that there is little benefit to routine scanning in asymptomatic patients who have undergone surgical treatment of uncomplicated CSDH and highlight opportunities to make practice more efficient.
Overall survival and response to radiation and targeted therapies among patients with renal cell carcinoma brain metastases
Authors: Juloori Aditya , Miller Jacob A. , Parsai Shireen , Kotecha Rupesh , Ahluwalia Manmeet S. , Mohammadi Alireza M. , Murphy Erin S. , Suh John H. , Barnett Gene H. , Yu Jennifer S. , Vogelbaum Michael A. , Rini Brian , Garcia Jorge , Stevens Glen H. , Angelov Lilyana , Chao Samuel T. 
Published: February 2019

OBJECTIVEThe object of this retrospective study was to investigate the impact of targeted therapies on overall survival (OS), distant intracranial failure, local failure, and radiation necrosis among patients treated with radiation therapy for renal cell carcinoma (RCC) metastases to the brain.METHODSAll patients diagnosed with RCC brain metastasis (BM) between 1998 and 2015 at a single institution were included in this study. The primary outcome was OS, and secondary outcomes included local failure, distant intracranial failure, and radiation necrosis. The timing of targeted therapies was recorded. Multivariate Cox proportional-hazards regression was used to model OS, while multivariate competing-risks regression was used to model local failure, distant intracranial failure, and radiation necrosis, with death as a competing risk.RESULTSThree hundred seventy-six patients presented with 912 RCC BMs. Median OS was 9.7 months. Consistent with the previously validated diagnosis-specific graded prognostic assessment (DS-GPA) for RCC BM, Karnofsky Performance Status (KPS) and number of BMs were the only factors prognostic for OS. One hundred forty-seven patients (39%) received vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs). Median OS was significantly greater among patients receiving TKIs (16.8 vs 7.3 months, p < 0.001). Following multivariate analysis, KPS, number of metastases, and TKI use remained significantly associated with OS.The crude incidence of local failure was 14.9%, with a 12-month cumulative incidence of 13.4%. TKIs did not significantly decrease the 12-month cumulative incidence of local failure (11.4% vs 14.5%, p = 0.11). Following multivariate analysis, age, number of BMs, and lesion size remained associated with local failure. The 12-month cumulative incidence of radiation necrosis was 8.0%. Use of TKIs within 30 days of SRS was associated with a significantly increased 12-month cumulative incidence of radiation necrosis (10.9% vs 6.4%, p = 0.04).CONCLUSIONSUse of targeted therapies in patients with RCC BM treated with intracranial SRS was associated with improved OS. However, the use of TKIs within 30 days of SRS increases the rate of radiation necrosis without improving local control or reducing distant intracranial failure. Prospective studies are warranted to determine the optimal timing to reduce the rate of necrosis without detracting from survival.
Iron concentration linked to structural connectivity in the subthalamic nucleus: implications for deep brain stimulation
Authors: Dimov Alexey , Patel Wahaj , Yao Yihao , Wang Yi , O’Halloran Rafael , Kopell Brian H. 
Published: February 2019

OBJECTIVEThe objective of this study was to investigate the relationship between iron and white matter connectivity in the subthalamic nucleus (STN) in patients undergoing deep brain stimulation (DBS) of the STN for treatment of Parkinson’s disease.METHODSNine Parkinson’s disease patients underwent preoperative 3T MRI imaging which included acquisition of T1-weighted anatomical images along with diffusion tensor imaging (DTI) and quantitative susceptibility mapping (QSM). MR tractography was performed for the seed voxels located within the STN, and the correlations between normalized QSM values and the STN’s connectivity to a set of a priori chosen regions of interest were assessed.RESULTSA strong negative correlation was found between STN connectivity and QSM intensity for the thalamus, premotor, motor, and sensory regions, while a strong positive correlation was found for frontal, putamen, and brain stem areas.CONCLUSIONSQuantitative susceptibility mapping not only accurately delineates the STN borders but is also able to provide functional information about the STN functional subdivisions. The observed iron-to-connectivity correlation patterns may aid in planning DBS surgery to avoid unwanted side effects associated with DBS.
Health-related quality of life following adolescent sports-related concussion or fracture: a prospective cohort study
Authors: Russell Kelly , Selci Erin , Black Brian , Ellis Michael J. 
Published: February 2019

