bluuebunny/crossref_metadata_2025_split huggingface dataset:
307 Active Exchange of CSF for Rapid Removal of Blood in Hemorrhagic Stroke—Multicenter Experience in 40 Patients
Authors: Jahromi Behnam Rezai , Soini Silja , Baig Ammad , Wilson Jennifer , Bhinder Vikram , Hess Ryan M. , Göhre Felix , Hijazy Ferzat , Tanskanen Päivi , Siironen Jari , Levy Elad I. , Niemela Mika Risto , Siddiqui Adnan Hussain , Brandmeir Nicholas 
Published: March 2024

INTRODUCTION:
Spontaneous Intracerebral hemorrhage (ICH) and subarachnoidal hemorrhages (SAH) can represent with intraventricular hemorrhage (IVH). Previous studies have demonstrated, patients with IVH have higher mortality and morbidity. Neuroinflammation due to organization of blood in cerebrospinal fluid (CSF) is one of the key contributing factors to poor outcome.

METHODS:
Data utilizing the new active EVD system were collected from six leading centers in the EU and USA. 40 patients were analyzed, 21 patients had SAH, 13 patients had spontaneous ICH related IVH, and six patient had vascular anomaly related hemorrhage. Blood removal from ventricular system was calculated utilizing daily CT imaging. Actual and expected shunt dependency were calculated for SAH patients with CHESS score.

RESULTS:
Removal of blood from CSF system with the active EVD was achieved safely. Pace of blood removal was highly related to irrigation volume used during treatment. All the 13 spontaneous ICH patients had IVH clearance of median 91.3% (0.7-100%) in average 7.6 days. Additionally, in the SAH patients, there was lower shunt (2) dependency compared to those observed in literature and to expected (11) calculated based on CHESS score. Vascular anomaly cohort had median IVH clearance 91.3% in average 8.0 days.

CONCLUSIONS:
It is safe and feasible to remove blood from CSF system in an accelerated fashion via active EVD. Active removal of blood reduced adverse events in this patient population. Removal of blood is highly related to irrigation rate. Prospective trials are needed to demonstrate the target population who will benefit the most from CSF exchange during hemorrhagic stroke treatment.
311 Rupture-Risk Stratifying Patients With Cerebral Arteriovenous Malformations Using Quantitative Hemodynamic Flow Measurements
Authors: Nico Elsa , Hossa Jessica , McGuire Laura Stone , Alaraj Ali 
Published: March 2024

INTRODUCTION:
Up to 60% of cerebral arteriovenous malformations (AVMs) present with an intracranial hemorrhage, however, noninvasive neuroimaging has increasingly diagnosed incidental AVMs. AVM management depends on weighing the lifetime rupture risk against the risks of intervention. Although AVM rupture risk relies primarily on angioarchitectural features, measuring hemodynamic flow is gaining traction. An accurate understanding of AVM hemodynamic flow parameters will help stratify patients by rupture risk and select treatment plans.

METHODS:
The literature was reviewed for articles that quantified AVM flow.

RESULTS:
Quantitative digital subtraction angiography (QDSA), 4D spin-labeled magnetic resonance angiography (4D-SL-MRA), and 4D-Flow magnetic resonance imaging (4D-Flow-MRI) studies measure relative flow; 3D phase-contrast MRI (PC-MRI) studies measure relative and true flow; and quantitative MRA (QMRA) studies measure true flow. QDSA studies have correlated increased rupture risk with prolonged venous outflow, however there are mixed findings with respect to arterial inflow. Similarly, a higher AVM inflow-to-outflow ratio has been associated with greater rupture risk in studies using PC-MRI. 4D-SL-MRA studies, on the other hand, have demonstrated a lower time-to-peak draining-vein-to-feeder-artery ratio in patients with AVM rupture. Finally, 4D-Flow-MRI studies have shown inconsistent findings whereas QMRA studies have found no significant associations between AVM hemodynamic flow parameters and rupture risk.

