bluuebunny/crossref_metadata_2025_split huggingface dataset:
128 The Sagittal Angle of the Trigeminal Nerve at the Porus Trigeminus is a Radiologic Predictor of Surgical Outcome in Microvascular Decompression for Classical Trigeminal Neuralgia
Authors: Bethamcharla Raviteja , Branstetter Barton F. , Sekula Raymond F. 
Published: March 2024

INTRODUCTION:
Classical Trigeminal Neuralgia (cTN) is a facial pain syndrome with specific diagnostic criteria, including paroxysms that last 1-120 seconds, are sharp, stabbing, or electric in character, and are induced by innocuous stimuli. The most commonly accepted cause of cTN is neurovascular compression (NVC) of the proximal cisternal segment of the trigeminal nerve by an adjacent artery. Microvascular decompression surgery (MVD) provides immediate and durable relief in many patients.

METHODS:
Pre-operative MRIs from 300 patients with cTN who underwent MVD were analyzed to identify patients with a hyperacute SATNaPT (defined as less than 3 standard deviations below the mean). The rate of surgical success (pain-free after at least 12 months) was compared between patients with a hyperacute SATNaPT and all other patients.

RESULTS:
Patients without a hyperacute SATNaPT had an 82% likelihood of surgical success, whereas patients with a hyperacute SATNaPT had a 58% likelihood of surgical success (p < 0.05). Patients with a hyperacute SATNaPT who also had no evidence of vascular compression on preoperative MRI had an even lower likelihood of success (29%, p < 0.05).

CONCLUSIONS:
In patients with cTN being considered for MVD, a hyperacute SATNaPT is a negative prognostic biomarker that predicts a higher likelihood of surgical failure. Patients with a hyperacute SATNaPT, particularly those without MRI evidence of vascular compression, may benefit from other surgical treatments or a modification of MVD to adequately address the underlying cause of cTN.
129 Neuroimaging Analysis of Bilateral Thalamic Delivery for Gene Therapy
Authors: Daci Rrita , Shazeeb Mohammed , Owusu-Adjei Thomson Brittany , Mietus Constance Jennifer , Vachha Behroze , Moser Richard P. , Gray-Edwards Heather , Sena-Esteves Miguel , Flotte Terrence , Cataltepe Oguz 
Published: March 2024

INTRODUCTION:
Axonal transport from the thalamus (an integrative hub for the entire cortex) has been shown to facilitate widespread gene/protein delivery. Here, we report our neuroimaging experience with bilateral thalamic convection-enhanced delivery of adeno-associated virus (AAV) vectors for GM2 gangliosidoses.

METHODS:
Magnetic resonance imaging (MRI) of eight pediatric patients who underwent bilateral thalamic HEXA/HEXB delivery were retrospectively reviewed. Quantitative three-dimensional volumetric analyses of MRI thalamic signals were used to establish volume of distribution (Vd) versus volume of infusion (Vi). The distance of cannula placement within the thalamus was calculated and validated using the numbers used in the intraoperative ROSA robotic software. Backflow and leakage into surrounding structures were also analyzed.

RESULTS:
Fourteen thalamic injection volumes were considered in the final analysis. Calculated volume of thalamic infusate signal was up to 43.8% (mean = 21.3±13.3) of the thalamic volume. The Vd/Vi ratio ranged from 0.4-2.7 (mean = 1.9±0.7), depending on infusate volume. Diffusate shape was round to slightly ellipsoid in all patients. Backflow and leakage were encountered in 14.3% and 12.5%, respectively, of thalamic injections.

