bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stereotactic DOTATATE Positron Emission Tomography/Computed Tomography–Guided Resection of a Multiply Recurrent World Health Organization Grade 2 Parasagittal Meningioma: A Technical Case Report
Authors: Nandoliya Khizar R. , Jamshidi Pouya , Castellani Rudolph J. , Tate Matthew C. , Avery Ryan J. , Magill Stephen T. 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Resection of parasagittal meningiomas is challenging due to venous and superior sagittal sinus involvement. Recurrent tumors can be particularly challenging given scar tissue from prior surgery and radiation, which can be difficult to differentiate from active tumor on preoperative MRI. Cu-64-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE) is a somatostatin receptor (SSTR) ligand detectable on positron emission tomography (PET) imaging. SSTR is expressed by most meningiomas. While DOTATATE-PET has been investigated for radiotherapy planning, its use in guiding oncological meningioma resection is understudied. Here, we present a case example demonstrating its use in guiding surgical planning and maximizing the extent of resection.

CLINICAL PRESENTATION:
A 45-year-old man with a World Health Organization grade 2 bilateral parasagittal meningioma presented with recurrence after 2 prior resections, wound infection and washout, and fractionated radiotherapy with boost to residual disease. Preoperative angiography demonstrated an occluded sagittal sinus beyond the extent of the residual tumor. Stereotactic DOTATATE PET-computed tomography (CT) imaging was integrated with the neuro-navigation and used intraoperatively to identify extent of active tumor, differentiating it from scar tissue and gliosis. This was used to facilitate oncological tumor resection with negative pathological margins that correlated with the absence of DOTATATE signal.

CONCLUSION:
Stereotactic DOTATATE PET-CT is a valuable addition to the neurosurgeon's toolkit, particularly when integrated into the neuro-navigation, for achieving complete resections of recurrent meningiomas, or meningiomas where the extent of tumor invasion can be challenging to define on preoperative MRI.
Rupture of a Spinal Dural Arteriovenous Fistula as a Differential Diagnosis of a Coronary Syndrome: Case Report
Authors: Ramón Juan Fernando , Garcia Rairan Luis , Araque Yessid , Fuentes Santiago , Useche Nicolas 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spine and can lead to progressive paraplegia if left untreated. However, because of their nonspecific clinical presentation, they are often misdiagnosed as other pathologies, such as discopathies or degenerative neuropathies, which can result in delayed diagnosis and treatment.

CLINICAL PRESENTATION:
A case of a 73-year-old female with a history of acute coronary syndrome who presented to the emergency department with sudden onset chest pain suggestive of an acute myocardial infarction is presented. Further evaluation revealed a subdural hematoma at T2-T5 and T8-L5, caused by a ruptured SDAVF at the T12-L1 level. The patient required emergency decompression surgery, but because of late diagnosis, she suffered a spinal cord injury with an ASIA-A classification.

CONCLUSION:
SDAVF is a disease with nonspecific initial symptoms, which can easily be mistaken for other pathologies. However, early recognition of the presence of the fistula, especially in cases of rupture, can improve prognosis and increase the chance of better outcomes. It is important to keep this condition in mind when evaluating patients with unexplained neurological symptoms and consider SDAVF as a differential diagnosis of acute coronary syndrome.
Late Removal of Brain-Penetrating Nails Adherent to Intracranial Arteries: A Case Report
Authors: Qian Cheng , Isokangas Juha-Matti , Lahtinen Maija , Suutari Angelica , von und zu Fraunberg Mikael , Knuutinen Oula 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Pneumatic nail guns are a rare cause of penetrating brain injury, and subsequent nail removal in the acute setting is well reported. However, reports of late removal or removal of nails adjacent to intracranial vessels are rare. In the delayed setting, scar formation around the nails and surrounding brain structures may complicate surgical removal. Here, we report a case of late removal of brain-penetrating nails adherent to the middle cerebral artery branches.

CLINICAL PRESENTATION:
A 70-year-old left-handed male presented with mild aphasia, vertigo, and facial nerve palsy. Imaging studies demonstrated two nails fired 2 months before in the right temporal lobe adjacent to the middle cerebral artery branches. The nails were surgically removed through a modified pterional approach after meticulous dissection of scar tissue adherent to the nails. Before removal, proximal vessel control was achieved.