OBJECTIVEThe longitudinal effects of sports-related concussion (SRC) in adolescents on health-related quality of life (HRQOL) remain poorly understood. Hence, the authors established two objectives of this study: 1) compare HRQOL outcomes among adolescents with an acute SRC or a sports-related extremity fracture (SREF) who were followed up until physician-documented clinical recovery; and 2) identify the clinical variables associated with worse HRQOL among adolescent SRC patients.METHODSThe authors conducted a prospective cohort study of adolescents with acute SRC and those with acute SREF who underwent clinical assessment and follow-up at tertiary subspecialty clinics. Longitudinal patient-reported HRQOL was measured at the time of initial assessment and at each follow-up appointment by using the adolescent version (age 13–18 years) of the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale and Cognitive Functioning Scale.RESULTSA total of 135 patients with SRC (60.0% male; mean age 14.7 years; time from injury to initial assessment 6 days) and 96 patients with SREF (59.4% male; mean age 14.1 years; time from injury to initial assessment 8 days) participated in the study. At the initial assessment, the SRC patients demonstrated significantly worse cognitive HRQOL and clinically meaningful impairments in school and overall HRQOL compared to the SREF patients. Clinical variables associated with a worse HRQOL among SRC patients differed by domain but were significantly affected by the patients’ initial symptom burden and the development of delayed physician-documented clinical recovery (> 28 days postinjury). No persistent impairments in HRQOL were observed among SRC patients who were followed up until physician-documented clinical recovery.CONCLUSIONSAdolescent SRC is associated with temporary impairments in HRQOL that have been shown to resolve in patients who are followed up until physician-documented clinical recovery. Future studies are needed to identify the clinicopathological features that are associated with impaired HRQOL and to assess whether the initiation of multidisciplinary, targeted rehabilitation strategies would lead to an improvement in HRQOL.
Limitations of patient experience reports to evaluate physician quality in spine surgery: analysis of 7485 surveys
Authors: Agarwal Nitin , Faramand Andrew , Bellon Johanna , Borrebach Jeffrey , Hamilton D. Kojo , Okonkwo David O. , Kanter Adam S. 
Published: February 2019

OBJECTIVEThe Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) is a standardized patient experience survey that is used to evaluate the quality of care delivered by physicians. The authors sought to determine which factors influenced CG-CAHPS scores for spine surgery, and compare them to their cranial-focused cohorts.METHODSA retrospective study of prospectively obtained data was performed to evaluate CG-CAHPS scores. Between May 2013 and May 2017, all patients 18 years of age or older with an outpatient encounter with a neurosurgeon (5 spine-focused neurosurgeons and 20 cranial-focused neurosurgeons) received a CG-CAHPS survey. Three domains were assessed: overall physician rating, likelihood to recommend, and physician communication. Statistical analyses were performed using chi-square tests.RESULTSSeven thousand four hundred eighty-five patient surveys (2319 spine and 5166 cranial) were collected from patients presenting to the outpatient offices of an attending neurosurgeon. Analysis of the overall physician rating showed that 81.1% of spine neurosurgeons received a “top-box” score (answers of “yes, definitely”), whereas 86.2% of cranial neurosurgeons received a top-box response (p < 0.001). A similar difference was observed with the domains of “likelihood to recommend” and “physician communication.” Overall physician rating was also significantly influenced by the general and mental health of the patients surveyed (p < 0.001). For spine surgeons seeing patients at more than one facility, the scores with respect to location were also significantly different in all domains for each individual provider (p < 0.001).CONCLUSIONSOverall, spine-focused neurosurgeon ratings differed significantly from those of cranial-focused neurosurgical subspecialty providers. Office location also affected provider ratings for spine neurosurgeons. These results suggest that physician ratings obtained via patient experience surveys may be representative of factors aside from just the quality of physician care provided. This information should be considered as payers, government, and health systems design performance programs based on patient experience scores.
A comprehensive biomechanical analysis of sacral alar iliac fixation: an in vitro human cadaveric model
Authors: Cunningham Bryan W. , Sponseller Paul D. , Murgatroyd Ashley A. , Kikkawa Jun , Tortolani P. Justin 
Published: February 2019