CONCLUSIONS:
Quantitative hemodynamic studies on the relationship between AVM flow and rupture risk have not reached a clear consensus; however, the preponderance of data suggests that higher arterial inflow and lower venous outflow in the AVM nidus contribute to increased hemorrhagic risk. Future studies should consider using larger sample sizes and standardized definitions of hemodynamic parameters to reach a consensus. In the meantime, classic angioarchitectural features may be more strongly correlated with AVM rupture than the amount of blood flow.
314 Long-term Follow-up of Cerebral Aneurysms Completely Occluded at 6 Months After Intervention With the Woven EndoBridge (WEB) Device: A Retrospective Multicenter Observational Study
Authors: El Naamani Kareem , Mastorakos Panagiotis , Adeeb Nimer , Lan Matthews , Castiglione James , Khanna Omaditya , Zanaty Mario , Ghosh Ritam , Abbas Rawad , Tjoumakaris Stavropoula I. , Gooch Michael Reid , Herial Nabeel , Rosenwasser Robert H. 
Published: March 2024

INTRODUCTION:
The Woven EndoBridge (WEB) device has been widely used to treat intracranial wide neck bifurcation aneurysms. Initial studies have demonstrated that approximately 90% of patients have the same or improved long-term aneurysm occlusion after the initial 6-month follow-up.

METHODS:
This is an analysis of a prospectively maintained database across 13 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB device who achieved complete occlusion at first follow-up and had available long-term follow-up.

RESULTS:
A total of 95 patients with a mean age of 61.6 ± 11.9 years were studied. The mean neck diameter and height were 3.9 ± 1.3 mm and 6.0 ± 1.8 mm, respectively. The mean time to the first and last follow-up was 5.4 ± 1.8 and 14.1 ± 12.9 months, respectively. Out of all the aneurysms that were completely occluded at 6 months, 84 (90.3%) showed complete occlusion at the final follow-up, and 11(11.5%) patients did not achieve complete occlusion. The positive predictive value (PPV) of complete occlusion at the first follow was 88.4%. Importantly, this did not differ between Digital Subtraction Device (DSA), Magnetic Resonance Angiography (MRA), or Computed Tomography Angiography (CTA).

CONCLUSIONS:
This study underlines the importance of repeat imaging in patients treated with the WEB device even if complete occlusion is achieved short term. Follow-up can be performed using DSA, MRA, or CTA with no difference in positive predictive value.
315 A Propensity Score-matched Comparative Study of Balloon Guide Catheters Versus Conventional Guide Catheters for Mechanical Thrombectomy With Stenting in Tandem Strokes: Comparison of 1st-pass Effect, Symptomatic ICH, and 90-day Functional Outcomes
Authors: Baig Ammad , Waqas Muhammad , Turner Ryan C. , Kuo Cathleen , Donnelly Brianna M. , Lai Rosalind , Raygor Kunal P. , Bouslama Mehdi , Lim Jaims , Neumaier Jenna L. , Cappuzzo Justin Mark , Davies Jason , Snyder Kenneth Vincent 
Published: March 2024

INTRODUCTION:
Extensive clot burden in tandem strokes accounts for poor mechanical thrombectomy (MT) outcomes. Several studies have shown benefit of balloon guide catheters (BGC) in MT and carotid artery stenting.

METHODS:
Tandem stroke patients identified from our endovascular database were dichotomized into groups treated with BGCs versus conventional guide catheters. One-to-one PSM adjustment for baseline demographics and treatment selection bias using nearest-neighbor matching was performed. Patient demographics, presentation characteristics, and procedural details were recorded. Outcomes assessed were final modified thrombolysis in cerebral infarction (mTICI) grade, periprocedural symptomatic intracranial hemorrhage (sICH) rate, in-hospital mortality, and 90-day modified Rankin Scale (mRS) score. Mann-Whitney U-test and multivariate logistic regression were performed to compare procedural parameters and clinical outcomes.

RESULTS:
Concurrent carotid revascularization (stenting with/without angioplasty) and MT was performed in 125 cases (BGC: 85; no BGC: 40). After PSM (40 patients/group), BGC group had a significantly shorter procedure duration (77.9 vs. 61.5 min; odds ratio [OR] = 0.996; p = 0.006), lower discharge National Institutes of Health Stroke Scale score (8.0 vs. 11.0; OR = 0.987; p = 0.042), and higher odds of 90-day mRS 0-2 score (52.3% vs. 27.5%; OR = 0.34; p = 0.040). On multivariate regression, BGC group had a significantly higher first-pass effect rate (mTICI: 2B-3) (OR = 1.115, 95% confidence interval [CI] = 1.015-1.432; p = 0.013) and lower periprocedural sICH rate (OR = 0.615; 95% CI = 0.406-0.932; p = 0.025). No difference in in-hospital mortality was observed (OR = 1.591; 95% CI = 0.976-2.593; p = 0.067).

