bluuebunny/crossref_metadata_2025_split huggingface dataset:
391 Intraarterial Verapamil for Neuroprotection in Ischemic Stroke
Authors: Newman Madison , Binning Mandy Jo , Veznedaroglu Erol , Liebman Kenneth M. , Hakma Zakaria , Rahme Rudy J. , Ross Jennifer 
Published: March 2024

INTRODUCTION:
Verapamil is an FDA-approved calcium channel blocker administered for the standard-of-care treatment of vasospasm. Preclinical studies have shown that verapamil reduces inflammation and protects penumbra neurons from further damage and eventual death.

METHODS:
Patients were recruited based on inclusion and exclusion criteria in a clinical protocol reviewed and approved by two institutional review boards. The final cohort comprised 42 emergency care patients with an acute onset focal neurological deficit consistent with ischemic stroke and/or a computed tomographic scan consistent with acute cerebral ischemia. All patients were 18 years of age or older that presented within 24 hours of symptom onset and had a significant but not severe neurological deficit, measured by a National Institutes of Health Stroke Scale (NIHSS) score greater than four but less than 22. All patients received a mechanical thrombectomy intervention after identifying a large vessel occlusion (LVO).

RESULTS:
The Verapamil-treated group (N = 23) included 22 patients with middle cerebral artery (MCA) occlusions and 1 with a basilar posterior cerebral artery (PCA) occlusion. In these patients, investigators administered 10 mg of Verapamil intraarterially following mechanical thrombectomy. Patients exposed to control conditions (N = 19) were matched for age, biological sex, admission NIHSS score, occlusion location, administration of tPA, and achieved TICI score. Intraarterial Verapamil treatment did not significantly increase sICH, hemorrhagic transformation, or death compared to standard of care treatment, demonstrating safety in an acute ischemic stroke patient population. Verapamil treatment was associated with significantly greater changes in mRS score, improved recovery time, and shortened length of hospital stay compared to standard-of-care treatment.

CONCLUSIONS:
This study suggests that verapamil is a safe and effective neuroprotective drug in ischemic stroke clinical populations that require mechanical thrombectomy for treatment.
392 Validation of a Mathematical Model for Rupture of Spherical Intracranial Aneurysms
Authors: Street Seth , Johnson Mark D. , Palmisciano Paolo , Schaffer Lauren , Dierker David , Prestigiacomo Charles J. 
Published: March 2024

INTRODUCTION:
An accurate mathematical model of intracranial aneurysm (IA) mechanics is of great value for its potential utility in assessing probability of IA rupture, thus informing the decision to pursue surgical intervention with its associated risks. Such a model for spherical IAs has been proposed which predicts a wall-thickness-to-IA-radius ratio (WTR) of 6.1*10-3 at which IAs rupture (Chaudhry et al. 2006). To our knowledge, no further work has been done to validate this model with clinical data. We assess the accuracy of this model using cases of ruptured and unruptured IAs.

METHODS:
Aneurysm height, width, neck diameter, and vessel radius were measured on CTAs/MRAs/DSAs of IAs of the basilar tip, anterior communicating, and posterior communicating arteries. Binary logistic regression analysis was performed to determine the WTR where there is a 50% probability of rupture.

RESULTS:
52 unruptured and 28 ruptured spherical IAs were included. Binary logistic regression revealed a strong association between decreased WTR and rupture status. The point at which there is a 50% chance of rupture was found to be WTR = 8.6*10-3, from which the proposed 6.1*10-3 differs by only 29%.

CONCLUSIONS:
The model for IA rupture mechanics proposed by Chaudhry et al. agrees reasonably well with clinical data and could serve as a foundation upon which further investigation may be based. This study was limited primarily by its method of approximating aneurysm wall thickness, which may have over- or under-estimated the actual thickness. Future studies may improve on this by utilizing direct measurements of wall thickness through histological examination.
396 Creating a High-Precision, Dynamic Machine Learning Model Using Time Series Data to Predict Cerebral Vasospsm in Aneurysmal Subarachnoid Hemorrhage
Authors: Sen Rajeev D. , McGrath Margaret , Wang Lucy , Shenoy Varadaraya , Meyer R. Michael , Kim Louis J. , Levitt Michael Robert , Sekhar Laligam N. 
Published: March 2024

INTRODUCTION:
Cerebral vasospasm (CV) occurs in up to one-third of patients who suffer from aneurysmal subarachnoid hemorrhage (aSAH) and can result in significant morbidity. Prior attempts to predict CV after aSAH have failed because they use static data collected on the day of presentation. We hypothesize that trending clinical and radiographic data including transcranial dopplers (TCDs) throughout 14 intensive care unit (ICU) days can be used to create a highly predictive, dynamic machine learning model for CV.

