bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcome of severe and critical covid patient receiving NIV or invasive ventilation
Authors: Saad Tarif Ahmed , Badr Salem Mohamed , Abdalrazik Fatmaalzahraa S. 
Published: November 2024

Abstract
Background
Oxygen support therapy plays a pivotal role in managing severe COVID-19 pneumonias causing respiratory failure. Non-invasive ventilation (NIV) strategies are commonly suggested methods to improve oxygenation in such patients.

Objective
We aimed to determine clinical outcomes in hypoxemic COVID-19 patients receiving non-invasive vs. invasive ventilation.

Material and methods
This cross-sectional study was conducted on 40 patients who tested positive by RT-PCR for SARS-CoV-2 RNA and required either invasive or NIV and admitted to the ICU of the 15th of May hospital for 3 months from June 2022 to August 2022. Patients were classified as: Severe: SpO2 < 90%, Pao2\FiO2 < 300, RR > 30, or lung infiltrate > 50%. Critical: the above criteria plus respiratory failure, septic shock, and\or multiorgan dysfunction.

Results
There was a significant difference between the two groups regarding shifting to another mode and ferritin levels. In the NIV group, seven patients were successfully discharged and only two patients were discharged in the invasive group. There was a significant difference between critical and severe regarding length of stay (ICU and Hospital). The Kaplan-Meier survival curve for dead cases showed that the mortality occurrence was significant in invasive ventilation than NIV group with mean duration free from death in NIV group 18.8 compared to 14.8 in the invasive ventilation group.

Conclusions
The NIV use in subjects with critical-to-severe COVID-19 was successful in most of the subjects and can be a safe treatment option. Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator-associated lung injury.
Germline Genetic Susceptibility Testing Among Emirati Nationals at Risk for Hereditary Breast and Ovarian Cancer Syndrome
Authors: Rawashdeh Rifaat R. , Pederson Holly , Iskanderian Rafal , Khan Fawad , Altrabulsi Basel , Ricci Stephanie , Eng Charis , Jallad Bassel , Al Mannaei Asma Ibrahim , Alameri Mohamed Salem , Attia Azza , Grobmyer Stephen R. 
Published: November 2024

PURPOSE
Breast cancer among Emirati patients is characterized by early-onset disease and later stages at presentation. Little is known about the germline genetic variants that may contribute to these observations. The goal of this study is to characterize the rate and implications of germline genetic variants among a cohort of Emirati patients at risk for hereditary breast and ovarian cancer syndrome.

MATERIALS AND METHODS
A retrospective study was performed to analyze the results of clinical germline genetic testing (March 2020-January 2023) among a cohort of consecutive Emirati patients at risk for hereditary breast and ovarian cancer syndrome: group A: patients with personal history of breast or ovarian cancer (n = 135); group B: unaffected patients with family history of breast or ovarian cancer (n = 37); and group C: patients presenting for cascade testing (n = 20). Management of patients identified to have pathogenic/likely pathogenic (P/LP) variants was analyzed.

RESULTS

The rate of P/LP germline variants for each group was: group A: 17.3%, group B: 16.6%, group C: 57.9%.
BRCA1
gene was the most commonly identified gene harboring P/LP variants, followed by
BRCA2
, among this cohort. Four unrelated patients had a recurrent
BRCA1
pathogenic variant: c.4065_4068del (p.Asn1355Lysfs*10). Only two patients in this series elected risk-reducing mastectomy and four patients elected risk-reducing bilateral salpingo-oophorectomy.

CONCLUSION
A higher rate of P/LP variants is seen among Emirati patients at risk for hereditary breast and ovarian cancer syndrome compared with reports of similar patients from Western populations. Efforts to increase utilization and awareness of germline genetic testing are warranted among Emirati patients.
Cranial Nerve IX and X Neurectomy for Glossopharyngeal Neuralgia: Case Report and Operative Video
Authors: Patel Bhuvic , Pugazenthi Sangami , Dowling Joshua 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Glossopharyngeal neuralgia (GPN) is a rare condition that is often misdiagnosed as trigeminal neuralgia. The condition is characterized by intermittent, severe pain in the distribution of the glossopharyngeal nerve. We present an illustrative case of GPN with an operative video detailing neurectomy of the glossopharyngeal nerve and the upper rootlets of the vagus nerve for treatment of idiopathic GPN in a patient with a history of squamous cell carcinoma.