CONCLUSIONS:
BGCs used for concurrent MT–carotid revascularization with flow arrest were safe and resulted in superior clinical and angiographic outcomes in tandem stroke patients.
320 Intraoperative Angiography in Neurosurgery: Temporal Trend, Access Site, and Operative Indication Considerations From a Six-year Institutional Experience
Authors: Tudor Thilan , Sussman Jonathan , Sioutas Georgios , Salem Mohamed M. , Muhammad Najib , Romeo Dominic , Tarbay Antonio Corral , Kim Yohan , Ng Jinggang , Rhodes Isaiah , Gajjar Avi A , Choudhri Omar , Zager Eric L. , Srinivasan Visish M. , Janko Brian T. 
Published: March 2024

INTRODUCTION:
Historically, the transfemoral approach (TFA) has been the most common access site for cerebral intraoperative angiogram (IOA). However, in line with trends in cardiac interventional vascular access preferences, transradial approach (TRA) and transulnar approach (TUA) are gaining popularity due to favorable safety and patient satisfaction outcomes.

METHODS:
Between July 2016 and December 2022, 317 angiograms were included based on our case definition, comprising 59 TRA cases, 11 TUA cases, 243 TFA, and four transpopliteal cases. Fluoroscopy time, contrast dose, reference air kerma (RAK), and dose area products (DAP) per target vessel catheterized were the primary endpoints of interest. Univariate and multivariate regression analyses were conducted to evaluate predictors of elevated contrast dose and radiation exposure metrics.

RESULTS:
Contrast dose per vessel catheterized was significantly lower in TRA/TUA cases versus TFA cases (p = 0.001), but radiation exposure metrics did not differ between access site groups. TRA/TUA versus TFA does not significantly predict elevated levels of radiation exposure or contrast dose. Aneurysm cases were associated with significantly lower odds of elevated radiation exposure for all radiation metrics (p < 0.05) whereas AVM cases had higher odds of elevated radiation exposure across all measures (p < 0.01). There was a significant relationship between case number and operative indication over the study period (p < 0.001) with a decrease in the proportion of cases for aneurysm treatment offset by increases in total cases for the management of AVF and AVM.

CONCLUSIONS:
TRA and TUA are safe and effective access site options for neurointerventional procedures and are increasingly employed. Cases using wrist access may be associated with a lower contrast dosing for patients.
325 The Economic Impact of Pediatric and Adolescent Gunshot Wound Mortality
Authors: Liles Campbell , Leech Ashley , Bhamidipati Akshay , Dambrino Robert J. , Chambless Lola Blackwell , Patrick Stephen , Shannon Chevis N. , Wellons John C. 
Published: March 2024

INTRODUCTION:
Gunshot wounds (GSW) are the leading cause of pediatric/adolescent mortality in the United States. The total economic impact of lost productivity has not been previously quantified.

METHODS:
The CDC WONDER database was utilized to document GSW fatalities of individuals 19 years and younger between 2001-2021. The weighted net present value (NPV) of potential future lost income for each child was calculated based on the Social Security Administration’s estimated NPV of lifetime earnings at age 20, using a 4% discount rate, and factoring in updated US census data on education status, graduation rates, and wage-gaps. Each year’s total lost income was adjusted to 2022 USD using the CPI-W. Sensitivity analysis tested the robustness of our model parameters’ variability on our model results.

RESULTS:
64,503 total pediatric/adolescent GSW mortalities have occurred since 2001. Total estimated NPV income loss in 2022 USD is $58.78 Billion. This correlates with an estimated loss to Social Security of $7.29 Billion. Sensitivity analyses found that changes in salary had the highest potential impact on the final outcomes. Overall, the worst-case income scenario (-20% change in base salary) showed an estimated $47 Billion economic loss in 2022 USD. A similar analysis for total pediatric mortality due to neurological disease showed an economic loss of $18.86 Billion.