METHODS:
We conducted an IRB-approved retrospective study including 428 patients with aSAH hemorrhage treated at our institution between June 2014 and December 2018. For each patient, 74 features were trended including vital signs, lab values and ventriculostomy output. TCD measurements included anterior and posterior circulation velocities, Lindegaard Ratios and pulsatility indices. We employed a generative transformer-based model that uses patient representations from aggregate prior time points to predict the likelihood of CV.

RESULTS:
Of the 428 aSAH patients, 85 had angiographic-proven CV. There was no difference in demographic features including age, gender distribution and BMI between the CV and no-CV groups. Throughout 14 ICU days, the CV patients consistently displayed elevated mean arterial pressure and cerebral perfusion pressure. All TCD measurements were higher for the CV group. Initial logistic regression models based on static data from post-ictus days 1 through 4 showed steadily increasing F1 scores from 0.67 to 0.76. Feature analysis identified Lindegaard Ratios as the most heavily weighted features.

CONCLUSIONS:
Daily TCDs paired with additional longitudinal clinical data can be used to create a high-precision dynamic machine learning model for predicting CV after aSAH. These methods could also permit identification of patients at low risk of CV for reduced ICU length of stay.
399 Infundibulum Study: A Retrospective Analysis of Cerebral Vascular Infundibula. An Analysis on Growth and Its Significance at an Australian Tertiary Neurosurgical Centre
Authors: Yousif Saif , Vile Alex , Pattavilakom Anathababu , Jayalath Rumal 
Published: March 2024

INTRODUCTION:
Debate exists regarding the natural history of cerebral infundibula. Pre-aneurysmal lesions and benign anatomical variants have both been proposed. To date there are no large cohort studies defining natural history.

METHODS:
Retrospective surveillance infundibula were undertaken in a single tertiary cerebrovascular centre. All Infundibula diagnosed on either MRA, CTA or DSA and followed up for 5 years were eligible for inclusion. Radiological and demographic characteristics were recorded at baseline. Infundibula growth, rupture and aneurysmal formation were outcomes of interest. Kaplan Meir curves were used to assess variables of interest with respect to time on surveillance. Groupwise comparison as conducted via Fischer exact testing.

RESULTS:
420 cerebral infundibula were followed prospectively, across 402 patients over 2418 infundibula-years. Eleven (2.62%) grew on surveillance, and three (0.7%) formed de-novo aneurysms. Median time to growth was 85 months (36-263) and median time to aneurysm formation was 112 months (96-142). Of the Infundibula that grew, the proportion that were male sex was significant higher compared to those that did not (p < 0.007). Of the Infundibula that grew in surveillance, 2/11 (18.2%) formed aneurysms (p = 0.001). With respect to Kaplan Meir analysis, male sex remained a significant predictor of growth (p = 0.007) and growth on surveillance (p < 0.001) remained a significant predictor of aneurysm formation.

CONCLUSIONS:
Growing infundibula are high risk of forming aneurysms and warrant ongoing surveillance.
402 Minimally Invasive Parafasicular Surgery for Hemorrhagic Stroke. First Experience. From January 2018 to December 2022. Panama
Authors: De Leon Alvino , Wong Eduardo 
Published: March 2024

INTRODUCTION:
Hemorrhagic stroke represents 10-15% of all strokes, with a mortality of 40% and independence of 25% at six months, and represents a significant burden for public health. Minimally invasive surgery (MIS) methods through parafasicular approaches are a new option.

METHODS:
A prospective study from January 2018 to December 2020. The evaluation includes age, gender, comorbidities, GCS, and mRS scales. CT was the only form of imaging, establishing size, signs of intracranial hypertension, hydrocephalus, intraventricular bleeding, and surgical planning. The craniotomy is done through craniometrics points, and employing a tubular port for the parafasicular approach was done within the first 24 hours. The ultrasound, microscope, and endoscope were used. The objective was the reduction of the hematoma to less than 15cc. The postoperative period was semi-intensive.

