bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in the Treatment of Pediatric Hydrocephalus Since 2014: Understanding the Role of the 2014 Hydrocephalus Guidelines
Authors: Larrew Thomas , Corrigan Corinne , Bauer David F. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
The management of hydrocephalus has significantly changed over the past decade. Endoscopic third ventriculostomy has become more prevalent, and shunt surgery has become more protocolized through research efforts by the Hydrocephalus Clinical Research Network. In 2014, the Pediatric Hydrocephalus Guidelines were first published, providing a cohesive source for clinical guidance. We planned to investigate national trends in the management of pediatric hydrocephalus after the publication of the 2014 Pediatric Hydrocephalus Guidelines as guidelines act as a compilation of historic and recent literature in a scientific field.

METHODS:
A multipronged approach was used to evaluate changes in the treatment of pediatric hydrocephalus since 2014. First, we queried the Pediatric Health Information System between 2013 and 2018 to identify national trends in shunt procedures for hydrocephalus. To assess the recommendation in the guidelines to use antibiotic-impregnated catheters (AICs) in shunts, national sales records of AICs were obtained from 2 large neurosurgical device companies.

RESULTS:
A total of 11,179 shunt procedures were performed within the Pediatric Health Information System database in the study period. In the preguideline publication period (2013-2014), there was a shunt revision-to-placement ratio of 1.63 while in the postguideline publication period (2015-2018), there was a ratio of 0.84 (P < .0001). National sales data revealed that antibiotic-impregnated drain sales increased from 2% to 77% since publication.

CONCLUSION:
Findings from this investigation suggest progress in pediatric hydrocephalus management since 2014. The shunt revision-to-placement ratio improved, and the use of AICs increased over this period. Improved outcomes are likely associative findings rather than causative with the guidelines representing a culmination of widespread changes in hydrocephalus care such as increased use of endoscopic third ventriculostomies, protocolized care, and image-guided shunt placement. Further research into the impact of clinical practice guidelines is needed to better understand the impact of this tool on surgeons and patient care.
Bridging the Global Technology Gap in Neurosurgery: Disparities in Access to Advanced Tools for Brain Tumor Resection
Authors: Valerio Jose E. , Ramirez-Velandia Felipe , Fernandez-Gomez Maria Paula , Rea Noe S. , Alvarez-Pinzon Andres M. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
The advent of advanced technologies has brought unprecedented precision and efficacy to neurosurgical procedures for brain tumor resection. Despite the remarkable progress, disparities in technology access across different nations persist, creating significant challenges in providing equitable neurosurgical care. The purpose of the following work was to comprehensively analyze the existing disparities in access to innovative neurosurgical technologies and the impact of such disparities on patient outcomes and research. We seek to shed light on the extent of the problem, the underlying causes, and propose strategies for mitigating these disparities.

METHODS:
A systematic review of published articles, including clinical studies, reports, and healthcare infrastructure assessments, was conducted to gather data on the availability and utilization of advanced neurosurgical technologies in various countries.

RESULTS:
Disparities in technology access in neurosurgery are evident, with high-income countries benefiting from widespread implementation, while low- and middle-income countries face significant challenges in technology adoption. These disparities contribute to variations in surgical outcomes and patient experiences. The root causes of these disparities encompass financial constraints, inadequate infrastructure, and insufficient training and expertise.

CONCLUSION:
Disparities in access to advanced neurosurgical technology remain a critical concern in global neurosurgery. Bridging this gap is essential to ensure that all patients, regardless of their geographic location, can benefit from the advancements in neurosurgical care. A concerted effort involving governments, healthcare institutions, and the international community is required to achieve this goal, advancing the quality of care for patients with brain tumors worldwide.
Endoscopic Repair of Cerebrospinal Fluid Leak
Authors: Schwartz Lindsey , Mohiuddin Ismail , Rajendran Sibi , Huang Meng 
Published: November 2024

BACKGROUND AND IMPORTANCE:
The evolution of endoscopic techniques in spine has allowed novel approaches to various pathologies. We describe the use of endoscopy for repair of refractory cerebrospinal fluid (CSF) leak after lumbar puncture (LP).