CLINICAL PRESENTATION:
A 62-year-old man with a history of left mandibular alveolar squamous cell carcinoma status postresection presented with left-sided severe, paroxysmal pain in the posterior one-third of his tongue refractory to medical treatment and without evidence of recurrent malignancy or vascular compression on imaging studies. After he failed medical management, glossopharyngeal neurectomy was performed through a left suboccipital craniotomy during which cranial nerves IV, V, VI, VII/VII, IX, X, and XI were visually inspected for malignant recurrence, and the glossopharyngeal nerve and the upper 2 to 3 nerve rootlets of the vagus nerve were severed. The patient had immediate, complete, and durable resolution of his symptoms without any new neurological deficits.

CONCLUSION:
Glossopharyngeal neurectomy has been shown to be an efficacious surgical treatment for GPN, as first described by Walter Dandy in 1920. In this report, we describe the workup and treatment of GPN with important diagnostic considerations and present a detailed video demonstrating technical and anatomic considerations when performing glossopharyngeal neurectomy.
The Risk Analysis Index Has Superior Discrimination Compared With the Modified Frailty Index-5 in Predicting Worse Postoperative Outcomes for the Octogenarian Neurosurgical Patient
Authors: Yocky Alyssa G. , Owodunni Oluwafemi P. , Courville Evan N. , Kazim Syed Faraz , Schmidt Meic H. , Gearhart Susan L. , Greene-Chandos Diana L. , George Naomi , Bowers Christian A. 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Healthcare systems continuously strive to improve quality and value of care. Advances in surgical technologies, enhanced perioperative surgical planning, and multidisciplinary care strategies are increasing the number of elective procedures in the geriatric population. However, frail older adults are still more likely to have poor postoperative outcomes. We examined the impact of frailty on postoperative outcomes, we compared the discriminative thresholds for the Risk Analysis Index (RAI), modified Frailty Index-5 (mFI-5), and increasing patient age.

CLINICAL PRESENTATION:
Octogenarian patients undergoing spine, cranial, and other procedures captured in the American College of Surgeons National Surgical Quality Improvement Program between 2012 and 2020 were included. We used receiver operating characteristic curve to examine discriminative thresholds of RAI, mFI-5, and increasing patient age. Multivariable analyses were performed. Our primary outcomes were 30-day mortality, extended length of stay (eLOS [≥75th percentile]), and continued inpatient care >30 days (pLOS). Secondary outcomes were skilled care facility (skilled nursing facility [SNF]) discharges and readmissions.

DISCUSSION:
In total, 20 710 octogenarians were included, with a mean age of 83 years (SD, 2.5) and a men (52.7%) and White (79.8%) majority. The RAI had higher predictive discriminative thresholds for 30-day mortality (C-statistic of 0.743), eLOS (C-statistic: 0.692), and pLOS (C-statistic: 0.697) compared with the mFI-5 (C-statistic: 0.574, 0.556, and 0.550, respectively), and increasing patient age (C-statistic: 0.577, 0.546, and 0.504, respectively), P < .001. On multivariable analyses, RAI showed a larger effect size with adverse postoperative outcomes by increasing frailty strata than mFI-5 and increasing patient age. Nonetheless RAI showed decreased risk for SNF discharges.

CONCLUSION:
We found that RAI was a more accurate predictor than mFI-5 and increasing patient age for 30-day mortality, eLOS, and pLOS in octogenarian neurosurgery patients. More research is needed on RAI's performance in different specialized neurosurgical populations. Moreover, it is increasingly clear that comprehensive risk assessment strategies tailored to optimize perioperative care should be prioritized to potentially improve outcomes for this at-risk population.
Cisterno-Ventricular Lavage After Aneurysm Clipping for the Prevention of Delayed Infarction in Patients With Subarachnoid Hemorrhage
Authors: Scheiwe Christian , Grauvogel Jürgen , Csók István , Fistouris Panagiotis , Fung Christian , Beck Jürgen , Reinacher Peter C. , Roelz Roland 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Cerebral infarction due to delayed cerebral ischemia (DCI) is an important source of morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Breakdown products of cisternal and ventricular blood are putative triggers of cerebral vasospasm, which may progress to cerebral infarction. Therefore, intracranial blood clearance is a promising treatment approach. Surgical clipping of aneurysms of the anterior circulation grants access to the basal cisterns of the brain, allowing placement of cisterno-ventricular catheters (CVCs) for postoperative irrigation therapy. Here, we report on the implementation of this simple technique to enable clearance of subarachnoid and ventricular blood.