CONCLUSIONS:
The economic impact of income lost due to pediatric GSW fatalities between 2001-2021 is estimated to be $58.78 billion, with minimum value of $47 billion after sensitivity analysis. This estimate likely undervalues the total economic impact of pediatric gun violence since it is based on median salaries and excludes medical treatment, long-term disability/morbidity, multiplier effects, or future offspring productivity. The total cost to society of pediatric GSW mortality significantly exceeds all neurologic-related mortality and is too high for physicians and policymakers to ignore.
342 Systematic Review of Disparities in Treatment, Surgical Management, Outcomes by Race and Insurance Status Disparities in Spine Oncology
Authors: Dennis Daniella , Natchiappan Nivedha , Braun Maxime , Banerjee Mitali , Paro Mitch , McNeill Ian Thomas 
Published: March 2024

INTRODUCTION:
Healthcare disparities within neurosurgery and spine surgery have been documented with respect to race and insurance type. To date, there has not been a systematic review of disparities in spinal oncology access, treatment and outcomes.

METHODS:
A systematic review was performed following PRISMA guidelines with a strategy to identify disparities broadly within spine oncology using the following MeSH terms: “spinal neoplasms,” “healthcare disparities,” “race,” “insurance status,” and “socioeconomic status.” Studies were included and excluded based on pre-established criteria.

RESULTS:
Out of a total of 400 papers, 17 papers were reviewed. Black patients with spine oncologic conditions experienced decreased access to care and disparities in treatment modalities offered when compared to non-Black patients. Further, when minority and white patients were compared, differences were seen in the clinical presentation of symptoms and in-hospital outcomes. Minority patients were found to have longer postoperative length of stay and higher rates of surgical complications. A similar trend is seen when comparing Medicaid patients versus privately insured patients with respect to access to treatment and differences in treatment modality. Furthermore, patients with public insurance experienced higher rates of postoperative mortality compared to those with private insurance.

CONCLUSIONS:
Disparities within the treatment of spine oncology patients are present with respect to factors such as race, socioeconomic status, and insurance type. Further exploration into the root causes for these disparities should be performed to inform policy and programs aimed at establishing equity for the care of spine oncology patients.
350 Surgical Treatment of Refractory Low Back Pain Using BurstDR Capable Spinal Cord Stimulation (SCS) in Patients Without Options for Corrective Surgery; 12-month Results From a Paddle Lead Cohort
Authors: Falowski Steven M. , Heros Robert , Sales J. Rafe , Tavel Edward , Lansford Todd , Weinand Martin E. , Baxi Nrupen , Garber Jason E. , Forage James , Telfeian Albert Edward , Christopher Anne , Haddad Souheil F. , Dorsi Michael J. , Gilligan Chris , Mirzadeh Zaman , Deer Timothy Ray , Jameson Jessica , Moeschler Susan , Desai Mehul , Pilitsis Julie G. , Okaro Udoka , Yue James 
Published: March 2024

INTRODUCTION:
DISTINCT is a randomized controlled trial evaluating passive recharge burst SCS compared to CMM in improving pain and pain-related physical function in patients suffering from chronic back pain without prior lumbar surgery, and for whom corrective surgery is not an option. Sub analysis of outcome measures are presented for subjects implanted with paddle leads at both 6 and 12 months.

METHODS:
An independent board-certified spine surgeon reviewed each case confirming a lack of corrective surgical options. Out of 29 sites and 115 implants, 10 sites implanted 50 subjects with paddle leads. Primary and secondary endpoints assessed improvements in low back pain intensity (NRS), low back pain-related disability (ODI), pain catastrophizing (PCS), and patient global impression of change (PGIC).

RESULTS:
Data are available for 47 and 44 subjects at 6 and 12 months respectively. Subjects reported significant reductions in pain relief at 6 and 12 months, decreasing from 7.8 ± 1.2 at baseline to 2.0 ± 1.6 and 2.2 ± 2.2 respectively (p < 0.0001). Disability was substantially (< 20 points) reduced from severe to mild at 6 and 12 months; ODI reduced from 54.4 ± 15.0 at baseline to 19.9 ± 14.1 and 22.1 ± 13.6 respectively (p < 0.0001). Pain catastrophizing improved to reflect the average of a non-chronic pain population; decreased from 27.6 ± 13.1 at baseline to 8.1 ± 8.2 and 7.8 ± 9.9 (p < 0.0001). 76% report definite and meaningful improvements on PGIC. One lead related event was reported and resolved by repositioning

CONCLUSIONS:
Passive recharge bursts using paddle leads provide substantial relief to patients suffering from severe, debilitating, NSLBP. Patients report dramatic improvements in pain, function, and pain-related emotional distress. In addition, the rate of adverse events is low supporting a favorable safety profile.
352 Outcomes After Microvascular Decompression for Sole Arterial Versus Venous Compression in Trigeminal Neuralgia
Authors: Nair Sumil , Xie Michael , Ran Kathleen Renee , Kilgore Collin , Kalluri Anita , Huang Judy , Lim Michael , Bettegowda Chetan , Xu Risheng 
Published: March 2024

INTRODUCTION:
In most cases of trigeminal neuralgia (TN), the trigeminal nerve is compressed by the arterial vasculature.

