bluuebunny/crossref_metadata_2025_split huggingface dataset:
109 Exploring an Angiogenic Biomaterial Strategy for the Treatment of Moyamoya Disease
Authors: Chaparro Eduardo , Erning Kevin , Fulton Amy , Mace Brian , Gonzalez L. Fernando , Hasan David M. , Segura Tatiana 
Published: March 2024

INTRODUCTION:
Moyamoya disease is a rare cerebrovascular disorder characterized by progressive intracranial artery narrowing followed by a net of smaller fibrous root like blood vessels created in response to the scarcity of oxygen. Current treatment options for moyamoya disease are limited and often involve invasive surgical procedures. Recent studies have shown that hyaluronic acid (HA) gels can enhance angiogenesis and improve blood flow in ischemic tissues. Our laboratory has demonstrated that delivering angiogenic biomaterials in previously damaged brain tissue can generate a vascularized bed laying the groundwork for the use of angiogenic materials to other ischemic conditions.

METHODS:
We used C57/B6 mice, male and females, divided into 4 groups: 1. Controls – no surgery, no treatment; 2. Vehicle – unilateral occlusion of the internal carotid artery (ICA) and contralateral stenosis of the ICA, 2mm craniotomy, treated with saline solution; 3. Surgery as previously described, treated with a HA gel 4. Surgery as before, treated with Cluvena. Brains were dissected 2 weeks after treatment, sectioned and stained with CD31 to label new endothelial cells.

RESULTS:
Area fraction was used to calculate CD31 fluorescence. We found that animals subjected to occlusion/stenosis with no treatment had a statistically significant lower vessel percent area in comparison with normal animals. In contrast, animals treated with HA or Cluvena had a statistically significant higher vessel percent area than untreated animals.

CONCLUSIONS:
The use of biomaterials showed to be effective restoring vascularity in brains subjected to ischemia. There is a positive trend in favor of Cluvena versus HA restoring endothelial cells, suggesting that biomaterials including HA could provide enough angiogenic effect. Further research is needed to confirm the benefits of Cluvena.
110 Trends and Risk Factors for Medical Malpractice Litigation in Open Cranial Neurosurgery
Authors: Gupta Saksham , Stenberg Carl , Gerstl Jakob V. E. , Nonnenbroich Leo , Lindberg Rebecca , Chabros Jeremy , Smith Timothy R. , Arnaout Omar 
Published: March 2024

INTRODUCTION:
Neurosurgery is the most litigious specialty amongst all specialties across medicine. Understanding the reasons for malpractice claims can help inform neurosurgeons improve care and mitigate litigation risk.

METHODS:
The Westlaw Edge and LexisNexis databases were searched for cases involving medical malpractice claims due to cranial surgery between the years 1985-2023. Data collected included case date, verdict ruling, jurisdiction, sustained injuries, and awards or settlement amounts.

RESULTS:
Of 1546 cases reviewed, 317 were identified as malpractice claims resulting from cranial surgery. The primary causes for litigation were perioperative complications (n=115), delayed or denied treatment (n = 95), insufficient follow-up care (n = 51), inappropriate procedure selection (n = 39), and inadequate informed consent (n = 8). Tumor surgery had the highest number of claims (n = 81), followed by vascular (n = 59), trauma (n = 54), infection (n = 43), functional/epilepsy (n = 28), and other/not defined (n = 56). Regarding verdict ruling, 39.4% (n = 125) ruled in favour of the defendant; 20.5% (n = 65) in favour of the plaintiff; 2.2% of verdicts resulted in mixed ruling (n = 7); in 10.7% (n = 34) of claims were resolved in an out-of-court settlement; and in 27.1% (n = 86) the verdict was not available. The subspecialty with the highest proportion of plaintiff verdicts was tumor 29.2%, (n = 19), and tumor also had the highest proportion of defendant verdicts 26.40%, (n = 33). The average verdict amount awarded to plaintiffs was $5,592,703, while the average settlement amount was $2,751,807.

CONCLUSIONS:
The authors highlight several risk factors for medical malpractice claims across cranial neurosurgery. These results suggest that litigation may be mitigated with accurate and timely diagnosis, timely referrals and coordinated care.
1132 Phase 1 Correlates of Seizure Onset Zone for Prediction of sEEG Placement and Clinical Outcomes
Authors: Katlowitz Kalman , Allam Anthony , Weiner Howard L. , Curry Daniel 
Published: March 2024

INTRODUCTION:
Approximately 20 million people worldwide suffer from drug resistant epilepsy. Treatment of the seizure onset zone (SOZ) can reduce seizure burden. When phase 1 testing fails to identify a clear surgical lesion, stereo-electroencephalography (sEEG) offers a high-resolution spatial map of cortical and subcortical activity. However, each additional lead placed also increases the chances of a complication. Preoperative identification of optimal targets is crucial to minimizing the risk-benefit ratio of sEEG placement.

