bluuebunny/crossref_metadata_2025_split huggingface dataset:
491 Scalp Incisions With Stairstep Pericranial Edges to Minimize Sequalae of Poor Wound Healing in Supratentorial Brain Tumor Surgery
Authors: Popp Nicholas , Singhal Ishan , Laing Brandon , Krucoff Kate , Krucoff Max Ostrinsky 
Published: March 2024

INTRODUCTION:
Wound healing problems are especially prevalent in craniotomies for intra-axial brain tumors as patients often require radiation, chemotherapy, and chronic steroids. All surgeons have postoperative patients with poor skin healing (i.e., excessive scabbing) at follow up, some of whom progress to infections that may involve the bone graft or hardware. While newer techniques like minimally invasive approaches and routine vancomycin powder use have helped overall complication rates, poor skin healing remains a frustratingly persistent cause of morbidity.

METHODS:
Ninety-one consecutive patients underwent supratentorial, intra-axial brain tumor surgery with a single surgeon at a single institution using this technique. Patient demographics, pathology, adjuvant interventions, and other independent risk factors were analyzed.

RESULTS:
No wound-related complications requiring readmission, intravenous antibiotics, or reoperation were encountered at a median 3-month follow up. There were also no surgical site infections, dehiscences, or CSF leaks. Fifty-one patients (57.3%) had postoperative radiotherapy, eighty-five patients (93.4%) had perioperative steroids, and fifty-six patients (61.5%) had postoperative chemotherapy. Six patients (6.5%) had concerns for poor initial scalp healing at routine follow up and were placed on a short course of oral antibiotics prophylactically. None (0%) of these individuals progressed to infection or required further intervention. One other patient developed a shunt infection in this interval that required removal unrelated to the craniotomy site.

CONCLUSIONS:
Here we outline the principles and demonstrate the execution of stairstep pericranial edges in supratentorial brain surgery. This technique, designed with plastic surgeons, provides an intact, vascularized layer of pericranium beneath the incision and over the bone graft/hardware to optimize wound healing and prevent morbid sequelae in inevitable cases of poor initial skin healing.
492 Novel BH3 Mimetic Bcl-2 Inhibitor Promotes Autophagic Cell Death and Reduces in Vivo Glioblastoma Tumor Growth
Authors: Avsar Timucin , Calis Seyma , Kilic Turker 
Published: March 2024

INTRODUCTION:
Anti-apoptotic members of the Bcl-2 family proteins play central roles in the regulation of cell death in glioblastoma, the most malignant type of brain tumor. Despite the advances in GBM treatment, there is still an urgent need for new therapeutic approaches.

METHODS:
In silico studies resulted in 500,000 molecules being screened with computer-aided drug design methods and the molecule with the highest binding affinity was selected and named BAU-243. Cell viability, IC50 value, tumor formation potential, tumor spheroid formation potential, tumor invasion studies were investigated following BAU-243 application. The molecular changes caused by Bcl-2 inhibition were demonstrated by quantitative PCR, western blot and immunofluorescence methods. In in vivo studies, glioma tumors were transplanted intracranially into Nod Scid Gamma(NSG) mice using the mouse xenograft model.

RESULTS:
Here, we report a novel 4-thiazolidinone derivative BH3 mimetic, BAU-243 that binds to Bcl-2 with a high affinity. BAU-243 effectively reduced overall glioblastoma cell proliferation including a subpopulation of cancer-initiating cells in contrast to the selective Bcl-2 inhibitor ABT-199. While ABT-199 successfully induces apoptosis in high BCL2-expressing neuroblastoma SHSY-5Y cells, BAU-243 triggered autophagic cell death rather than apoptosis in A172 cells, indicated by the upregulation of BECN1, ATG5, and MAP1LC3B expression. Lc3b-II, a potent autophagy marker, was significantly upregulated following BAU-243 treatment. Moreover, BAU-243 significantly reduced tumor growth in vivo in orthotopic brain tumor models when compared to the vehicle group, and ABT-199 treated animals. To elucidate the molecular mechanisms of action of BAU-243, we performed computational modeling simulations that were consistent with in vitro results.