METHODS:
Twenty patients with aSAH were selected for intraoperative placement of a CVC through the fenestrated lamina terminalis after aneurysm clipping. Continuous irrigation was performed using the fibrinolytic urokinase and, on detection of vasospasm, nimodipine. All consecutive patients with aSAH with aneurysm clipping admitted between 2008 and 2015 served as controls. The primary end point was occurrence of cerebral infarction due to DCI.

RESULTS:
Placement of the CVC and application of lavage therapy were feasible and safe in all patients because no adverse events were observed. Cerebral infarction due to DCI occurred in 0/20 patients (0%) selected for lavage therapy vs 46/223 patients (20.6%) in the control cohort (P = .017). Shunt-dependent hydrocephalus occurred in 2/17 survivors (12%) from the CVC group vs 44/187 (23.5%) in the control group (P = .37).

CONCLUSION:
Clipping of ruptured aneurysms of the anterior circulation allows placement of a CVC through the fenestrated lamina terminalis and postoperative lavage therapy. The risks of infarction due to DCI can be mitigated using this simple intraoperative approach.
Topical Vancomycin as a Tool for the Prevention of Surgical Site Infections in Cranial Neurosurgery: A Retrospective Cohort Study
Authors: Leal-Isaza Juan Pablo , Garcia Rairan Luis , Ramírez-Sanabria Andrés David , Mejía-Michelsen Isabella , Camargo Julian , Araque Yessid , Pedraza María Camila , Mendoza Juliana , Fonseca Pierre , Ramírez-Arquez Ericka , Nicolas Campo Teo , Quiñones-Ossa Gabriel Alexander , Mattar M. Salvador , Davidson Juan Sebastian , Gómez-Amarillo Diego Fernado , Mejía Cordovez Juan Armando , Hakim Daccach Fernando , Ramon Cuellar Juan Fernando , Jimenez Hakim Enrique 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Surgical site infections (SSI) in neurosurgery result in prolonged hospitalizations, readmissions, poor outcomes, and even death. Prevention of SSI remains paramount to mitigate the risk of this complication. In this study, we aimed to evaluate the effect of topical use of vancomycin powder during surgical closure in cranial surgery for the reduction of SSI.

METHODS:
This is a retrospective cohort study of cranial neurosurgical patients from 2016 to 2022 in Fundación Santa Fe de Bogotá. Baseline clinical and surgical characteristics were collected, as well as vancomycin powder use. The primary outcome of interest was SSI within 90 days after surgery. A P value of .05 was considered significant.

RESULTS:
We found a total of 1395 patients, of which 1108 met the selection criteria. Surgical site infection was seen in 32 patients (2.9%). Topical use of vancomycin powder during surgical closure was associated with a lower frequency of SSI in cranial surgery n = 10 (2.3%) relative to those who did not use vancomycin n = 22 (3.3%), and it was found to be a protective factor in the multinomial regression, with a statistically significant result (relative risk = 0.397, P = .034).

CONCLUSION:
The evidence supporting the use of vancomycin powder during surgical closure is currently weak, as the association did not reach statistical significance in the primary analysis. However, a P value of less than 0.05 was obtained in the multivariate analysis. To further assess the efficacy of this intervention, additional randomized prospective studies are needed.
Subarachnoid Hemorrhage Because of Ruptured Multiple Peripheral Fusiform Aneurysms Associated With Systemic Lupus Erythematosus: A Case Report
Authors: Hirose Yuki , Hashimoto Koji , Murase Ryota , Yoshioka Hideyuki , Wakai Takuma , Tateoka Toru , Ogiwara Masakazu , Kinouchi Hiroyuki 
Published: November 2024

BACKGROUND AND IMPORTANCE:
In rare cases, systemic lupus erythematosus (SLE) can cause subarachnoid hemorrhage (SAH) because of aneurysm rupture. Such aneurysms are most commonly located in the posterior circulatory system, but can occur extremely rarely in the spinal vascular territory.