RESULTS:
25 patients were included, mean age 56 years, 56% men and 44% women. Location: 5 frontal, 18 basal nuclei, and 2 temporal. 60% left. 32% intraventricular extension. The average ICH Score was 1.84. The average volume was 50 cc. Mean GCS of 10 and mean mRS of 4. The mean ICH reduction was 95%, and the mean residual volume was 2.4cc. Not deceased. A reoperation. Larger ICH and intraventricular hemorrhage had a worse outcome (p = 0.01 and p = 0.04). Higher ICH Scores were associated with a worse outcome than those with a lower score (2.4 vs. 1.5; p = 0.008). Average follow-up of 4 months. Mean mRS at the discharge of 4 and the follow-up of 3 GCS in the follow-up of 14.

CONCLUSIONS:
MIP surgery reduces the size of the hematoma, improves the quality of life, and is safe.
404 Mobile Pupillometry for Detection of Vasospasm, Delayed Cerebral Ischemia, and Neuro Exam Change in Subjects With Aneurysmal Subarachnoid Hemorrhage
Authors: Maxin Anthony , Gulek Bernice G. , Shaibani Rami , McGrath Lynn , Abecassis Isaac Josh , Levitt Michael Robert 
Published: March 2024

INTRODUCTION:
The pupillary light reflex (PLR) parameters are quantitative biomarkers that can be used to detect neurological disease. Vasospasm complicates aneurysmal subarachnoid hemorrhage (aSAH) trajectory, causing morbidity and mortality.

METHODS:
We prospectively collected PLR parameters from patients with aSAH admitted to a neurological intensive care unit twice daily using quantitative smartphone pupillometry recordings. PLR parameters included: Maximum pupil diameter (MAX), minimum pupil diameter (MIN), percent change in pupil diameter (CHANGE), latency in beginning of pupil constriction to light (LAT), mean constriction velocity (MCV), maximum constriction velocity (MAXCV), mean dilation velocity (MDV). One-tailed t-tests were performed to determine changes in PLR parameters between the following comparisons: (1) patients with and without radiographic vasospasm (defined by computed tomography angiography (CTA) or digital subtraction angiography (DSA)); (2) patients with and without delayed cerebral ischemia (DCI); and (3) patients with and without neurological exam change due to vasospasm.

RESULTS:
42 total subjects were enrolled. For patients with (n = 13) and without (n = 29) radiographic vasospasm, significant PLR parameter differences were observed in: MAX (p = .024) and MIN (p = .0018). For patients with (n = 14) and without (n = 28) DCI, significant PLR parameter differences were observed in: CHANGE (p = .008). For patients with (n = 13) and without (n = 29) neurological exam change due to vasospasm, significant PLR parameter differences were observed in: MIN (34.7 vs 31.7, p = .014), CHANGE (20.6 vs 24.7, p = .025), and LAT (.36 vs .2, p = .0002). All other PLR parameters were not significantly different between groups for the three comparisons.

CONCLUSIONS:
Quantitative smartphone pupillometry may be of clinical use in the detection of radiographic vasospasm, DCI, and neuro exam changes via separate and distinct parameters from the PLR.
410 Can a Universal Width Fit all? Exploring Optimal Dimensions for Cervical Disc Arthroplasty Implants
Authors: Ibrahim Sufyan , Nieves Antonio Bon , Nathani Karim , Bhandarkar Archis R. , Graepel Stephen , Freedman Brett , Bydon Mohamad 
Published: March 2024

INTRODUCTION:
Given the wide spectrum of implant widths, which are typically coupled to specific height and/or depth dimensions, and the desire to match native bony anatomy, as opposed to resecting/burring the bones to achieve implant-fit, there is need to clearly delineate subaxial cervical anatomy, especially at superior endplate (SEP).

METHODS:
Scans of the cervical spines from a convenience sample of 50 young, healthy patients (29 males, 21 females), aged 23-28 years (mean: 25.1±1.3 years), with mean BMI of 30.44 kg/m2, who underwent CT for negative trauma evaluations. The following measurements were estimated.

RESULTS:
The mean IUD at the posterior-third(A3), was the limiting width at all levels, which only increased from 11.3 ± 2 mm at C4 to 13.4 ± 2.9 mm at C7. The 3rd quartile of mean A3 distance were: C4–12.61 mm, C5–13.38 mm, C6–15.18 mm, C7–15.25 mm. A1 and A2 were both greater than 14 mm in majority of the subjects (C4–50%, C5–56%, C6–72%, C7–90%), whereas A1 and A2 were >17 mm (most contacted depth by all marketed implants) only in 2% at C4, 4% at C5, 16% at C6 and 44% at C7. While linear parameters differed significantly between the male and female sex, there was no statistically significant difference in mean A3 at any level (all p > 0.05). There also was no appreciable statistically significant difference between measured indices when grouped by BMI category.