CONCLUSIONS:
This study provides the first in-human quantitative MRI data for intrathalamic infusion. The ideal location for the cannula tip was determined to be between the mediodorsal and lateral dorsal nuclei and the ideal trajectory keeps all of the cannula steps within the thalamic boundaries. We also compare these data to published NHP and our own NHP and sheep data. Overall, the Vd/Vi ratios are lower in human subjects (∼2) than in animal subjects (∼3). We hypothesize that this may be due in part to species specific differences in displacement of extracellular fluid versus infusion volume.
157 Minimally Invasive Treatment of Idiopathic Normal Pressure Hydrocephalus Using the Endovascular eShunt Implant
Authors: Lylyk Pedro , Matouk Charles Christian , Siddiqui Adnan Hussain , Lylyk Ivan , Bleise Carlos , Scrivano Esteban , Lylyk Nicholas Pedro , Antonios Joseph Paul , Beneduce Brandon , Levy Elad I. , Heilman Carl B. , Malek Adel M. 
Published: March 2024

INTRODUCTION:
Idiopathic Normal Pressure Hydrocephalus (NPH) is a reversible form of dementia typically treated with ventriculo-peritoneal shunt surgery. Recently we have described the first percutaneous transfemoral transvenous deployment of an endovascular CSF shunt (eShunt® System; CereVasc, Inc., Auburndale, MA, USA) to treat communicating hydrocephalus.

METHODS:
Patients were included after demonstrating >20% gait improvement in lumbar drainage trial. Gait was assessed using Timed Up & Go (TUG) test, cognition using Montreal cognitive assessment (MoCA), and urinary incontinence using Neurogenic Bladder Symptom Score (NBSS). Results were normalized per-patient to pre-treatment scores. A composite outcome score (COS) incorporating TUG/MOCA/NBSS was computed.

RESULTS:
Eleven patients (4 female; mean age 74.8 ± 4.2 years) underwent successful eShunt placement. Follow-up data showed significant improvement in gait by 35.4% at 30-days (n = 6, P < 0.003), 24.8% at 90-days (n = 6, p < 0.03) and by 32.8% at 180-days (n = 4, p < 0.01) compared to baseline. MOCA and NBSS showed significant improvements at 30-days and the COS was significantly improved at all time points (p < 0.005 at 30-, 90- and 180-days). No procedural/delayed hemorrhage or unexpected readmissions were encountered during this early follow-up phase.

CONCLUSIONS:
In elderly patients affected by NPH and its insidious effect on mobility, cognition and urinary continence, these results show that the endovascular eShunt implant can be safely deployed with a favorable risk profile and with rapid and sustained improvements in functional outcome scores.
161 Importance of Hospital Centrality Analysis in Brain Metastasis
Authors: Tong Lilin , Patel Ruchit , Dhand Amar , Bi Wenya Linda 
Published: March 2024

INTRODUCTION:
Management of patients with brain metastasis (BrM) is complex and interdisciplinary, with patients transitioning between distinct hospitals within an interconnected network at different points of their disease. Prior neurosurgical health delivery quality studies often analyze hospitals in isolation, negating the complexities of patient journey. A facility’s position in an integrated clinical network may therefore play a critical consideration in patient management and outcomes.

METHODS:
We selected BrM patients using ICD codes from the Healthcare Cost and Utilization Project (HCUP) inpatient and emergency department databases from Massachusetts (2018-2019). Hospitals were separated into quartiles based on connectivity, defined as sum of all weighted ties to other hospitals in MA. We compared patient and hospital characteristics across connectivity quartiles and determined impact of hospital connectivity on all-cause mortality, readmission rates, and length of stay using multivariate regression.

RESULTS:
A total of 4679 BrM patients were mapped across MA. While highly connected hospitals were on average larger than peripheral hospitals (p < 0.001), many highly connected hospitals had a low number of patient beds. Patients who visit highly connected hospitals were more likely to live in large metropolitan areas and higher income neighborhoods, and be covered by private insurance (all p < 0.001). Comorbidity scores and age were not meaningfully different between hospitals of varying connectivity scores. Hospital centrality, but not hospital volume, was inversely associated with mortality and readmissions rate, with highly connected hospitals having a lower risk of death (Q1: 2.4 (1.46-3.83); Q2: 1.6 (1.07-2.29); Q3: 1.4 (1.11-1.86); Q4 (ref)).