METHODS:
We retrospectively reviewed all patients undergoing microvascular decompression at our institution, identifying patients with either sole arterial or venous compression. We dichotomized patients into arterial or venous groups and obtained demographics and postoperative complications for each case. Barrow Neurological Index (BNI) pain scores were collected preoperatively, postoperatively, and at final follow-up, as well as recurrence of pain. Differences were calculated via Chi-squared tests and t-tests. Ordinal regression was used to account for variables known to influence TN pain. Kaplan-Meier analysis was used to determine recurrence-free survival.

RESULTS:
Of 1044 patients, 642 (61.7%) had either sole arterial or venous compression. 472 of these cases demonstrated arterial compression, and 170 displayed sole venous compression. Patients in the venous compression group were significantly younger (p < 0.001). Patients with sole venous compression demonstrated worse preoperative (p = 0.04) and final follow-up (p < 0.001) pain scores. Patients with sole venous compression had significantly higher rate of pain recurrence (p = 0.02) and BNI score at pain recurrence (p = 0.04). On ordinal regression, venous compression was found to independently predict worse BNI pain scores (OR = 1.66, p = 0.003). Kaplan-Meier analysis demonstrated a significant relationship between sole venous compression and increased risk of pain recurrence (p = 0.03).

CONCLUSIONS:
TN patients with sole venous compression demonstrate worse pain outcomes following MVD compared to those with only arterial compression.
366 Frailty Is a Risk Factor for Mortality in Operative and Non-operative Type II Odontoid Fracture Patients: An ACS-TQIP Survival Analysis of 22,440 Patients
Authors: Courville Evan , Owodunni Oluwafemi , Schmidt Meic H. , Crandall Cameron , Norii Tatsuya , Shin Peter C. , Bowers Christian 
Published: March 2024

INTRODUCTION:
Type II Odontoid Fractures (T2OF) are the most prevalent cervical spine fractures in adults =65 years old. Nonetheless, there is insufficient data regarding the influence of frailty on outcomes for both nonoperative and operative, treatment approaches.

METHODS:
We conducted a retrospective review of T2OF patients from 2015 to 2020 using the ACS-TQIP® database. Using unmatched and propensity score-matched (PSM) risk-adjusted models we assessed the association between frailty and all adverse outcomes. Survival probabilities were examined using Kaplan-Meier (K-M) plots and frailty-based risk stratification. Our outcomes include major complications, hospital length of stay (LOS), nonhome discharge (NHD), mortality rates, and survival probabilities.

RESULTS:
There were 22,440 T2OF patients, comprised of 31.8% (n = 7,138) robust, 35.2% (n = 7,913) typical, 22.9% (n = 5,158) frail, and 9.9% (n = 2,231) very frail patients. Results from unmatched multivariable analyses revealed a dose-dependent relationship between frailty and all outcomes, in both cohorts (p < 0.05). PSM resulted in 3,942 nonoperative and operative matched pairs. Preoperative characteristics were similar between cohorts, except for age: 75 years (IQR: 60-83) nonoperative and 70 years (IQR: 56-78) operative, and male sex: nonoperative 1,799 (55.8%) and operative 439 (61.1%). Significant mortality reductions (43-77%; p < 0.05) were observed in the operative cohort compared to the nonoperative cohort across all frailty strata. As expected, the operative cohort had longer LOS and increased NHD risk ranging from 64-97%, p < 0.001. In K-M analyses, survival declined significantly across increasing frailty strata p < 0.001.

CONCLUSIONS:
Increasing frailty in T2OF patients was independently associated with major complications, LOS, NHD, and decreased survival. Interestingly, operative patients exhibited improved survival compared to nonoperative patients across all frailty strata. These findings highlight the importance of frailty in T2OF management and care coordination.