bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries
Authors: Monteiro Fernando Sabino Marques , Sasse Andre Deeke , Araujo Denizar Vianna , McKay Rana R. , da Trindade Karine Martins , Soares Andrey , Alves João Ricardo , Valverde Douglas Andreas , Bastos Diogo Assed , James Nicholas D. , Herchenhorn Daniel 
Published: November 2024

PURPOSE
The Brazilian Public Health System (BPHS) serves approximately 71,730 patients with prostate cancer (PC) every year for which androgen deprivation therapy (ADT) is the primary treatment for patients with advanced hormone-sensitive prostate cancer (aHSPC). Androgen receptor pathway inhibitors (ARPIs) are not accessible through the BPHS. Using the BPHS as a model, this study assesses the long-term economic effect of surgical versus medical castration in aHSPC treatment to strategize cost reduction and the incorporation of ARPI in developing countries.

PATIENTS AND METHODS
Data of patients with aHSPC (ie, TxN1M0 ineligible for local treatment or TxNxM1) from the BPHS database were analyzed from January 1, 2011, to December 31, 2021, using the TECHTRIALS artificial intelligence platform. The main outcomes were quantitative and descriptive analyses as well as a cost analysis of surgical versus chemical castration.

RESULTS
Of the 274,519 patients with aHSPC who received active treatment during the 11-year study period, 90% (n = 246,683) underwent chemical castration and 10% (n = 27,836) underwent bilateral subcapsular orchiectomy (BSO). The median duration of chemical castration was 28 months. The BPHS spent an estimated total of $665,552,091.40 US dollars (USD) on chemical castration and $5,939,348.47 USD on BSO, respectively. The cost per patient was $2,698 USD and $213.37 USD for chemical castration and BSO, respectively. Hypothetically, if all patients with aHSPC had undergone BSO, the total direct cost for the BPHS would have been $42,774,832.20 USD, saving $622,777,259.20 USD over 11 years, making it possible to offer low-dose abiraterone to 65% of aHSPC patients.

CONCLUSION
On the basis of this extensive financial analysis from the world's largest public health system database, BSO appears to be a valuable alternative to chemical castration for treating aHSPC. In resource-limited environments, the cost savings from using BSO may allow access to drugs that will improve survival such as ARPIs.
Efficacy and Safety of Biosimilar Cetuximab Versus Innovator Cetuximab in Indian Patients With Head and Neck Cancer: A Multicenter, Randomized, Double-Blind, Phase III Trial
Authors: Prabhash Kumar , Deshmukh Chetan , Malhotra Hemant , Sharma Atul , Jain Minish , Dhamne Nilesh , Nagarakar Rajnish , Ganesan Prasantha , Mahobia Vijay K. , Das Chandan K. , Kumar Rejnish , Shivanna Prakash S. , Avaronnan Manu P. , Chaithanya Puligundla K. , Chaudhary Vaibhav , Singh Kartar , Aagre Suhas , Ravishankar Bellala , Mehta Dhruv , Shilpa Kandipalli , Maniar Vashishth , Chatterjee Koushik , Majumdar Saroj D. , Dana Rohitashwa , Noronha Vanita , Menon Nandini , Sharma Akhilesh , Pawar Roshan , Shahavi Vinayaka , Yadav Rajiv , Aiwale Amol 
Published: November 2024

PURPOSE
Squamous cell carcinoma of the head and neck (SCCHN) is the sixth most common cancer, with approximately 225,419 new cases with over 125,000 deaths annually in India. This trial compared the efficacy and safety of biosimilar cetuximab versus innovator cetuximab (IC) in combination with platinum-based chemotherapy in patients with recurrent locoregional or metastatic SCCHN.

METHODS
This phase III trial is a multicenter, randomized, double-blind and parallel group study performed in Indian patients with recurrent locoregional or metastatic SCCHN. Patients were randomly assigned in 2:1 ratio to receive biosimilar cetuximab and IC in combination with cisplatin and fluorouracil via intravenous infusions. The primary end points were disease control rate (DCR) and overall response rate (ORR) as per response evaluation criteria in solid tumors version 1.1. The secondary end points included pharmacokinetics (PK), immunogenicity, safety, and tolerability.