CLINICAL PRESENTATION:
We describe a patient with SLE who had a sudden onset of posterior neck pain. Cranial computed tomography and MRI showed SAH, but no aneurysm could be identified on computed tomography angiography or magnetic resonance angiography. Digital subtraction angiography (DSA) revealed multiple small fusiform aneurysms in the spinal vascular territory, which were treated conservatively without rebleeding. One year later, the patient suffered from recurrent SAH. On DSA, the fusiform aneurysms seen at the previous admission had disappeared and a de novo small fusiform aneurysm was observed in the anterior spinal artery. Conservative treatment was performed, and rebleeding was not observed thereafter. On follow-up DSA performed 2 weeks later, the aneurysm had decreased in size.

CONCLUSION:
In SLE, spinal arteriography should be performed to evaluate the possible development of peripheral fusiform aneurysms in the spinal vascular territory associated with vasculitis, and careful follow-up is necessary considering the risk of rebleeding because of de novo aneurysms.
Time-Spatial Labeling Inversion Pulse (Time-SLIP) MRI for Evaluating Cerebrospinal Fluid Velocity and Visualizing Flow Dynamics in Patients With Chiari Type I Malformation
Authors: Inoue Tatsushi , Joko Masahiro , Murayama Kazuhiro , Ikedo Masato , Saito Fumiaki , Muto Jun , Takeda Hiroki , Kaneko Shinjiro , Hirose Yuichi 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Phase-contrast MRI is unstable and is not widely implemented in the imaging of Chiari malformation type I (CM-I) because of its low signal-to-noise ratio and the need for subsequent additional averaging. Time-spatial labeling inversion pulse MRI (T-SLIP MRI) is an emerging imaging modality with a high signal-to-noise ratio. This study is the first to examine cerebrospinal fluid (CSF) dynamics on the basis of velocity exclusively in patients with CM-I using T-SLIP MRI before and after posterior fossa decompression.

METHODS:
Eleven patients with CM-I underwent T-SLIP MRI before and/or after posterior fossa decompression. CSF dynamics were analyzed at 5 points around the craniovertebral junction. T-SLIP measurements included (1) targeted CSF labeling; (2) manual frame-by-frame annotation of the labeled CSF wave; (3) description of CSF flow in terms of wave functions calculated using computation software; and use of this function for (4) calculation of CSF velocity (rostral and caudal peak), total distance traveled by labeled CSF, and mean CSF velocity (

). Differences between preoperative and postoperative peak velocity (rostral and caudal) and

were assessed using paired t-test.

RESULTS:
Rostral and caudal peaks significantly increased at 2 of the 5 points (40%), whereas

significantly increased at 4 points (80%), altogether covering all observation points with significant changes. CSF filling the syrinx through the syrinx wall from the spinal subarachnoid space and complex CSF flow at the dorsal craniovertebral junction were captured preoperatively and postoperatively, respectively.

CONCLUSION:
T-SLIP MRI data for patients with CM-I were successfully quantified on the basis of velocity. Tailor-made optimal decompression should be pursued based on both T-SLIP data with high accuracy and bibliographical craniometric data with surgical outcomes, which can now be easily and comprehensively analyzed using machine learning.
Analysis of Surgical Smoke Generated by Electrocautery in a Simulated Neurosurgical Operating Room Using a Postmortem Porcine Model for Laminectomy and Craniotomy Exposures: A Preliminary Study
Authors: Levy Bennett R. , Monteiro Andre , Jaikumar Vinay , Donnelly Brianna M. , Smolar David E. , Lim Jaims , Mullin Jeffrey P. , Levy Elad I. 
Published: November 2024

BACKGROUND AND OBJECTIVES:
Electrocautery is a widely used tool to coagulate and separate tissue during neurosurgical procedures. Surgical smoke generated by electrocautery has harmful properties if inhaled over long-term. To our knowledge, no efforts have been made within the neurosurgery field to investigate the air quality of operating rooms (ORs) where neurosurgical procedures are being performed. We analyzed the presence and quantitation of volatile organic compounds and respirable dust in surgical smoke generated by electrocautery use during a neurosurgical OR simulation for laminectomies and craniotomies and evaluated whether surgical masks can adequately prevent inhalation of such substances.