CONCLUSION:
Brain-penetrating nail removal weeks after the original incident may be complicated by extensive scarring. This can be dealt with a generous craniotomy, proximal vessel control through microsurgical or endovascular means, and careful dissection of scar tissue around the nails.
Stereotactic Radiosurgery and Highly Active Antiretroviral Therapy for HIV-Related Primary Central Nervous System Lymphomas: A Prospective Study Analyzing the Efficacy and Safety
Authors: Alvarez Pinzon Andres M. , Ramon Alonso Jose , Wolf Aizik , Ramirez-Velandia Felipe , Valerio Jose E. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Stereotactic radiosurgery (SRS) has been well established and considered a safe alternative for primary central nervous system lymphomas (PCNSLs). However, in HIV-related PCNSL, the use of SRS remains controversial. The purpose of this study was to evaluate the efficacy and safety of SRS in HIV-related PCNSL.

METHODS:
Forty-two adult patients with confirmed PCNSL and no previous radiotherapy or chemotherapy were selected, with 16 receiving Gamma Knife Radiosurgery (GKRS) alone and 26 receiving Highly Active Antiretroviral Therapy (HAART) before GKRS. Follow-up evaluations were conducted at 3, 6, 12, and 24 months post-treatment using clinical and imaging techniques. Statistical analyses were performed using SPSS v22, assessing for new lesions, changes in lesion size, progression-free survival, and overall survival.

RESULTS:
HAART/GKRS showed a significantly higher rate of complete response compared with the GKRS group, with 53.8% vs 18.8% (P = .048). The mean progression-free survival for the HAART/GKRS group and the GKRS group was 39.7 months and 31.2 months, respectively (P = .0051). Patients with a delayed HAART initiation (>6 months) exhibited an increased burden of T2 white matter lesions and a higher number of large lesions (odds ratio = 1.9, 95% CI = 1.44-2.42, P = .001). However, no significant difference was observed between the two groups regarding radionecrosis.

CONCLUSION:
The study highlights the potential benefits of adding HAART to GKRS for patients with PCNSL, leading to improved survival outcomes. An early initiation of HAART was associated with less tumor progression, underscoring the importance of timely administration of HAART in patients with AIDS-related PCNSL.
Clinical and Radiological Outcomes of Full-Endoscopic Decompression for Lumbar Spinal Stenosis With Grade I Degenerative Spondylolisthesis: A Retrospective Study With a Minimum 1-Year Follow-up
Authors: Choi Sang-Soo , Ahn Geon , Jang Il-Tae , Kim Hyeun Sung 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Decompression without fusion is a surgical option for the treatment of lumbar spinal stenosis (LSS) with grade I degenerative spondylolisthesis (DS). However, the outcomes of full-endoscopic decompression remain unknown. This study aimed to investigate the clinical and radiological outcomes of lumbar full-endoscopic decompression for spinal stenosis with grade I DS.

METHODS:
A total 43 patients with LSS with grade I DS who underwent lumbar full-endoscopic unilateral laminotomy for bilateral decompression and were followed up for a minimum of 1 year were retrospectively reviewed. Data on demographic characteristics, operative details, radiological images, clinical outcomes, and complications were analyzed.

RESULTS:
Pain, evaluated using the visual analog scale, was significantly reduced in patients undergoing full-endoscopic decompression in both the leg and back; the Oswestry Disability Index scores also improved (P < .001). MacNab's outcome classification was excellent or good in 95% of patients. One patient eventually needed the fusion surgery, and two patients required further diskectomy surgery because of recurrent symptoms. During follow-up, an increase in the vertebral slip was observed in 46.5% of the patients, but it was not statistically significant (P = .46). The progression of DS, defined as percentage of slip >5%, was observed only in 7% of the patients. An increase in vertebral slip was not associated with the clinical outcomes. There was no difference in radiological outcomes, such as angular motion (P = .36) and translation (P = .13), compared with the preoperative state. The operation did not exacerbate spinal instability. Rather, fewer patients had spinal instability postoperatively.