RESULTS

Of 180 patients enrolled, 120 patients received biosimilar cetuximab and 60 patients received IC treatment. No significant statistical difference was observed in the primary outcomes between two groups. Treatment difference in DCR and ORR response was found to be –5.21 (90% CI, –8.94 to –1.48) and –4.79 (90% CI, –19.42 to 9.84), respectively, indicating noninferiority to reference product. The incidence of treatment-emergent adverse events (AEs; biosimilar cetuximab: 89.2%
v
IC: 91.7%;
P
= .8364) and serious AEs (biosimilar cetuximab: 23.3%
v
IC: 13.3%;
P
= .0603) and PK parameters were comparable between treatment groups. The immunogenicity findings showed higher incidence of anticetuximab antibodies in the biosimilar cetuximab group compared with the IC group at the end of Study.

CONCLUSION
The findings of this study demonstrated noninferiority along with comparable PK, safety, and immunogenicity of biosimilar cetuximab and IC in patients with recurrent or metastatic SCCHN.
Initial Patient Satisfaction With Telemedicine in Neurosurgery Outpatient Clinic During the Early COVID-19 Pandemic
Authors: Kozel Olivia A. , Baskaran Archit B. , Manjunath Anusha , Goel Chirag , Jones Michael R. , Gibson William , Jahromi Babak S. , Tate Matthew C. , Dahdaleh Nader S. , Rosenow Joshua M. 
Published: November 2024

BACKGROUND:
Throughout the COVID-19 pandemic, the medical community has been saturated by the necessity for telemedicine, or “telehealth”, appointments. With limited prior exposure, the many challenges that accompany telehealth visits have affected how physicians conduct daily tasks and how patients perceive healthcare experiences. In the early stages of the COVID-19 pandemic, telemedicine was new to most neurosurgical patients. This study seeks to evaluate the overall neurosurgical patient experience with telemedicine.

OBJECTIVE:
To assess overall neurosurgical patient satisfaction with telemedicine to build an understanding of the effectiveness of these encounters for future planning.

METHODS:
After a telemedicine appointment, patients received an electronic survey. Survey questions focused on demographic information, encounter type, medical history questions, and overall satisfaction with telemedicine. Responses for the survey questions were formulated using a 5-point Likert scale.

RESULTS:
Two hundred seventy patients were seen via telemedicine by 1 of 4 providers included in this study. 43 patients returned the surveys, with a completion rate of 16%. Patients indicated higher scores for overall satisfaction and quality of appointment. Of note, 23% of participants responded that they would be willing to pay out of pocket for a telemedicine appointment, while 77% responded they would not be willing to pay out of pocket.

CONCLUSION:
Our survey results show patients felt comfortable discussing healthcare issues using telehealth, that appropriate levels of care were received, and they would be willing to use telehealth again. Future efforts will be necessary to educate providers and patients about the utilization of technological devices, ensure patient access to telehealth, and standardize ethical guidelines.
Improving Surgical Outcomes in Middle Cranial Fossa Cerebrospinal Fluid Leak Repair
Authors: Ng Jia Hui , Bala Arul , Hendriks Thomas , Kuthubutheen Jafri 
Published: November 2024

BACKGROUND:
Spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone occur in the absence of known iatrogenic or traumatic injury and without underlying congenital malformation. Holistic treatment of the condition requires meticulous perioperative evaluation of the patient to mitigate underlying risk factors. Similarly, surgery for CSF leaks requires careful consideration of all potential routes of CSF leakage to improve short- and long-term surgical outcomes.

OBJECTIVE:
To describe our surgical technique in this article, which addresses most of the potential routes of spontaneous CSF otorrhea. Perioperative management of the patients is also described.

METHODS:
A total of 65 patients underwent CSF leak repair using a middle cranial fossa approach and the techniques described in this paper. Their surgical outcomes are described.

RESULTS:
Preoperatively, all patients had either biochemically proven beta trace protein–positive CSF otorrhea or the presence of an encephalocele on preoperative imaging. Using this technique, all patients had short-term successful repair of their CSF leak, whereas a long-term success rate of 87.7% was achieved. No major complications were encountered.

CONCLUSION:
Holistic treatment of spontaneous CSF leaks of the temporal bone, together with using a surgical approach that considers all potential routes of CSF leakage, may help to improve long- and short-term surgical outcomes.
Emergent Revascularization After Transposition of an Unexpected Intraosseous Anomalous Subarcuate Loop During Vestibular Schwannoma Surgery: A Case Report
Authors: Sakata Kiyohiko , Hashimoto Aya , Yoshitake Hidenobu , Kajiwara Sosho , Orito Kimihiko , Nakamura Hideo , Morioka Motohiro 
Published: November 2024

BACKGROUND AND IMPORTANCE:
The presence of an anomalous anteroinferior cerebellar artery (AICA) embedded within the subarcuate fossa increases the difficulty of cerebellopontine angle (CPA) tumor surgery. Iatrogenic injury of posterior fossa arteries can result in serious morbidity.