CONCLUSIONS:
We demonstrate a vital role for hospital connectedness in impacting BrM patient outcome, independent of hospital volume and patient characteristics. Structural barriers, such as insurance or patient residence, may impede patients from receiving care at highly connected hospitals.
173 Electrical Stimulation Used as an Adjunct to Cervical Spine Fusion in Patients at Risk for Pseudarthrosis
Authors: Wind Joshua James , Lansford Todd , Weinstein Marc , Campbell Peter , Vokshoor Amir A. , Beaumont Andrew , Hassanzadeh Hamid , Radcliff Kris , Aleem Ilyas , Coric Domagoj , Cowgill Ian 
Published: March 2024

INTRODUCTION:
Prior studies show that pulsed electromagnetic field (PEMF) stimulation promotes bone healing and can be a valuable tool to help overcome biological deficiencies in patients at risk. The current study further evaluates the adjunct effect of PEMF in subjects undergoing cervical spinal surgery presenting with risk factors for pseudarthrosis.

METHODS:
A prospective multicenter clinical trial (NCT 03177473) was conducted at eleven clinical sites. Subjects undergoing cervical spinal fusion surgery with one or more risk factors for pseudarthrosis were identified for enrollment. Risk factors for pseudarthrosis included multilevel fusion, prior failed cervical spine fusion, diabetes, osteoporosis, or smoking. Subjects undergoing cervical spinal fusion were required to wear the PEMF device for 4 hours/day for 6 months post-op. Fusion status was determined at the 12-month visit using anterior/posterior, lateral, and flexion/extension radiographs and computed tomography (without contrast). NDI, EQ-5D, SF-36, and VAS for neck and arm pain were collected as secondary outcome measures.

RESULTS:
Out of 160 subjects, 144 (90.0%) were graded as fused (all levels) at the 12-month visit. Fusion success was 91.7% (n = 55/60), 89.0% (n = 89/100), and 90.9% (n = 20/22) for subjects with 1, 2+, or 3+ risk factors, respectively. Significant improvements in NDI, SF-36, EQ-5D, VAS-arm and VAS-neck were observed compared to baseline (p < 0.001). A device compliance rate of 85.0% was observed at 3-months and 78.3% at 6-months in subjects who had successful cervical fusion.

CONCLUSIONS:
The PEMF bone growth stimulator device is a valuable tool to aid in fusion healing, especially in challenging populations. Subjects in this study experienced favorable fusion rates of 90% and significant improvement in patient reported outcomes despite having elevated comorbidity and/or complex surgeries.
174 Developing Mixed-Effects Models to Optimize Prediction of Postoperative Outcomes in a Modern Sample of Over 450,000 Patients Undergoing Elective Cervical Spine Fusion Surgery
Authors: Shahrestani Shane , Brown Nolan , Yue John K. , Tan Lee A. 
Published: March 2024

INTRODUCTION:
Cervical spine decompression and fusion surgery is commonly used to treat degenerative cervical spine pathologies.However, there is a paucity of high-quality data defining the optimal comorbidity indices specifically in patients undergoing cervical spine fusion surgery.

METHODS:
Using data from 2016–2019, we queried the Nationwide Readmissions Database (NRD) to identify individuals who had received cervical spine fusion surgery. The Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining indicator was used to assess patient frailty. To measure the level of comorbidity, Elixhauser Comorbidity Index (ECI) scores were queried. ROC curves were developed utilizing comorbidity indices as predictor variables for pertinent complications such as death, non-routine discharge, top-quartile cost, top-quartile length of stay (LOS), and one-year readmission.