CONCLUSIONS:
Results indicated that BAU-243 activates autophagic cell death by disrupting Beclin 1:Bcl-2 complex, and may serve as a potential small molecule for the treatment of glioblastoma.
499 Silent Corticotroph Staining Pituitary Neuroendocrine Tumors: Prognostic Significance in Radiosurgery
Authors: Maragkos Georgios A. , Mantziaris Georgios , Pikis Stylianos , Chytka Tomas , Liscak Roman , Peker Selcuk , Samanci Yavuz , Bindal Shray , Niranjan Ajay , Lunsford L. Dade , Kaur Rupinder , Tripathi Manjul , Pangal Dhiraj J. , Strickland Ben Allen , Zada Gabriel , Langlois Anne-Marie , Mathieu David , Warnick Ronald E. , Patel Samir , Minier Zayda , Speckter Herwin , Kondziolka Douglas S. , Lee Cheng-chia , Lee Vance Mary , Sheehan Jason P. 
Published: March 2024

INTRODUCTION:
There is conflicting evidence on the significance of adrenocorticotrophic hormone (ACTH) staining in the prognosis of nonfunctioning pituitary neuroendocrine tumors (NFpitNETs).

METHODS:
This retrospective, multicenter study included patients managed with SRS for NFpitNET residuals. The patients were divided into two cohorts: 1) silent corticotroph (SC) for NFpitNETs with positive ACTH immunostaining and 2) non-SC NFpitNETs. Rates of local tumor control, as well as the incidence of post-treatment pituitary and neurological dysfunction were documented. Factors associated with radiological and clinical outcomes were also analyzed.

RESULTS:
The cohort included 535 patients from fourteen centers with 84 (15.7%) patients harboring silent corticotroph NFpitNETs (SCs). At last follow-up, local tumor progression occurred in 11.9% of patients in the SC compared to 8.1% of patients in the non-SC cohort (p = 0.27). No statistically significant difference was noted in new-onset hypopituitarism rates (10.7% vs 15.4%, p = 0.25) or visual deficits (3.6% vs 1.1%, p = 0.088) between the two cohorts at last follow-up. When controlling for residual tumor volume, maximum dose, and patient age and gender, positive ACTH immunostaining did not have a significant correlation with local tumor progression (HR = 1.69, 95% CI = 0.8 - 3.61, p = 0.17).

CONCLUSIONS:
In contemporary radiosurgical practice with a single fraction dose of 8-25 Gy (median 15 Gy), ACTH immunostaining in NFpitNETs did not appear to confer a significantly reduced rate of local tumor control after SRS.
507 Neuroprotective Effects of a Steroid Receptor Coactivator Stimulator in a Murine Model of Acute Ischemic Stroke with Reperfusion
Authors: Garcia Roberto Losoya , McClendon Lisa , Robledo Ariadna , Von Waaden Nicholas , O'Leary Sean , Husain Adam , Lonard David , Dacso Clifford , O'Malley Bert , Kan Peter T. 
Published: March 2024

INTRODUCTION:
Stroke is the leading cause of adult disability and the fifth leading cause of mortality in the United States. Despite the study of many neuroprotective agents for acute ischemic stroke, none has been shown to be effective in large randomized clinical trials. Steroid receptor coactivator (SRC) is a promising class of agents since they are involved in cellular proliferation and regeneration, immune modulation, angiogenesis, antioxidant protection and are expressed in the brain.

METHODS:
Twenty c57bl/6 mice were randomly assigned to control or treatment groups (n = 10 mice per group). All mice underwent middle cerebral artery occlusion for 90 minutes followed by reperfusion via the intraluminal filament method. Occlusion was confirmed by laser doppler flowmetry. Intraperitoneal injections of saline (control) or 10-1 (treatment) were given 30 minutes after reperfusion. Each animal was tested using a modified Bederson’s neurological deficit scale (mNDS) and euthanized at the conclusion of the 24-hour survival period. Brain slices were stained with 2,3,5- triphenyltetrazolium chloride (TTC) to identify ischemic brain tissue.

RESULTS:
When compared with the control group, 10-1 treated mice showed significantly lower mNDS scores (p = 0.000336) and incidence of circling (p = 0.00256). Calculated infarct volumes, based on TTC staining, of the 10-1 treated group were significantly lower (p = 0.0009) when compared to the control group.