CLINICAL PRESENTATION:
A 70-year-old man presented with right-sided hearing loss and facial dysesthesia. Magnetic resonance imaging showed a tumor with solid and cystic components and 35-mm maximum diameter in the right CPA. The AICA traveled just dorsal to the tumor and was well-developed because the ipsilateral vertebral artery and posteroinferior cerebellar artery (PICA) were aplastic. During surgery, we unexpectedly encountered an anomalous loop of the AICA-PICA which was embedded in the subarcuate fossa. This loop was mobilized using an ultrasonic bone curette to enable further tumor resection. However, it occluded immediately after mobilization and required open thrombectomy and end-to-end anastomosis. After revascularization, near-complete tumor resection was achieved without causing facial nerve dysfunction or brainstem/cerebellar infarction. Pathological examination of the resected anomalous loop showed abnormal focal hypertrophy of the adventitia and the presence of external elastic lamina.

CONCLUSION:
Mobilization of an anomalous AICA-PICA loop embedded within the subarcuate fossa during VS resection can result in arterial occlusion which requires thrombectomy and revascularization. Surgeons should be aware of this vascular anomaly and be prepared to deal with its ramifications.
Severe Vertebrobasilar Vasospasm After Iatrogenic Rupture of a Posterior Fossa Epidermoid Cyst: A Case Report of a Rare Complication Managed With Endovascular Intervention
Authors: Housley Steven B. , Jacoby Wady T. , Farkash Zoe , Monteiro Andre , Lim Jaims , Davies Jason M. , Levy Elad I. 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Aseptic meningitis and hydrocephalus have been reported after intracranial epidermoid cyst rupture. We present a rare case of clinically symptomatic vasospasm after iatrogenic rupture.

CLINICAL PRESENTATION:
A middle-aged woman presenting with headache, facial paresthesia, and dizziness was found to have a 5-cm posterior fossa epidermoid cyst on magnetic resonance imaging. Resection was achieved through suboccipital craniectomy and C1 laminectomy. On postoperative day (POD) 1, the patient became unresponsive. After ventriculostomy placement for developing hydrocephalus, she failed to improve. Digital subtraction angiography revealed severe vertebrobasilar vasospasm, which was treated successfully with intra-arterial verapamil and milrinone. She experienced multiple episodes of recurrent vasospasm, all successfully treated with verapamil-milrinone. After ventriculoperitoneal shunt placement on POD 31, her condition stabilized; she was discharged to a rehabilitation center on POD 38.

CONCLUSION:
This successful treatment of rare, clinically symptomatic vasospasm postiatrogenic epidermoid cyst rupture may help guide treatment in similar scenarios.
Scalp Incisions With Stairstep Pericranial Edges to Minimize Sequalae from Poor Wound Healing in Supratentorial Brain Tumor Surgery: A Technical Note With Early Results
Authors: Popp Nicholas , Singhal Ishan , Laing Brandon , Krucoff Kate B. , Krucoff Max O. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Wound healing problems are especially prevalent in craniotomies for intra-axial brain tumors as patients often require radiation, chemotherapy, and chronic steroids. Although newer techniques such as minimally invasive approaches and routine vancomycin powder use have helped overall complication rates, poor skin healing remains a frustratingly persistent cause of morbidity. Therefore, here we describe the novel technique of elevating and closing a stairstep pericranial edge offset from the skin incision to protect hardware and support wound healing, and we report early outcomes using this technique.

METHODS:
Ninety-one consecutive patients underwent supratentorial, intra-axial brain tumor surgery with a single surgeon at a single institution using this technique. Patient demographics, pathology, adjuvant interventions, and other independent risk factors were analyzed.

RESULTS:
No wound-related complications requiring readmission, intravenous antibiotics, or reoperation were encountered at a median 3-month follow-up. There were also no surgical site infections, dehiscences, or cerebrospinal fluid leaks. Fifty-one patients (57.3%) had postoperative radiotherapy, 85 patients (93.4%) had perioperative steroids, and 56 patients (61.5%) had postoperative chemotherapy. Six patients (6.5%) were placed on a short course of oral antibiotics perioperatively due to concerns with initial scalp healing (ie, excessive scabbing at follow-up), none of whom progressed to infection or required further intervention. These are the cases where this technique is felt to have been most helpful by potentially preventing worse sequelae. One patient developed a shunt infection during this interval that required removal unrelated to the craniotomy site.