CONCLUSIONS:
IUD increases from cephalad-to-caudad but reduces from anterior-to-posterior at each level. For vast majority, regardless of gender/BMI, the IUD is at least 14 mm, especially in most commonly CDA-treated disc spaces(C5-6, C6-7), suggesting that 14 mm could serve as "one-width" for all CDAs, especially since primary goal of the arthroplasty is to create proper width-fit of implant without bony resection.
418 CXCL-10 Influences Local Regulation of Neuroinflammation After Intracranial Hemorrhage
Authors: Barker William , Wolfe Stacey Q. , Xiang Zhidan , Ma Renate , Yager Brock , Diz Debra 
Published: March 2024

INTRODUCTION:
Mitigating secondary injury from neuroinflammation is a critical investigation to identify therapeutic targets and improve ICH outcomes. Plasma CXCL10, a chemokine of chemo-attraction for monocytes/macrophages, T cells, and NK cells, is significantly elevated in hypertensive patients; therefore, we investigated the role of CXCL10 in local neuro-inflammation after hypertensive ICH. Furthermore, it is also vital to understand the local effects of common risk factors of ICH such as hypertension and cardiometabolic disease on pro-inflammatory chemokines.

METHODS:
A pilot study of autologous-injection ICH was induced in hypertensive (mREN2)7 (n = 5) and normotensive Hanover Sprague-Dawley male rats (n = 5). Tail-cuff blood pressure measurements and pre- and post-ICH neurobehavioral testing was performed. Rat sacrifice was performed at 5 days post-ICH with subsequent homogenization of hematoma area and contralateral area (2 mm brain slice around injection site). Hemoglobin was measured using whole hemispheres, but small slices were used for assessing immune inflammation. Lastly, qPCR testing was performed to determine CXCL-10 level of expression.

RESULTS:
CXCL-10 was significantly different in the local ipsilateral hemisphere of both the cardiometabolic mREN model (P = 0.012) and control SD (P = 0.025) rats compared to the contralateral hemisphere at 5 days post-ICH. There was no significant difference in CXCL-10 expression between SD and mREN rat models in contralateral or ipsilateral hemispheres.

CONCLUSIONS:
Cerebral CXCL-10 levels ipsilateral to ICH are significantly elevated compared to the contralateral hemisphere indicating the locally injured brain tissue expressed CXCL-10 to recruit immunocyte infiltration. CXCL-10 elevation does not appear to be influenced by comorbidities of cardiometabolic disease or hypertension. These results implicate CXCL-10 mediated processes such as activation and recruitment of leukocytes in post-ICH secondary injury, which may prove to be an important therapeutic target.
429 Sub-internship Academy: Implementation and Evaluation of Single-Day Resident-Driven Focused Sub-internship Preparation Course
Authors: Gal Zsombor Tamas , Nanda Pranav , Hsueh Brian , Robertson Faith C. , Razak Shahaan S. , Mazurek Mercy H. , West Timothy , Perez Nicole , Coumans Jean-Valery , Jones Pamela Stuart , Shankar Ganesh , Stapl Christopher James 
Published: March 2024

INTRODUCTION:
Strong performance in neurosurgical sub-internships requires familiarity with clinical and technical skills which may not otherwise be covered in standard medical school curricula. Thus, a need exists for immersive and comprehensive sub-internship preparation programs, which should be optimized based on student feedback.

METHODS:
Academy curriculum involved hands-on and discussion-based elements split into three stations: (1) suturing and general information, including a suturing and knot tying workshop and discussion of expectations of sub-interns; (2) introduction to the operating room and drilling, covering patient positioning, surgical technology, OR etiquette, and craniotomy basics; and (3) cases and clinical skills, reviewing clinical imaging, focused neurological exams, and medical note writing. An anonymous online post-survey was administered to collect data on participants’ perceptions of the utility of the academy.

RESULTS:
Twelve medical students participated in the inaugural neurosurgery sub-internship academy. Nine responded to a post-survey, which revealed following ratings: the overall program was rated as having maximal impact on sub-internship readiness and enthusiasm for neurosurgery by eight (88.9%) and seven (77.8%) respondents, respectively, and trends were comparable for individual curriculum components. A largely positive impact on mentorship access was also observed.