CONCLUSIONS:
We have shown that 10-1 is a promising therapeutic agent and provides substantial neuroprotection through its many multicellular processes in a rodent study. Current studies are being conducted to investigate the mechanism of 10-1 as neuroprotectant.
690 Residual In-stent Carotid Stenosis and Cigarette Smoking are Predictors of Restenosis After Stenting (CAS)
Authors: Lai Rosalind , Snyder Kenneth Vincent , Baig Ammad , Jacoby Wady , Kruk Marissa , Donnelly Brianna M. , Siddiqi Manhal Munir , Davies Jason , Siddiqui Adnan Hussain , Levy Elad I. 
Published: March 2024

INTRODUCTION:
Atherosclerosis of the internal carotid artery remains a significant contributor to stroke morbidity and mortality. While patient risk factors have been identified to be associated with carotid restenosis after carotid stenting (CAS), conflicting theroies exist on whether residual stenosis is an independent risk factor.

METHODS:
A single-center, prospectively maintained database was retrospectively reviewed for CAS procedures over a 12-year period. Patient demographic, procedural characteristics, radiographic and clinical details were noted. Comparison of baseline characteristics of patients with and without carotid restenosis were performed using chi-squared test for categorical variables and student t-test for continuous variables. Univariate and multivariate analyses were performed to determine risk factors associated with restenosis, defined as >70% on digital subtraction angiography.

RESULTS:
1017 consecutive carotid artery stenting (CAS) procedures were performed in 905 patients over the 12-year period, with 738 CAS procedures in 632 patients included after exclusion criteria. Overall restenosis rate was 17%, with a 14% restenosis rate at 2 years-time. Multivariable analysis demonstrated former/current smoking status (OR=2.1 [95%CI 1.2-3.9]), moderate contralateral stenosis (OR 3.0 [95%CI 1.4-6.7]), severe contralateral stenosis (OR3.0 [1.4-6.3]), and residual stenosis (OR 454 [95% 85-2413]) were associated with restenosis. AUC for the multivariable model was 0.78. Cut-point degree for residual stenosis was ∼30%, where there was a 9% and 35% rate of restenosis in those less than, and greater than, 30% residual stenosis, respectively.

CONCLUSIONS:
We present the largest single-center data in the US to date on carotid artery stenosis treated with CAS, and factors associated with restenosis. Residual in-stent carotid stenosis and smoking history were independent predictors. Maximizing treatment of initial stenosis within stent for carefully selected patients and aggressive smoking cessation education are important steps in preventing future carotid restenosis.
691 Correlation of Cerebral Arteriovenous Malformation Flow Measured by Quantitative Magnetic Resonance Angiography and MR-detected Arteriovenous Malformation Microhemorrhage
Authors: Hossa Jessica , McGuire Laura Stone , Patel Saavan , Ferrer Esteban Ramirez , Brunozzi Denise , Charbel Fady T. , Alaraj Ali 
Published: March 2024

INTRODUCTION:
Intracranial hemorrhage (ICH) significantly contributes to morbidity and mortality in cerebral arteriovenous malformations (AVM) patients, with a history of prior hemorrhage being the most significant predictor of a future hemorrhage. Recently, silent microhemorrhage as detected on magnetic resonance imaging (MRI) has been proposed as a potential risk factor for future hemorrhage in AVM patients. Recent data suggests that silent microhemorrhage is associated with higher nidal velocity measured through color-coded DSA, raising the question of correlation between flow and microhemorrhage.

METHODS:
All unruptured AVM patients with a baseline QMRA with noninvasive optimal vessel analysis (NOVA) and gradient echo or susceptibility-weighted MRI were retrospectively reviewed (2004-2022). AVM flow was calculated from the aggregate flow within primary arterial feeders relative to their contralateral counterparts. A review of the MRI determined the presence of microhemorrhages. Descriptive statistics, the X2 test, and a binomial logistic regression were performed to test the association of demographics, clinical, and AVM features with microhemorrhage.

RESULTS:
The study consisted of ninety patients, with fifty microhemorrhage-positive and forty microhemorrhage-negative patients. The presence of venous anomaly (varix, ectasia, aneurysm) is independently predictive of microhemorrhage (OR = 2.444, p = 0.050), and a compact AVM nidus trended towards independent negative predictability of microhemorrhage (OR =.462, p = 0.081). Calculated AVM flow trends higher in the microhemorrhage-positive group with the median flow 407 mL/min vs. 238 mL/min, and a trend towards predicting presence of microhemorrhage (OR = 1.375, p = 0.106).