RESULTS:
A total of 453,717 patients were eligible for analysis. Non-routine discharges occurred in 93,961 (20.7%) patients. The mean adjusted all-payer cost for the procedure was $22,573.14 ± $18,274.86 (Top Quartile: $26,775.80) and the mean LOS was 2.7 days ± 4.4 days (Top Quartile: 4.7 days). After surgery, there were 703 (0.15%) mortalities and 58,254 (12.8%) readmissions within one year post-operatively. Models using Frailty+ECI as the primary predictor consistently outperformed the ECI only model with statistically significant p-values, as determined by comparing respective AUCs, for most of the complications assessed. Cost and mortality were the only outcomes for which this was not the case, as Frailty outperformed both ECI and Frailty+ECI in cost (p < 0.0001 for all) and Frailty+ECI preformed as well as ECI alone in mortality (p = 0.10).

CONCLUSIONS:
Our data suggests that Frailty+ECI may most accurately predict clinical outcomes in patients receiving cervical spine surgery. These models may be used to identify high risk populations and patients who may necessitate greater resource utilization.
178 Brains on the Pitch: Investigating the Neurophysiological and Neurocognitive Effects of Repetitive Head Impacts in Adolescent Female Soccer Players During a Single Season
Authors: Orr Taylor , Brett Benjamin , Ryan Kaylin , Schiller Katherine , Rezaie Roozbeh , Salinas Felipe , Shimony Nir , Baughman Brandon , Narayana Shalini 
Published: March 2024

INTRODUCTION:
Repetitive exposure to head impact in contact sports has raised concerns for potential long-term structural and functional neurologic effects. This relationship has been minimally explored in female athletes, with conflicting results arising from the limited reports on this topic.

METHODS:
Prospective cohort design with pre- and post-season assessments of neurocognitive function, transcranial magnetic stimulation (TMS), and diffusion tensor imaging (DTI). Neurocognitive battery evaluated processing speed, memory, and executive function domains via computerized (ImPACT) and paper-and-pencil testing. TMS assessments included motor evoked potential onset; interhemispheric conduction times; intercortical and intracortical inhibition. DTI measures included fractional anisotropy (FA) for white matter tracts of interest, including: posterior limb of internal capsule; cortical spinal tract; corpus callosum - selected for common involvement in traumatic brain injury within other studies.

RESULTS:
One player was officially diagnosed with concussion and was included in analysis. Neurocognitive performance was intact relative to same aged peers, and there were no significant differences over the season based on mean reliable change indices (-0.79-0.93). Paired t-test analysis indicated that the TMS measures were not significantly different between the two timepoints. Furthermore, DTI FA values and TMS measures were not notably different pre- versus postseason.

CONCLUSIONS:
In this cohort of high school female athletes, we did not observe significant anatomic, physiologic, or functional effects from repetitive head impacts. Our findings contradict previous studies that showed significant neurophysiologic and neurocognitive changes, even in the absence of clinically-observed concussion. Further research is needed to fully understand the long-term consequences of repetitive head impacts in female athletes and to develop effective strategies for mitigating potential risks.
209 Transcriptomic Analysis of the Post-mortem Brain in Intracranial Atherosclerosis Implicates Interferon Signaling
Authors: Seah Carina , Devarajan Alex , Jurczyszak Denise , Chakka Akash , Huckins Laura , Brennand Kristen , Girgenti Matthew 
Published: March 2024

INTRODUCTION:
Intracranial atherosclerotic stenosis (ICAS) is a common cause of ischemic stroke. Stroke patients manifesting symptomatic ICAS often have poor prognoses, including worsened functional outcome, increased morbidity, and mortality. Despite risk factor management, ICAS exhibits a nonlinear rise in incidence with age, with an increase in unstable lipid-rich plaques. Understanding mechanisms of ICAS is crucial to improve clinical outcomes and reduce stroke incidence. Previous studies have demonstrated that intracranial arteries demonstrate different histopathologic profiles compared to extracranial arteries, likely lowering their risk of atherosclerosis. However, these studies are limited to healthy intracranial arteries. Comprehensive multiomic data examining diseased intracranial arteries are limited.