CLINICAL PRESENTATION:
A 31-year-old female presented with refractory postural headaches after undergoing LP. The patient underwent 4 total epidural blood patches (EBPs) with minimal symptomatic relief. The LP opening pressure was found to be 18 cm of water, inconsistent with underlying pseudotumor cerebri. A myelogram demonstrated persistent CSF leak and contrast accumulation within the dorsal epidural space at L2-3. Endoscopic exploration was ultimately performed, which demonstrated well-placed EBPs; however, continuous CSF egressed from a pinhole site. This was repaired with coagulation using a radiofrequency probe, DuraSeal (Integra LifeSciences) and DuraGen (Integra LifeSciences). Postoperatively, the patient noted resolution of debilitating intracranial hypotension symptoms and was able to return to work.

CONCLUSION:
Postdural puncture headaches occur in about 1/3 of patients after LP. Symptoms are often debilitating and can include nausea, neck pain, dizziness, tinnitus, visual changes, and hearing loss. Multiple pharmacological and invasive treatments, such as EBP, have been used historically with success, but Postdural puncture headaches refractory to these interventions can put patients at risk for serious complications including seizures and subdural hematomas. We present the first reported case of an endoscopic approach to repair refractory CSF leak in the lumbar spine. Our approach highlights the potential of minimally invasive endoscopic techniques in the repair of refractory CSF leak from the puncture site after LP.
Machine Learning for Individualized Risk Estimation in Anterior Lumbar Interbody Fusion
Authors: Karabacak Mert , Jagtiani Pemla , Schupper Alexander J. , Carr Matthew T. , Steinberger Jeremy , Margetis Konstantinos 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Although the anterior approach to the spine for anterior lumbar interbody fusion (ALIF) has been shown to be an effective procedure, there are different surgical risks compared with conventional posterior fusion. ALIF patients could potentially receive more personalized care plans that minimize the risk of negative outcomes by forecasting short-term postoperative results before the surgical procedure. The objective of this research was to evaluate the performance of machine learning (ML) algorithms in predicting short-term unfavorable postoperative outcomes after ALIF and to develop an easy-to-use and readily available instrument for this purpose.

METHODS:
Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified ALIF patients and used 6 ML algorithms to build models predicting postoperative outcomes. These models were then incorporated into an open-access web application.

RESULTS:
The analysis included 8304 ALIF patients. The LightGBM models achieved area under the receiver operating characteristic scores of 0.735 for prolonged length of stay and 0.814 for nonhome discharges. The random forest models achieved area under the receiver operating characteristics of 0.707 for 30-day readmissions and 0.701 for major complications. These top-performing models were integrated into a web application for individualized patient predictions.

CONCLUSION:
ML techniques show promise in predicting postoperative outcomes for ALIF surgeries. As data in spinal surgery expand, these predictive models could significantly improve risk assessment and prognosis. We present an accessible predictive tool for ALIF surgeries to achieve the goals mentioned above.
Focused Ultrasound as Rescue Treatment of Essential Tremor After Deep Brain Stimulation: 2 Case Reports
Authors: Gonzalez Antonio , Tardáguila Manel , Ispierto Lourdes , Muñoz Jorge , Gea Mireia , Jaumà Serge , Plans Gerard , Álvarez Ramiro , Vilas Rolán Dolores 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Approximately 25% to 55% of patients with essential tremor will eventually develop medication-refractory tremor. Currently, the standard surgical treatment for this condition is deep brain stimulation (DBS) of the ventralis intermedius nucleus of the thalamus and, more recently, the posterior subthalamic area. However, MRI-guided focused ultrasound (FUS) thalamotomy has shown promising results in improving tremor in patients with refractory essential tremor.

CLINICAL PRESENTATION:
We present 2 cases of patients with a disabling action tremor, recurring after DBS. A 55-year-old right-handed male and a 52-year-old woman presented with bilateral medically refractory action tremor, which began in their second decade of life. Both underwent bilateral DBS-ventralis intermedius, with the first patient showing a good initial response but the second patient showing a suboptimal response within the first year after DBS. In both cases, the DBS system was removed and the patients subsequently underwent left-sided FUS thalamotomy with a dramatic improvement of their tremor.