CONCLUSIONS:
Student perceptions of the relevance and utility of the sub-internship academy were positive, and the program fostered enthusiasm for neurosurgery and opportunities for mentorship. Evaluation of the program’s actual impact on preparedness and sub-internship performance as well as student retention in the field of neurosurgery will be performed in the future, in accordance with the Kirkpatrick model of training evaluation.
430 Academic Productivity of Neurosurgical Trainees Is Associated With Productivity of Gender Concordant Faculty
Authors: Bauer Isabel L. , Nosova Kristin , Deaver Courtney , Pico Annie , Challapalli Mahesh K. , Jukic Alma , Russell Rachel , Kern Ashley , Okonya Tracy , Fabrega Sofia del Carmen , Ramaiah Priya , Kenner Haley , Mamaril-Davis James , Seideman Travis , Kelber James 
Published: March 2024

INTRODUCTION:
Mentorship disparity is a commonly cited barrier to female neurosurgery trainees. The extent to which gender concordance with faculty impacts trainees’ academic productivity is underexplored.

METHODS:
The website of each ACGME accredited neurological surgery residency program was queried to identify the name and gender of all current (2022-2023) neurosurgical residents and academic faculty. Academic productivity, defined as the number of publications per person between 2021-2023 in 15 neurosurgery journals, was compiled into an original database. For each program, the average number of publications per female and male faculty and resident were recorded. Pearson correlation coefficients were calculated.

RESULTS:
A total of 959 faculty (female: 121, 12.6%) and 790 residents (female: 179, 22.7%) across 112 programs were identified. Forty (38%) programs had no female faculty; 32% had no female residents. The absence of female faculty was not statistically associated with the absence of female residents. In programs with only male faculty, academic productivity of male attendings was negatively associated with that of female residents (-0.47, p 0.0104).

CONCLUSIONS:
Academic productivity of male faculty correlates with productivity of male residents in their program; this relationship is not observed between faculty and residents of opposite genders. In programs with only male faculty, faculty productivity is inversely correlated with productivity of female residents. These findings reveal limited collaboration between residents and faculty of the opposite gender as a potential barrier to academic productivity. Furthermore, efforts to promote effective cross-sex collaboration could increase productivity for all members of neurosurgery divisions.
431 The Role of Stroke Prophylaxis in Traumatic Vertebral Artery Injury: A Literature-Based Cohort Study
Authors: Bambakidis Peter , Katsos Konstantinos , Michalopoulos Giorgos , Pennington Zach , Lakomkin Nikita , Meyer Fredric B. , Bydon Mohamad 
Published: March 2024

INTRODUCTION:
Vertebral artery injury (VAI) can precipitate posterior circulation strokes acutely following blunt trauma. VAI severity is conventionally classified by the Denver grading system, but at present, there remain no guidelines that translate Denver injury grade to antiplatelet or anticoagulant recommendations.

METHODS:
Four databases (Ovid MEDLINE, Ovid Embase, Cochrane Central, and Scopus) were queried to identify all studies evaluating stroke risk following blunt VAI. Stroke rates following VAI were compared for patients managed with observation only or antiplatelets. Sub-analyses stratifying outcomes by injury severity (Denver grade) were performed. Effectiveness of antiplatelet use was summarized by the number needed to prevent (NNP) post-VAI stroke.

RESULTS:
Of 2,256 unique studies identified, 34 comprising 1,138 patients were incluced. Overall VAI-related stroke risk was 1.75% before admission and 3.40% after admission. Grades I and II had a cumulative stroke risk of 2.43% (95% CI: 0.98-4.94), which differed significantly (p < 0.01) from Grade IV-associated risk (10.10%; 95% CI: 4.95-17.79). Overall stroke risk in patients without prophylactic treatment was 10.00% (95% CI: 9.07-10.9), and 0.43% (95% CI: 0.01-1.06) in their counterparts who received antiplatelets (NNP = 10). Patients with grade I-II VAI receiving no treatment had 5.19% (95% CI: 1.43-12.77) stroke risk compared to 0.55% (95% CI: 0.01-3.02) treated with antiplatelet agents (NNP = 22). Among grade IV VAI, the stroke risk among patients that received no treatment was 21.21% (95% CI: 8.98-38.91), while none of the patients that received antiplatelet therapy developed stroke (NNP = 5).

CONCLUSIONS:
The majority of VAI-related stroke occurs after initial presentation, suggesting a potential for prevention of post-VAI stroke. Antiplatelet treatment was associated with significantly lower odds of post-VAI stroke among patients with Grade I, II, or IV injury, with the impact increasing within injury grade. The results suggest the positive impact of antiplatelet therapy with increasing VAI injury severity.