CONCLUSIONS:
Patients with AVM-associated venous anomalies have an increased likelihood of AVM microhemorrhage. Higher AVM flow and a diffuse AVM nidus trend towards a higher likelihood of AVM microhemorrhage. These findings demonstrate the possible relationship between higher AVM flow and risk of future bleeding.
700 Flow-redirection Intraluminal Device (FRED) System for the Management of Intracranial Aneurysms: A Systematic Review and Metanalysis
Authors: Florez-Perdomo William , Moscote-Salazar Luis Rafael , Agrawal Amit , Janjua Tariq , Ossa Gabriel Quiñonez , García-Ballestas Ezequiel 
Published: March 2024

INTRODUCTION:
Multiple FDs are available for clinical use. Over the years, the FDs technology has improved considerably. However, overall complications and safety issues using FRED have not been evaluated in detail. Studies comprehensively investigating the clinical and technical events in FRED usage to treat IAs are not available. The purpose of this study is to investigate the outcome, overall complication rates, occlusion rate, retreatment, thromboembolic, and hemorrhagic complications for different patient cohorts treated with FRED flow diverter.

METHODS:
The following descriptors were used for the search: Flow-Redirection Intraluminal Device (FRED) system for the treatment of Intracranial aneurysms, Intracranial aneurysms, and Complication with no constraints applied was searched. Two authors independently revived and identified the studies, and two independent review authors extracted the data. A random-effect model was used to pool data, and the results were reported (odds ratios and 95% CI); heterogeneity was reported as I2.

RESULTS:
Nine studies were included in the final analysis, which involved retrospectively and prospectively collected data on 1167 patients. The use of FRED was associated with a rate of occlusion of 85% (95% confidence interval [CI] 79.5%–90.9%). Low retreatment rate of 2.5% (95% CI 1.0%–4.6%), low thromboembolic complication rate of 4.9% (95% CI 3.0%–7.31%), low hemorrhagic complication rate of 1.35% (95% CI 0.7%–2.0%). The mortality rate was 4% (95% CI 0.8%–2.1%). An overall good outcome was 95.1% (95% CI 92.1%–97.4%), and poor outcome was 4.8% (95% CI 2.5%–7.8%).

CONCLUSIONS:
The available evidence suggests that FRED offers favorable results for the management of intracranial aneurysms, results in high occlusion rate and low complication rates
708 Trends in Carotid Stenosis Literature Between 2012-2022: Applications of Endarterectomy and Translational Research
Authors: Kumarapuram Siddhant , Fu Allen , Sreenivasan Sanjeev , Tang Oliver Young , Kavia Jay , Khan Arsala , Ravoori Sanya , Mumudi Smriti , Roychowdhury Sudipta , Nanda Anil , Gupta Gaurav 
Published: March 2024

INTRODUCTION:
Carotid stenosis causes 10-20% of cases with ischemic stroke. Research in this clinical domain continues to progress in improving possible treatment modalities, imaging modalities, mechanistic understandings, and risk factors.

METHODS:
The WebOfScience database was investigated for 6,639 publication items between 2012-2022 pertaining to neurosurgical management of carotid stenosis. Networks were constructed analyzing keywords, key terms, and countries of publication. Subsequently, items within each network were organized into clusters and average publication date was measured for each term. Relevant items were tracked over time to compare their representation and utility in literature. Additionally, relevant key terms and connections were isolated from the network.

RESULTS:
For each network, the top 1,000 terms were selected for analysis. Terms were arranged into six major clusters (treatments, imaging, risk factors, prognostic markers, plaque characteristics, and basic science research). The most recent terms were observed in the treatment cluster (average publication year 2021.24) and basic science cluster (average publication year 2018.4). While terms within basic science have remained consistent over time, analysis of treatments elucidated that “carotid endarterectomy” surpassed “carotid artery stenting” in popularity after 2019. Additionally, the term “mouse” in the basic science cluster was connected to all clusters with a link strength of 18,084 (average 427.6).