CONCLUSION:
Here we outline in detail the principles, design, and execution of incisions and closures with stairstep pericranial edges in supratentorial brain surgery. This technique was designed in consultation with plastic surgeons to provide an intact, vascularized layer of pericranium beneath the healing skin and over the bone graft/hardware to optimize wound healing conditions and prevent morbid sequelae in inevitable cases of poor initial healing. Early results are promising.
Diagonal Earlobe Crease (Frank's Sign): a New Clinical Sign to Look for in Patients With Ruptured and Unruptured Intracranial Aneurysms? Patient Series
Authors: Chavez-Herrera Victor Ramzes , Velazquez-Castillo Joel Abraham , Hernandez-Gonzalez Flavio , Cervantes-Gonzalez Josue Alejandro , Cruz-Rosales Juan Luis , Sandoval-Bonilla Bayron Alexander , Soto-Rubio Diego Tonathiu , Perez-Carrillo Cristian Alberto , Garcia-Lopez Rabindranath 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Diagonal earlobe crease (DELC, Frank's sign) and intracranial arterial aneurysms (IAA) have a pronounced association with atherosclerosis. Therefore, detecting DELC in patients with IAA could be potential for clinical and research use.

CLINICAL PRESENTATION:
During a 2-month period, we diagnosed 20 patients with intracranial arterial aneurysms. Sixteen (80%) were positive for DELC, 12 were female, and 4 were male (ages ranging from 32 to 68 years and a mean of 52 years). Eleven were unruptured and 5 were ruptured. We highlight cases 1, 7, and 8.

CONCLUSION:
The interesting tight association of DELC and IAAs to atherosclerosis and the overwhelming presence of DELC in patients with IAAs could lead to potentially associated DELC with the development, growth, and rupture of IAAs. As a result, important clinical and research information could be found.
Lateral Compression is the Strongest Independent Predictor of Aneurysm Occlusion After Endovascular Treatment of Intracranial Aneurysms With the Woven EndoBridge Device
Authors: Delgado Almandoz Josser E. , Kayan Yasha , Copelan Alexander Z. , Ertelt Ashley M. , Scholz Jill M. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
The effect of lateral compression (LC) of the Woven EndoBridge (WEB) device on intracranial aneurysm (IA) occlusion and retreatment has not been studied in depth. This study aims to determine the effect of LC on aneurysm occlusion and retreatment after endovascular treatment with WEB.

METHODS:
We retrospectively reviewed IAs treated with WEB at our institution between February 5th, 2019, and March 31st, 2022. LC was determined in the immediate postdetachment angiogram by measuring the mean implanted WEB width at the equator in two orthogonal projections and subtracting it from the nominal WEB width. LC was then converted to the percentage of nominal WEB width (percent LC [%LC]). Independent predictors of complete and adequate aneurysm occlusion at follow-up and retreatment were determined using multivariate logistic regression analysis. Optimal %LC thresholds were determined using receiver operating characteristic analysis.

RESULTS:
One hundred and fifty-five IAs were included, with a mean size of 6.4 mm, a mean neck of 3.6 mm, and a mean time to last follow-up of 15.5 months. At last follow-up, complete and adequate aneurysm occlusion was present in 98 (63.2%) and 139 (89.7%) IAs, respectively. Twelve IAs were retreated (7.7%). %LC was the strongest independent predictor of complete and adequate aneurysm occlusion at first and last follow-up and an independent predictor of aneurysm retreatment. Optimal %LC thresholds for complete and adequate aneurysm occlusion at first follow-up were >17.1% and >15.7%, respectively. Compared with IAs in which these thresholds were not attained, IAs in which these thresholds were attained had significantly higher rates of complete (31% vs 68%, P-value <.0001) and adequate occlusion (81% vs 96%, P-value .004) at first follow-up. The optimal %LC threshold for aneurysm retreatment was ≤15.6%. IAs with ≤15.6% LC had a significantly higher rate of retreatment (15%) than IAs with >15.6% LC (4%, P-value .025).

CONCLUSION:
LC is the strongest independent predictor of aneurysm occlusion in IAs treated with WEB.
Explantation and Simultaneous Explantation-Reimplantation of Spinal Cord Stimulation Paddle Electrodes: Complication Rate and Predisposing Factors
Authors: Kuparinen Xenia , Ahmed Haji Omar Abdirisak , Vartiainen Nuutti , Marjamaa Johan , Gröndahl Joonatan , Kivisaari Riku , Resendiz-Nieves Julio 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Spinal cord stimulation (SCS) is an effective treatment for chronic pain that does not respond to conservative treatment. Nonetheless, up to 38% of all implanted SCS electrodes are explanted, and while the risks involved in the surgical implantation of SCS paddle electrodes are well documented, there is scarce information about SCS explantations and their associated complications. We aimed to document the complication rate and identify their predisposing factors in SCS paddle electrode explantations and simultaneous explantation-reimplantations.