CONCLUSION:
Endoscopic decompression alone has comparably good clinical outcomes with those of other surgical techniques in patients with LSS and DS. Few postoperative spinal instability occurred. Rather, the number of patients with instability decreased postoperatively. Full-endoscopic decompression may be a treatment option for patients with grade 1 DS.
Study Protocol for a Randomized Controlled Clinical Trial on the Outcome of Surgical Versus Primary Nonsurgical Treatment of Traumatic Thoracolumbar Spine Burst Fractures in Patients Without Neurological Symptoms—A34RCT
Authors: Häckel Sonja , Stienen Martin N. , Martens Benjamin , Neuhaus Valentin , Albers Christoph E. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
There are still major global differences in the treatment of acute traumatic thoracolumbar burst fractures in patients without neurological deficits and without posterior column injury. Treatment strategies range from conservative treatment with orthosis or early functional mobilization to various surgical stabilization techniques. The study's objectives are to evaluate the clinical (Oswestry Disability Index [ODI]) and radiographical outcomes (restoration and maintenance of spinal alignment; injury of the affected intervertebral disk) and determine the prevalence of complications until 24 months of follow-up.

METHODS:
The study is designed as a randomized, controlled, noninferiority clinical trial. All patients with a thoracolumbar burst fracture (Arbeitsgemeinschaft für Osteosynthesefragen spine type A3 or A4) age 18 to 70 years without neurological deficit and without posterior ligament injury can be enrolled. We will randomly assign 52 patients for either surgical or nonsurgical treatment. The surgical group will receive combined anterior–posterior (360°) spinal stabilization therapy. Participants in the nonsurgical group will be treated with a 3-point hyperextension orthosis for 6 weeks. The primary outcome is the difference in ODI at 2 years after injury.

EXPECTED OUTCOMES:
We expect to find that conservative treatment of burst fractures in the thoracolumbar spine will be noninferior to the surgical treatment.

DISCUSSION:
This study will provide high-quality data comparing a modern surgical treatment regime with a standardized conservative treatment in patients with thoracolumbar burst fractures.
Resident Opinions on Image Guidance for External Ventricular Drain Placement: A National Survey
Authors: Noh Thomas , Juvekar Parikshit , Watanabe Gina , Golby Alexandra J. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Low-quality data on image-guided external ventricular drain (EVD) accuracy are in large part due to a lack of widespread usage of this system for EVD placement. The potential disconnect between user preferences and existing technologies should be explored to guide future developments. The goal of this study was to survey neurosurgical residents regarding their EVD practices and determine the acceptable amount of setup time for an ideal neuronavigation system.

METHODS:
A 4-question survey was sent to approximately 1512 residents at 108 Acreditation Council for Graduate Medical Education–approved medical doctor neurosurgical training programs in the United States. The responses were received electronically, tabulated, and analyzed using descriptive statistics.

RESULTS:
A total of 130 respondents (9%) completed the survey, reflecting the highest number of neurosurgical resident respondents in an electronic qualitative survey of EVD practices thus far. Residents were willing to accept 6.39 min (SD = 3.73 min) on average for the setup of a bedside EVD image guidance system. The majority chose to use image guidance during EVD placement for cases of narrow slit-like ventricles (86.92%) over intraventricular hemorrhage (13.08%) and hydrocephalus (0%). A total of 90% of all resident respondents misplaced at least 1 EVD with 74% of post-graduate year–7 respondents misplacing more than 3 EVDs in their career. A total of 88.46% of respondents deemed more than a single pass as acceptable.

CONCLUSION:
Future EVD neuronavigation technologies should focus on achieving rapid registration times. These systems may be prioritized for patients with anatomic distortions. Current resident attitudes are accepting multiple EVD passes, likely because of the inherent limitations of the traditional freehand approach. Efforts should be made to encourage the best course for the patient.
BrainPath Tubular Retractor System for Subcortical Hemorrhagic Vascular Lesions: A Case Series of Technique and Outcomes
Authors: Verhey Leonard H. , Restrepo Orozco Andres , Abouelleil Mohamed , Mazaris Paul , Madura Casey J. , Bercu Michael , Singer Justin A. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Hemorrhagic subcortical vascular lesions such as cavernous malformations (CM) and arteriovenous malformations (AVM) can be neurologically devastating. Conventional open surgical resection is often associated with additional morbidity. The BrainPath® (NICO Corp.) transsulcal tubular retractor system offers a less-invasive corridor to deep-seated lesions. Our objective was to describe a single-center experience with the resection of subcortical hemorrhagic vascular lesions in adult and pediatric patients using the BrainPath® system.