CONCLUSION:
These cases demonstrate the feasibility of performing FUS thalamotomy as a rescue treatment for disabling tremor after DBS.
Directional Deep Brain Stimulation Lead Rotation in the Early Postoperative Period
Authors: Dang Huy Q. , Reyes Gabriel , Devara Ethan , Giridharan Nisha , Allam Anthony K. , Banks Garrett P. , Viswanathan Ashwin , Shofty Ben , Sheth Sameer A. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Directional deep brain stimulation (DBS) enables treatment optimization by current steering using segmented leads. Identification of the lead's rotational orientation is critical to guide programming decisions. Orientation is often assessed during or immediately after implant, but the degree of lead rotation in the following weeks is not well appreciated. Our objective was to measure the degree of DBS lead rotational orientation changes within the first few weeks after surgery.

METHODS:
We retrospectively reviewed the clinical records of patients who were implanted with segmented DBS leads at our institution. All included patients had at least 1 immediate postoperative computed tomography (CT) (CT1) and another CT at least 1 week later (CT2). We assessed lead rotational orientation angles on CT1 and CT2 and calculated the degrees of rotation change between the scans. We also assessed for any effect of the time interval between scans by calculating the correlation between CT1-CT2 latency and degrees of lead rotation.

RESULTS:
We assessed a total of 75 DBS lead orientations for 38 patients. The average change in lead orientation between CT1 and CT2 was 8.6° (median = 2.9°, range = 0.11-168.2°). Only 8 percent of patients (3/38) were found to have a significant change in orientation (>30°); however, when it occurred, it occurred bilaterally. There was no correlation between CT1-CT2 latency and lead rotation (r(74) = 0.04, P = .73).

CONCLUSION:
Our study finds that changes in lead orientation occurring over the first few weeks after surgery are rare. Thus, for most patients, the immediate postoperative CT is adequate for determining the orientation angles for clinical programming. However, if programming is found to be difficult, a repeat CT scan could be beneficial for a minority of patients.
How to Avoid and Handle Problems in the Placement of Cement-Augmented Fenestrated Percutaneous Pedicle Screws?
Authors: Padilla-Lichtenberger Fernando , Landriel Federico , Guiroy Alfredo , Casimiro Miguel , Silva Álvaro , Hem Santiago 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Pedicle screws with a central cannula and fenestrations allow cement augmentation, providing lower risk for screw loosening and pullout, especially in these patients with poor bone quality. This study aims to offer suggestions for resolving issues and reducing complications associated with the use of cement-augmented fenestrated pedicle screws.

METHODS:
A retrospective study was conducted across multiple centers on patients who received fenestrated pedicle screws with cement augmentation (CAFPS). Using 2-dimensional fluoroscopy guidance, we placed over 800 screws in 137 patients. Based on our analysis of common challenges and complications, 10 tips were compiled, that we believe are crucial for successfully implementing this technique, regardless of the brand or instrument used.

RESULTS:
The 10 tips included the following: (1) Indications of cement-augmented fenestrated pedicle screws; (2) use the K-wire blunt end in osteoporotic vertebrae; (3) know the longitude and diameter of the screw, by the measurement of the vertebrae to treat; (4) do not go bicortical; (5) clean the way of the screws fenestrae with saline; (6) protecting screw extensors with gauze; (7) measuring time and volume; (8) gently and smoothly introduce the cement; (9) do not panic. The presence of cement in the posterosuperior area adjacent to the pedicle does not necessarily indicate a leakage into the canal; and (10) fenestrated screw removal.

CONCLUSION:
The implementation of these tips could enhance technique performance and minimize complications in cement-augmented fenestrated pedicle screw placement.
Intraoperative Intermittent Pneumatic Compression Reduces Incidence of Venous Thromboembolism in Patients Undergoing Craniotomy: Study Protocol of a Randomized Multicenter, Single-Blind Trial
Authors: Scheer Maximilian , Schenk Grit , Taute Bettina , Richter Michael , Hlavac Michael , Gempt Jens , Krammer Matthias , Shiban Ehab , Sabel Michael , Stein Marco , Wienke Andreas , Höllig Anke , Strauss Christian , Rampp Stefan , Prell Julian 
Published: November 2024

BACKGROUND AND OBJECTIVE:
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication in craniotomy patients. The duration of surgery has been identified as a risk factor for the development of VTE. In a pilot study, the use of intermittent pneumatic venous compression (IPC) dramatically reduced the incidence of VTE. Despite randomization, a significant difference in the duration of surgery between the groups limited the validity of this result. The study was underpowered to compensate for this problem. We now present the protocol of a multicenter trial.