METHODS:
We retrospectively reviewed the outcomes and the characteristics of all patients who underwent explantation of surgically implanted SCS paddle electrodes at the Helsinki University Hospital Department of Neurosurgery between February 2005 and October 2020.

RESULTS:
One hundred thirty-one explantations were performed on 106 patients. The complication rate was 18.3% (24 operations). Major complications occurred during 5 operations (3.8%). No permanent neurological deficits were recorded. Smoking predisposed patients to postoperative complications (P = .023). On average, patients who suffered complications required a day longer hospitalization (2.22 vs 2.92, P = .011). Patients who had repeated explantations (3 or more) suffered significantly more complications than patients who had only 1 or 2 operations (62.5% vs 15.4%, P = .005).

CONCLUSION:
Our results suggest that the explantation of the SCS paddle electrode is a relatively safe surgical procedure. Although severe complications occurred, they were successfully managed. Repeated explantations should be treated cautiously as they seem to increase the complication rate considerably.
Mini-Craniotomy With Endoscopic Approach for Acute Subdural Hematoma Evacuation in a Patient With Complex Scalp Flap Defect: A Case Report
Authors: Kundishora Adam Joseph , Sundaresan Vinaik Mootha , Boroumand Sam , Hodges Sarah E. , Omay Sacit Bulent 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Acute subdural hematoma (aSDH) is one of the most common pathologies resulting from head trauma. Surgical management often involves a large craniotomy for hematoma evacuation. Prior complex cranial reconstructive surgery can complicate incision planning or limit craniotomy size.

CLINICAL PRESENTATION:
In this report, we describe a 61-year-old woman with a history of squamous cell carcinoma of the scalp, which previously required complex flap reconstruction and left a residual skull defect, who presented with an aSDH after a fall. Prior surgery and poorly vascularized skin significantly limited the available area for craniotomy. We used a mini-craniotomy with endoscopic adjunct to achieve appropriate visualization and complete evacuation of the hematoma.

CONCLUSION:
In cases of aSDH in which a mini-craniotomy is desirable and the potential location of the incision is limited, an endoscopic approach should be considered.
The Significance of Venous Outflow Obstruction in Dural Arteriovenous Fistulas
Authors: Evans Lachlan R. , Khanijou Visnu , Gauden Andrew J. , Kavar Bhadrakant , Davidson Andrew S. , Yan Bernard , Bush Steve , Dowling Richard , Laidlaw John D. , Mitchell Peter J. , Adamides Alexios A. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
The association between venous outflow obstruction (VOO) and cranial dural arteriovenous fistulas (DAVF) is well established; however, its impact on the natural history remains unclear. This article aims to characterize its clinical significance and further describe the natural history of DAVF.

METHODS:
A retrospective cohort study was performed at a tertiary neurosurgical center. Cohort characteristics were described with a focus on patients with VOO. Annualized event rates and risk factors for hemorrhage and nonhemorrhagic neurological events (NHNE) were also investigated.

RESULTS:
The cohort consisted of 108 patients, 74 of which had follow-up greater than 1 month including 24 low-grade (Cognard I-IIa) fistulas (21.7 lesion-years) and 50 high-grade (Cognard IIb-V) fistulas (60 lesion-years). 18 patients with concurrent VOO were identified; most (83.3%) were high-grade DAVF and had obstruction of the direct draining sinus. Annualized rates of hemorrhage and NHNE for high-grade DAVF were 4.6% and 10.6%, respectively. Those high-grade lesions presenting with hemorrhage had a 10.9% annual rate of recurrent hemorrhage, while those presenting with NHNE had a 22.3% annual rate of subsequent NHNE. Fifteen high-grade DAVF with VOO (15.7 lesion-years) had annualized hemorrhage and NHNE rates of 6.4% and 31.9%, respectively. High radiological grade, an aggressive index presentation, and the presence of VOO were the predictors of hemorrhage and NHNE (P < .05).

CONCLUSION:
This study reports a novel association between VOO and a more aggressive clinical course. DAVF with high-grade angiographic features, an aggressive index presentation, or VOO should be considered for early treatment.