OBJECTIVEThe objective of the current study was to quantify and compare the multidirectional flexibility properties of sacral alar iliac fixation with conventional methods of sacral and sacroiliac fixation by using nondestructive and destructive investigative methods.METHODSTwenty-one cadaveric lumbopelvic spines were randomized into 3 groups based on reconstruction conditions: 1) S1–2 sacral screws; 2) sacral alar iliac screws; and 3) S1–iliac screws tested under unilateral and bilateral fixation. Nondestructive multidirectional flexibility testing was performed using a 6-degree-of-freedom spine simulator with moments of ± 12.5 Nm. Flexion-extension fatigue loading was then performed for 10,000 cycles, and the multidirectional flexibility analysis was repeated. Final destructive testing included an anterior flexural load to construct failure. Quantification of the lumbosacral and sacroiliac joint range of motion was normalized to the intact spine (100%), and flexural failure loads were reported in Newton-meters.RESULTSNormalized value comparisons between the intact spine and the 3 reconstruction groups demonstrated significant reductions in segmental flexion-extension, lateral bending, and axial rotation motion at L4–5 and L5–S1 (p < 0.05). The S1–2 sacral reconstruction group demonstrated significantly greater flexion-extension motion at the sacroiliac junction than the intact and comparative reconstruction groups (p < 0.05), whereas the sacral alar iliac group demonstrated significantly less motion at the sacroiliac joint in axial rotation (p < 0.05). Absolute value comparisons demonstrated similar findings. Under destructive anterior flexural loading, the S1–2 sacral group failed at 105 ± 23 Nm, and the sacral alar iliac and S1–iliac groups failed at 119 ± 39 Nm and 120 ± 28 Nm, respectively (p > 0.05).CONCLUSIONSAlong with difficult anatomy and weak bone, the large lumbosacral loads with cantilever pullout forces in this region are primary reasons for construct failure. All reconstructions significantly reduced flexibility at the L5–S1 junctions, as expected. Conventional S1–2 sacral fixation significantly increased sacroiliac motion under all loading modalities and demonstrated significantly higher flexion-extension motion than all other groups, and sacral alar iliac fixation reduced motion in axial rotation at the sacroiliac joint. Based on comprehensive multidirectional flexibility testing, the sacral alar iliac fixation technique reduced segmental motion under some loading modalities compared to S1–iliac screws and offers potential advantages of lower instrumentation profile and ease of assembly compared to conventional sacroiliac instrumentation techniques.
Two-year mortality and functional outcomes in combat-related penetrating brain injury: battlefield through rehabilitation
Authors: Larkin M. Benjamin , Graves Erin K. M. , Boulter Jason H. , Szuflita Nicholas S. , Meyer R. Michael , Porambo Michael E. , Delaney John J. , Bell Randy S. 
Published: February 2019

OBJECTIVEThere are limited data concerning the long-term functional outcomes of patients with penetrating brain injury. Reports from civilian cohorts are small because of the high reported mortality rates (as high as 90%). Data from military populations suggest a better prognosis for penetrating brain injury, but previous reports are hampered by analyses that exclude the point of injury. The purpose of this study was to provide a description of the long-term functional outcomes of those who sustain a combat-related penetrating brain injury (from the initial point of injury to 24 months afterward).METHODSThis study is a retrospective review of cases of penetrating brain injury in patients who presented to the Role 3 Multinational Medical Unit at Kandahar Airfield, Afghanistan, from January 2010 to March 2013. The primary outcome of interest was Glasgow Outcome Scale (GOS) score at 6, 12, and 24 months from date of injury.RESULTSA total of 908 cases required neurosurgical consultation during the study period, and 80 of these cases involved US service members with penetrating brain injury. The mean admission Glasgow Coma Scale (GCS) score was 8.5 (SD 5.56), and the mean admission Injury Severity Score (ISS) was 26.6 (SD 10.2). The GOS score for the cohort trended toward improvement at each time point (3.6 at 6 months, 3.96 at 24 months, p > 0.05). In subgroup analysis, admission GCS score ≤ 5, gunshot wound as the injury mechanism, admission ISS ≥ 26, and brain herniation on admission CT head were all associated with worse GOS scores at all time points. Excluding those who died, functional improvement occurred regardless of admission GCS score (p < 0.05). The overall mortality rate for the cohort was 21%.CONCLUSIONSGood functional outcomes were achieved in this population of severe penetrating brain injury in those who survived their initial resuscitation. The mortality rate was lower than observed in civilian cohorts.