CONCLUSIONS:
Modern research in carotid stenosis is characterized by two developments: advancements in basic science and increasing publication focus on carotid endarterectomy. Despite recent advancements in endovascular treatment of carotid stenosis, open treatment continues to remain a significant focus of study. As they continue to expand into modern scientific enterprise, developing nations will continue to impact the future of carotid stenosis research.
754 Prediction of 30-day All-Cause Readmission of Neurosurgery Patients Using Large Language Models
Authors: Jiang Lavender , Liu Chris , Nejatian Nima Pour , Nasir-Moin Mustafa , Wang Duo , Abidin Anas , Eaton Kevin , Riina Howard A. , Laufer Ilya , Punjabi Paawan , Miceli Madeline , Kim Nora Chung , Orillac Cordelia Marcela , Schnurman Zane , Livia Christopher , Weiss Hannah , Kurland David B. , Neifert Sean N. , Dastagirzada Yosef Michael , Kondziolka Douglas S. , Cheung Alexander , Yang Grace , Cao Ming , Flores Mona , Costa Anthony , Aphinyanaphongs Yindalon , Cho Kyunghyun , Oermann Eric Karl 
Published: March 2024

INTRODUCTION:
Existing clinical prediction algorithms mostly leverage small cohorts of structured data (e.g., medical imaging or laboratory data). However, large language models have demonstrated the ability to utilize unstructured data to outperform other machine learning approaches given sufficient data. Training large language models on unstructured clinical notes offers a possible alternative to structured data algorithm development in clinical tasks.

METHODS:
An unlabeled dataset of over seven million unstructured clinical notes (e.g., radiology reports and patient histories) was collected from four hospitals within the NYU Langone Health (NYULH) system and utilized to pre-train a bidirectional encoder representation with transformer (BERT) model. This model was further fine-tuned using a labeled dataset of discharge summaries to predict 30-day all-cause readmission. The resulting model, termed NYUTron, was assessed using a held-out retrospective cohort of patients from June to December 2021.

RESULTS:
Over the period of the retrospective study, there were a total 1,072 neurosurgery patients. The BERT model achieved an area under the receiver operating curve of 0.7883, a recall of 95.1% at a precision of 27.3%, and an accuracy of 82.1%.

CONCLUSIONS:
This study demonstrates how large language models and unstructured clinical notes can be used to provide information to physicians on clinical tasks with a flexible framework that is amenable to modification for other clinical tasks.
871 Bedside Neuronavigation for External Ventriculostomy as a Training Tool for Success: A Single-institution Experience and Meta-Analysis of Patients Outcomes and Procedural Accuracy
Authors: Bhanja Debarati , Wilding Hannah Eloise , Stoltzfus Mason , Kim Hali , Barnett Derek , Hazard Sprague , Rizk Elias Boulos 
Published: March 2024

INTRODUCTION:
External ventricular drain (EVD) placement is the most universally performed neurosurgical procedure, frequently by trainees. Freehand insertion, which approximates anatomical landmarks to achieve percutaneous ventricular access, bodes a complication risk as high as 40%. Neuronavigation is widely used for neurosurgical procedures; however, its use case for EVD has been inadequately explored.

METHODS:
A single-institution retrospective cohort study was performed, including all EVDs inserted in 2022. A PRISMA-guided systematic review was then conducted, querying databases for relevant articles. Primary outcomes of interest were optimal positioning (using Kakarla grading) and number of passes for ventricular access. Secondary outcomes included postoperative ventricular enlargement, hemorrhage, edema, and drain malfunction. Clinical data was pooled between single-institution and systematic review for meta-analyses. Outcomes were compared using risk ratios (RR [95% CI]) and standardized mean differences (SMD).

RESULTS:
Forty-seven patients (49 EVDs) were included from a single institution (17 neuronavigation; 32 freehand). Through systematic review, 1,289 patients (255 neuronavigation; 1,034 freehand) were identified from 10 eligible studies. Pooled together, patients were predominantly male (52%) and adult-aged (90%). EVD indications most commonly included hemorrhage (61%), obstructive pathology (15%), trauma (10%), and infection (7%). 85% of EVDs were placed by neurosurgical trainees. Frequency of catheter malposition was significantly lower in the neuronavigation cohort compared to the freehand cohort (10% vs. 36%; RR, 0.41 [0.24-0.69]). However, number of catheter passes remained the same between cohorts (mean [SD]; 1.11 [0.42] vs. 1.16 [0.51]; SMD; 0.04 [0.48]). Moreover, frequencies of postoperative ventricular enlargement, hemorrhage, edema, and drain malfunction, although were higher in the freehand cohort, did not differ significantly.

CONCLUSIONS:
These findings suggest neuronavigation helps trainees achieve safe and accurate ventricular access. Neuronavigation-guided external ventriculostomy may offer a promising, accessible, and bedside-ready approach to minimize morbidity, while mastering the procedural technique.