METHODS:
The departmental database was queried for patients who underwent resection of a hemorrhagic CM, AVM, or cerebral aneurysm through the BrainPath® tubular retractor system between January 2017 and September 2021. All patients underwent either postoperative MRI (for patients with CM) or digital subtraction angiography (for patients with AVM or aneurysm). Demographic and clinical characteristics, preoperative and postoperative imaging features, operative details, and surgical and clinical outcomes were extracted through a retrospective review of the medical records.

RESULTS:
Fourteen patients (mean [SD] age 32.3 [23.9] years; 7 (50%) female) underwent BrainPath®-based resection of a deeply seated CM (n = 7), AVM (n = 6), or ruptured cerebral aneurysm (n = 1). The mean maximal lesion diameter was 21.5 (12.6) mm. The mean operative time was 134 (53) minutes. Residual lesion was present in 2 patients, both of which underwent repeat BrainPath®-assisted surgery for complete resection. All lesions were completely resected or obliterated on postoperative MRI or digital subtraction angiography. At a mean follow-up of 4.1 (1.1) years, the median modified Rankin Scale score was 1 (range 0-6).

CONCLUSION:
In a well-selected cohort, we show the effective use of BrainPath® tubular retractors for resection or obliteration of subcortical hemorrhagic vascular lesions. This report further exemplifies the expanded role of the endoport system beyond that of intracerebral hemorrhage and tumor. Further study will elucidate the impact of this less-invasive brain retraction technique on clinical outcome in patients with vascular lesions.
DOES SHAPE SYMMETRY EXIST IN THE LUNATE BONE? TOWARDS DEVELOPMENT OF A PATIENT-SPECIFIC LUNATE IMPLANT
Authors: Tümer N. , Stok J. V. D. , Lima R. , Blom I. , Kraan G. 
Published: November 2024

IntroductionKienböck's disease is generally defined as the collapse of the lunate bone, and this may lead to early wrist osteoarthritis. Replacing the collapsed lunate with an implant has regained renewed interest with the advancing technology of additive manufacturing, enabling the design of patient-specific implants. The aims of this project are (1) to determine how accurate it is to use the contralateral lunate shape as a template for patient-specific lunate implants, and (2) to study the effects of shape variations wrist kinematics using 4D-computed tomography (CT) scanning.MethodsA 3D statistical shape model (SSM) of the lunate was built based on bilateral CT scans of 54 individuals. Using SMM, shape variations of the lunate were identified and the intra- and inter-subject shape variations were compared by performing an intraclass correlation analysis. A radiolucent motor-controlled wrist-holder was designed to guide flexion/extension and radial/ulnar deviation of ex vivo wrist specimens under 4D-CT scanning. In this pilot, three shape mode variations were tested per specimen in two specimens were. After post-processing each CT, the scapholunate angle (SLA) and capitolunate angle (CLA) were measured.ResultsThe shape of the lunate was not symmetrical, defined as exceeding the intra-subject variation in five different shape modes. The FE tests show a generalized increase in scapholunate and capitolunate angle when using lunate implants, and comparing variation of shape modes showed that shape mode 3 has a significant effect on the measured angles (p<0.05).DiscussionThe design of patient-specific lunate implants may prove to be challenging using a ‘mirror’-design as it will lead to a degree of shape asymmetry. The pilot study, to determine the effects of those shape variations on wrist kinematics suggest that the degree of shape variation observed indeed may alter the wrist kinematics, although this needs to be further investigated in study using more specimens.
UNRAVELING OSTEOARTHRITIC REMODELLING: MATRIX METALLOPROTEINASE -2,-3,-7 AT THE CORE OF PERICELLULAR MATRIX PROTEOLYSIS
Authors: Danalache M. , Umrath F. , Riester R. , Schwitalle M. , Guilak F. , Hofmann U. K. 
Published: November 2024