METHODS:
Two laminectomy exposures and two bicoronal exposures were performed in two freshly euthanized pigs using electrocautery in a simulated neurosurgical OR. In each of the four neurosurgical procedure models, air sampling media and pumps were connected to a 3D-printed human face model. In two of these models, the face was covered with a standard surgical mask; in the other two models, no masks were placed. The models were positioned at a distance of 40 cm from the surgical field. Air samples were analyzed by an independent laboratory. Analyses of total amounts of respirable dust and 31 organic volatile compounds were conducted. The mean total amounts of the samples obtained from the masked and nonmasked models were compared.

RESULTS:
In the two masked and two nonmasked models, all 31 organic volatile compounds were below the levels of quantitation. The total amounts of respirable dust were higher in the two nonmasked models than in the two masked models.

CONCLUSION:
The total amount of organic volatile compounds seems to be low at the distance measured regardless of mask use; however, further studies are needed to determine whether even small amounts can be harmful over time. Standard surgical masks reduced the amounts of inhalable respirable dust.
Supplementary Motor Area Syndrome After Resection of a Dominant Hemisphere Parasagittal Meningioma: A Case Report
Authors: Walker Samantha E. , Kaoutzani Lydia , Vale Fernando L. 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Supplementary motor area (SMA) syndrome is a common, transient postoperative complication of intra-axial tumor resections involving the SMA and posterior cingulate gyrus. It is also reported as a rare complication of resecting extra-axial lesions. Meningiomas represent the most common, nonmalignant primary central nervous system tumor in adults, which present most commonly in parasagittal locations. Resection of dominant hemisphere parasagittal meningiomas overlying or infiltrating into the SMA region carry a recognizable risk for developing SMA syndrome postoperatively.

CLINICAL PRESENTATION:
We present a 58-year-old woman with intermittent headaches and concern for new-onset seizures. MRI demonstrated an extra-axial mass involving the left frontal convexity and SMA region with homogenous postcontrast enhancement. There was radiographic involvement of the superior sagittal sinus and inner table of the skull. Fluid-attenuated recovery signal and perilesional vasogenic edema were also noted. The imaging findings favored a parasagittal meningioma, and surgical resection was performed. Arachnoid invasion and pial infiltration of the tumor over the SMA were evident during the operation.

CONCLUSION:
A detailed understanding of the functional neuroanatomy and clinical pathophysiology of eloquent cortical regions is important for preoperative planning and patient counseling. Surgical resection of lesions in such areas can result in rare complications uniquely implicated in specific patient subsets. Recognizing these patients in the preoperative setting is imperative for proper counseling of patients and families.
Complete Clival Resorption and Pontine Pneumatosis Secondary to Severe Cocaine-Induced Midline Destructive Lesion: A Case Report
Authors: Almansouri Abdulrahman , Tham Alex , Abobotain Abdulaziz , Almarwani Mashael , Tewfik Marc , Sirhan Denis 
Published: November 2024

BACKGROUND AND IMPORTANCE:
Cocaine-induced midline destructive lesions manifest as various degrees of distortion to normal anatomy. We present a rare case of substance-induced clival defect that underwent surgical repair.

CLINICAL PRESENTATION:
This patient presented with transient neurological deficits and was found to have severe clival destruction and pontine pneumatosis secondary to prolonged cocaine use. Surgical reconstruction of the clival defect was performed using a combined open and endoscopic approach.

DISCUSSION:
When anatomical integrity is severely compromised, defects of the clival region can be repaired using a hybrid open-endoscopic approach. In this case, the lack of local mucosal tissue for reconstruction led to the use of a pedicled pericranial flap.

CONCLUSION:
Complete clival resorption secondary to cocaine use is uncommon. In advanced cases, pontine inflammation is present on imaging studies. Combined endoscopic and open clival reconstruction is effective in restoring anatomic integrity.