METHODS:
We performed bulk transcriptomic analysis in 4 tissues in a post-mortem brain dataset (N=304), with 34 patients with cerebral atherosclerosis confirmed via autopsy, 90 patients with peripheral atherosclerosis, and 180 controls. Cell type deconvolution was conducted to identify differential expression signatures in 7 neuronal and glial subtypes. To examine interferon response further in glial cells, we generated human induced pluripotent stem cell (hiPSC)-derived astrocytes treated with 3 doses of interferon and performed transcriptomic analysis.

RESULTS:
Cerebral atherosclerosis was significantly (pathway enrichment p<10e-9) associated with interferon signaling compared to peripheral atherosclerosis and controls. Glial cells particularly expressed patterns associated with cerebral atherosclerosis. Astrocytes, oligodendrocytes, excitatory neurons, and endothelial cells were most impacted. In hiPSC-derived astrocytes treated with interferon, we identified upregulation of interferon-inducible genes matching those found in intracranial atherosclerosis in the post-mortem brain, implicating glial reactivity to interferon-related stress.

CONCLUSIONS:
Our study implicates interferon signaling as critical within the development of cerebral atherosclerosis. Protection of the intracranial arteries from atherosclerosis may occur due to reduced expression of interferon-inducible genes. Targeted treatment of cerebral atherosclerosis should consider interferon-signaling modulators.
219 A Proposed Technique for Early Venous Sacrifice as an Alternative to Standard Yasargil Technique for Resection of Cerebral AVM's
Authors: Sack Kenneth , Watson Joseph C. , Al-Inaya Yana , Wellington Jack , Dhaliwal Jazz , Amiri Fariba , Zidaru Ana , Spezzani Chiarra , Lehman Natalia , Borjas Nagheli Fernanda , Martinek Monika , Abdeljabbar Nadine , Bone Matan , Abdulrauf Saleem 
Published: March 2024

INTRODUCTION:
This study introduces an alternative technique to the standard Yasargil resection of AVMs.

METHODS:
This 20-year prospective observational study compared the outcomes of 510 consecutive patients undergoing resection of AVM using either the early venous sacrifice technique (test group, n = 206) or a historical control group who underwent AVM resection using standard technique (Yasargil Technique, n = 304).

RESULTS:
The test group had significantly more Grade II (35% vs 30.3%) and Grade III (45.1% vs 38.8%) AVMs, while the control group had significantly more Grade I (40.4% vs 7.8%) AVMs. There was no difference in the number of Grade IV or Grade V AVMs. Overall, the test group presented with higher grade AVMs than the control group. Outcomes analyzed included post-operative stroke (CVA), death, modified Rankin Scale (mRS) score, need for blood transfusion, and incomplete obliteration of the AVM. Patients in the test group were 58% less likely to require blood transfusion compared to control (5.8% vs 13.8%, 58% RRR, NNT = 12.5, p = 0.004). Although not statistically significant, there was a trend toward reduced risk of CVA (RRR = 26%), post-operative mRS = 3 (RRR = 30%), and death (RRR = 51%) in the test group relative to the traditional Yasargil technique.

CONCLUSIONS:
In the proposed technique the number of patients requiring blood transfusions was reduced by 1 for every 12.5 patients treated with the standard technique. The number of patients experiencing poor mRS (>3) was reduced by 1 for every 48.7 patients treated. The number of patients experiencing post- operative CVA was reduced by 1 for every 58 patients treated.
224 Artificial Intelligence-based Decision Support Predicts Requirement for Neurosurgical Intervention in Acute Traumatic Brain Injury: Automated Surgical Intervention Support Tool (ASIST-TBI) Development, Validation and Simulated Prospective Deployment
Authors: Malhotra Armaan K. , Smith Christopher , Shakil Husain , Ackery Alun , Mamdani M. , Nathens Avery , Wilson Jefferson , Colak Errol , Witiw Christopher 
Published: March 2024

INTRODUCTION:
Artificial intelligence (AI) model integration into clinical workflow offers potential to optimize decision-support for transfer of acute traumatic brain injury (TBI) patients to appropriate trauma centers.