IntroductionChondrocytes are enveloped within the pericellular matrix (PCM), a structurally intricate network primarily demarcated by the presence of collagen type VI microfibrils and perlecan, resembling a protective cocoon. The PCM serves pivotal functions in facilitating cell mechanoprotection and mechanotransduction. The progression of osteoarthritis (OA) is associated with alterations in the spatial arrangement of chondrocytes, transitioning from single strings to double strings, small clusters, and eventually coalescing into large clusters in advanced OA stages. Changes in cellular patters coincide with structural degradation of the PCM and loss of biomechanical properties. Here, we systematically studied matrix metalloproteinases (MMPs), their distribution, activity, and involvement in PCM destruction, utilizing chondrocyte arrangement as an OA biomarker.MethodsCartilage specimens were obtained from 149 osteoarthritis (OA) patients, and selected based on the predominant spatial pattern of chondrocytes. Immunoassays were employed to screen for the presence of various MMPs (-1, -2, -3, -7, -8, -9, -10, -12, -13). Subsequently, the presence and activity of elevated MMPs were further investigated through immunolabeling, western blots and zymograms. Enzymatic assays were utilized to demonstrate the direct involvement of the targeted MMPs in the PCM destruction.ResultsScreening revealed increased levels of MMP-1, -2, -3, -7, and -13, with their expression profile demonstrating a distinct dependency on the stage of degeneration. We found that MMP-2 and -3 can directly compromise the integrity of collagen type VI, whereas MMP-3 and MMP-7 disrupt perlecan.ConclusionsPresence of both pro- and active forms of MMP-2, -3, and -7 in OA-induced patterns, along with their direct involvement in collagen type VI and perlecan degradation, underscores their crucial role in early PCM destruction. Given the early stages of the disease already exhibit heightened MMP expression, this understanding could inform early targeted therapies aimed at arresting abnormal PCM remodelling.AcknowledgmentsFaculty of Medicine of the University of Tübingen (grant: 2650-0-0).
DOES A NOVEL INTRAOPERATIVE NAVIGATION PLATFORM ALLOW TO RETAIN NATIVE KNEE FUNCTION FOLLOWING TOTAL KNEE ARTHROPLASTY?
Authors: Taylan O. , Louwagie T. , Bialy M. , Peersman G. , Scheys L. 
Published: November 2024

IntroductionThis study aimed to evaluate the effectiveness of a novel intraoperative navigation platform for total knee arthroplasty (TKA) in restoring native knee joint kinematics and strains in the medial collateral ligament (MCL) and lateral collateral ligament (LCL) during squatting motions.MethodSix cadaver lower limbs underwent computed tomography scans to design patient-specific guides. Using these scans, bony landmarks and virtual single-line collateral ligaments were identified to provide intraoperative real-time feedback, aided in bone resection, implant alignment, tibiofemoral kinematics, and collateral ligament elongations, using the navigation platform. The specimens were subjected to squatting (35°-100°) motions on a physiological ex vivo knee simulator, maintaining a constant 110N vertical ankle load regulated by active quadriceps and bilateral hamstring actuators. Subsequently, each knee underwent a medially-stabilized TKA using the mechanical alignment technique, followed by a retest under the same conditions used preoperatively. Using a dedicated wand, MCL and LCL insertions—anterior, middle, and posterior bundles—were identified in relation to bone-pin markers. The knee kinematics and collateral ligament strains were analyzed from 3D marker trajectories captured by a six-camera optical system.ResultBoth native and TKA conditions demonstrated similar patterns in tibial valgus orientation (Root Mean Square Error (RMSE=1.7°), patellar flexion (RMSE=1.2°), abduction (RMSE=0.5°), and rotation (RMSE=0.4°) during squatting (p>0.13). However, a significant difference was found in tibial internal rotation between 35° and 61° (p<0.045, RMSE=3.3°). MCL strains in anterior (RMSE=1.5%), middle (RMSE=0.8%), and posterior (RMSE=0.8%) bundles closely matched in both conditions, showing no statistical differences (p>0.05). Conversely, LCL strain across all bundles (RMSE<4.6%) exhibited significant differences from mid to deep flexion (p<0.048).ConclusionThe novel intraoperative navigation platform not only aims to achieve planned knee alignment but also assists in restoring native knee kinematics and collateral ligament behavior through real-time feedback.AcknowledgmentThis study was funded by Medacta International (Castel San Pietro, Switzerland).