METHODS:
All patients receive medical compression stockings and low-molecular-weight heparin from the first postoperative day. The therapy group receives IPC stockings intraoperatively. Postoperatively, all patients receive lower-extremity duplex sonography to detect/exclude DVT within the first 7 postoperative days. Contrast-enhanced chest CT is the gold standard for the detection of PE and is performed in cases of clinical suspicion of PE.

EXPECTED OUTCOMES:
The incidence of VTE is the primary end point. The distinction between symptomatic and asymptomatic, etiologies, influence of lesion type, duration of surgery, and mortality will be evaluated as secondary end points. The pilot study showed a VTE incidence of 26% in the control group vs 7% in the treatment group. To avoid overly optimistic treatment effect assumptions, we assume VTE rates of 9% and 24% in the treatment and control groups, respectively, and thus calculated a number of 127 patients per treatment group.

DISCUSSION:
If this trial shows that intraoperative IPC reduces the risk of VTE to the extent observed in our pilot study (number needed to treat: 5.24), the potential benefit to neurosurgical patients would be significant. The results would potentially influence treatment guidelines by providing the high-quality evidence needed to make robust recommendations.
Durotomy During Outpatient Lumbar Discectomy Should Not Preclude Same-Day Discharge: A Case Series
Authors: Golubovsky Joshua L. , Spadola Michael , Wathen Connor , Malhotra Neil R. , Welch William C. , Marcotte Paul 
Published: November 2024

BACKGROUND AND OBJECTIVES:
With advances in surgical techniques over the past 40 years, single-level lumbar hemilaminectomy and microdiscectomy (HLMD) has become a standard outpatient surgery. Incidental durotomy is a common complication of lumbar decompression surgeries and often precludes same-day discharge based on preexisting paradigms, involving bedrest that have no empirical support, but often lead to increased complications in available evidence-based studies. Limited data exist regarding the safety of same-day discharge after lumbar decompression involving an incidental durotomy. The objective of this study was to establish the safety of same-day discharge after repair of incidental durotomy after single-level lumbar HLMD.

METHODS:
This study involved a retrospective review of the electronic medical record for all adult patients undergoing single-level lumbar hemilaminectomy and microdiscectomy by a single surgeon at our institution from 2013 through 2021. Descriptive statistics were used for data analysis.

RESULTS:
346 lumbar single-level HLMD were performed during this time frame by a single surgeon. There were 17 incidental durotomies (4.9%), all primarily repaired. Of the 17 patients with incidental durotomy, all but 5 returned home on postoperative day 0, with the 5 who remained inpatient staying for reasons unrelated to the dural tear. Patients had no durotomy-associated complications, readmissions, or reoperations regardless of same-day discharge home.

CONCLUSION:
Same-day discharge after primary repair of incidental durotomy in single-level lumbar HLMD seems to be safe and may significantly improve health care costs associated with HLMD. This investigation should be expanded to other one-level to two-level lumbar decompression surgeries and minimally invasive and endoscopic approaches.
A Novel Combined Microsurgical and Endovascular Approach for Type II Endoleak Embolization Through Direct Puncture of a Lumbar Segmental Artery: A Technical Case Instruction
Authors: Nguyen Vincent N. , Rennert Robert C. , Sternbach Sarah , Cavaleri Jonathon , Abedi Aidin , Atai Nadia A. , Han Sukgu , Russin Jonathan J. 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Despite the advances in endovascular aortic repair techniques, type II endoleaks with aneurysm sac expansion remain frequent and challenging problems.

CLINICAL PRESENTATION:
An elderly gentleman underwent a combined microsurgical and endovascular procedure to address a type 2 endoleak and the growth of a recurrent abdominal aortic aneurysm caused by direct puncture of a lumbar segmental artery. The patient tolerated the procedure well and was discharged without complications. Follow-up imaging revealed no further endoleak and a smaller aneurysm size.