METHODS:
We retrospectively identified TBI patients from 2005-2021 treated at a quaternary Canadian trauma center. We employed various modeling techniques including principal component analysis, three-dimensional convolutional neural networks, and a transformer-based approach using Vision Transformer (ViT) architecture. Model training, validation, and testing was performed using head CT scans with binary ground truth labels corresponding to whether the patient received neurosurgical intervention witin 72 hours. The finalized model, termed Automated Surgical Intervention Support Tool for TBI (ASIST-TBI), was then deployed in a simulated prospective fashion on consecutive TBI patients at our center between March 2021 - September 2022.

RESULTS:
A dataset of 2,806 trauma patients with acute head CT scans were divided into training, validation, and testing groups; the ViT model exhibited optimal performance. There was accurate prediction of requirement for neurosurgical intervention with an area under the receiver operating curve (AUC) of 0·92, accuracy of 0·87, sensitivity of 0·87, and specificity of 0·88 on the testing cohort. In simulated 18-month prospective deployment, an additional 612 consecutive scans were used to assess the performance of ASIST-TBI. Classification accuracy remained robust with AUC of 0·89, 0·85 sensitivity, 0·84 specificity, and 0·84 accuracy. We manually reviewed false positive and false negative cases to identify reasons for misclassification.

CONCLUSIONS:
We developed a novel deep learning model that accurately predicts requirement for acute neurosurgical intervention using unlabeled TBI scans. ASIST-TBI has potential application to optimize state-wide triage efficiency and care pathways for brain-injured patients.
229 Quantitative Imaging Biomarkers for Risk Stratification of Intracranial Aneurysms
Authors: Veeturi Sricharan , Pinter Nandor , Baig Ammad , Ranghuram Ashrita , Sanchez Sebastian , Samaniego Edgar , Levy Elad I. , Siddiqui Adnan Hussain , Tutino Vincent 
Published: March 2024

INTRODUCTION:
Aneurysm wall enhancement (AWE) has emerged as a potential imaging biomarker for risk stratification of Intracranial aneurysms (IAs). Herein, the contrast-enhanced MRI (CE-MRI) exhibits markedly higher intensity on the IA sac as compared to the non-enhanced MRI (NE-MRI). However, currently it is assessed subjectively by clinicians which can introduce subjectivity.

METHODS:
We retrospectively collected 105 IAs with their NE-MRI, CE-MRI and Time-of-flight angiography images. IAs were classified as high or low risk if they had PHASES >5 or ELAPSS >20. We then identified the significantly different RFs and used them to build a logistic regression model for identifying high-risk IAs. We also compared the performance of this model with traditional AWE metrics like CCRatio (Average intensity on the IA sac normalized by the corpus callosum intensity) and CRStalk (Average intensity on the IA sac normalized by the pituitary stalk intensity).

RESULTS:
We found 35 high-risk IAs in the cohort and identified 183 RFs that were significantly different between them. After eliminating collinear RFs, we used 52 RFs to build our final model. We observed that the RF based model vastly outperformed the conventional metrics. In the testing set, we observed that the LR model had a higher accuracy as compared to conventional metrics. We observed that non-uniformity in pre-contrast MRI, homogeneity in post-contrast MRI and the difference in gray level non-uniformity had the highest odds ratios in the LR model.

CONCLUSIONS:
RFs from pre- and post-contrast MRI could identify high-risk IAs better than conventional metrics. This model in combination with 3D visualization could aid in better visualization of VWE and better risk stratification of IAs.