CONCLUSION:
This unique case presents a novel multidisciplinary surgical strategy for treating complex, recurrent aortic aneurysms with type II endoleaks. The approach is tailored to the individual patient and has shown effectiveness. Long-term follow-up data will be crucial for assessing the efficacy and durability of this approach.
Parental Leave in Neurosurgery: A US Cross-Sectional Study
Authors: Sanusi Olabisi , Kalu Richard U. , Obayashi James , Beird Nathan , Williamson Theresa , Geltzeiler Mathew , Nahed Brian V. , Rodriguez Maria I. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
The Accreditation Council for Graduate Medical Education implemented a minimum of 6 weeks parental leave for residents in July 2022. The implementation and impact have not previously been studied in neurosurgery. Our primary study objectives were to determine whether an institution had a parental leave policy and quantify the Family and Medical Leave Act (FMLA) and total parental leave (TPL) time taken by neurosurgeons.

METHODS:
We conducted a cross-sectional survey (August 2023 to December 2023) of neurosurgeons (residents and faculty) in Accreditation Council for Graduate Medical Education–accredited programs. We elicited demographic information, experience with parental leave, and career satisfaction. Association between continuous variables was evaluated using Pearson's correlation. Data distribution was evaluated using the Shapiro–Wilks test. Central tendency comparison was performed using one-way analysis of variance, Kruskal–Wallis, or Mann–Whitney U tests.

RESULTS:
There were 147 anonymous survey respondents (response rate 15.7%), with an average age of 41 years. The majority (72.2% and 73%) were female and married. The mean age of first pregnancy was 32 years. On average, female residents and faculty took more TPL (7.7 weeks vs 9.0 weeks) and FMLA (6.0 weeks vs 6.8 weeks) than men (resident TPL:2.0 weeks, FMLA: 1.5 weeks. faculty TPL: 2.1 weeks, FMLA: 1.6 weeks). There was a significant difference between how much parental leave leadership believe residents have vs amount of FMLA (P-value = .004) and TPL (P-value = .001) residents took. There was a correlation between age and the amount of TPL (Pearson's R −0.307, P-value = .009).

CONCLUSION:
Our survey demonstrates that neurosurgeons, in general, took less than the minimum suggested leave. Departmental leadership perceived that residents took more leave than they reported. This study highlights an opportunity to increase support for parental leave among neurosurgeons.
Outcomes of Management of Progressive Radiosurgery-Treated Brain Metastasis With Resection Followed by Pathology-Informed Management: A Retrospective Study
Authors: Bhatia Rohini K. , George Jessica , Siu Catherine , Lee Emerson , Redmond Kristin J. , Baker Brock , Jackson Christopher M. , Bettegowda Chetan , Mukherjee Debraj , Hobbs Robert F. , Weingart Jon , Lim Michael , Kleinberg Lawrence 
Published: November 2024

BACKGROUND AND OBJECTIVES:
In patients treated with stereotactic radiosurgery (SRS) for brain metastases, follow-up imaging demonstrating progression may result from treatment effect/radionecrosis (RN) or tumor progression. We report long-term outcomes for a cohort of patients who demonstrated radiological progression on serial imaging after initial radiation and who underwent resection, at which point histology informed further management.

METHODS:
A retrospective chart review identified 76 patients with an associated 82 brain lesions between 2009 and 2022, that were initially treated with SRS, and then demonstrated suspicious imaging developing through at least 2 scan time points with either pathologic confirmation of tumor or RN.

RESULTS:
Of the 82 lesions, 55 lesions (67.1%) were found to be tumor and were treated with repeat radiation and 27 (32.9%) were found to have pathologically confirmed RN and conservatively managed. 14/27 lesions ultimately found to be radionecrotic required steroids preoperatively due to neurological symptoms. None of these lesions required further intervention with median postsurgery follow-up of 24.4 months (range 1-104 months). There were 55 instances (in 51 patients) of confirmed recurrent/progressive tumor who we treated with repeat aggressive radiation with either Cs-131 brachytherapy (12 [21.8%]) or SRS (43 [78.2%]). Among patients treated with reirradiation, the median follow-up to local failure was 15.2 months (95% CI 7.3-26.6 months). The 2-year local control rate was 79.5% (95% CI 68.3%-92.5%).

CONCLUSION:
These results support resection of radiosurgery-treated lesions with progression continuing through serial imaging, and this pathology-informed management results in excellent control of both RN and tumor progression after radiosurgery.