METHODS:
We studied epilepsy patients that underwent sEEG placement followed by resection, stimulation, or laser ablation at a single institution from 1/2012 to 11/2021. Leads were identified by their respective Phase 1 indications. Preoperative and 1-year postoperative clinical outcomes were compared. Hypothesis testing was performed via the Wilcoxon rank sum test and Fisher’s exact test. A logistic generalized linear mixed effect model was used for multivariate analysis.

RESULTS:
101 patients had 1752 leads placed with 239 SOZs found and treated. Mean weekly seizure frequency decreased from 25.2 to 7.8 (p < 0.001). SOZ leads were more likely to have concordant findings (p < 0.001) across studies. Lesions with PET hypometabolism (OR 1.4), MRI abnormalities (OR 1.9), MEG Clusters (OR 1.9) and calcifications (OR 3.2) were significantly more likely to predict SOZ, though PET hypometabolism was not significant in multivariate analysis. While the reason for lead placement in the SOZ did not predict seizure outcomes, patients with other lesions that had MEG Clusters or Calcifications had an average 15% worse seizure reduction than those without (p < 0.005).

CONCLUSIONS:
Certain Phase 1 aspects of a putative lesion, such as MRI abnormalities, the presence of calcifications, or MEG clusters can predict SOZ and clinical outcomes.
1134 A Call to Revise the Thirty-year-old SRS Dose Guidelines for Brain Metastases
Authors: Niranjan Ajay , Wei Zhishuo , Lunsford L. Dade 
Published: March 2024

INTRODUCTION:
Stereotactic Radiosurgery (SRS) currently is the most widely used neurosurgical strategy for treatment of brain metastases. Many centers still rely on 30-year-old dose volume guidelines derived from RTOG 90-05.

METHODS:
Between 2014 and 2020 330 NSCLC patients (median age = 65 years) with 2910 brain metastases underwent Gamma knife SRS. The number of tumors treated per patient ranged from 1-56 and the total tumor cumulative volume ranged from .05 to 33.09 cc (median = 3.17). The median prescribed tumor margin dose was 18 Gy.

RESULTS:
Median overall survival after radiosurgery was 15.5 months. Radiological tumor progression was noted 66 out of 2910 tumors (2.27%) in 51 out of 330 patients (15.45%). Tumors were divided into 4 categories based on tumor volumes (<1.5 cc, 1.5-<5 cc, 5-<10 cc, and = 10cc). The effect of margin dose, and % tumor covered in 18 Gy, 20 Gy, and 24 Gy on local tumor control was analyzed for all 4 categories. In tumors with volumes >1.5 cc local tumor control was significantly better (P < 0.05) when =65% of the tumor volume received at least 24 Gy. No relationship was found between tumor control and 75, 90, and 100 % volumes receiving 18 or 20 Gy.

CONCLUSIONS:
In this study neither conformality of dose delivery nor tumor margin doses were the most important predictors of local tumor control as long as =65% of the tumor volume received at least 24 Gy. This finding can serve as a prescriptive guideline that allows margin doses below the RTOG guidelines, reduces reliance on strict conformality, and improves tumor control.
1135 Classification of Temporal Lobe Epilepsy Anatomo-clinico-electrical Hypotheses: A Stereo EEG Study
Authors: Mallela Arka , Hect Jasmine , Pupi Michael , Anthony Austin , Fogg David , Angonese Arthur , Abou-Al-Shaar Hussam , Roberts Zachary , Anand Sharath Kumar , Aung Thandar , Gonzalez-Martinez Jorge 
Published: March 2024

INTRODUCTION:
Temporal lobe epilepsy (TLE) has historically been divided into mesial and lateral (neocortical) TLE, but electrophysiological, semiological, and anatomical evidence indicate that the epileptogenic zone (EZ) and areas of propagation involve both temporal and extratemporal structures. Hypothesis-driven, structured interrogation is crucial for a successful stereo EEG (SEEG) exploration and subsequent successful surgical intervention.

METHODS:
59 patients (ages 19-77) with drug-resistant TLE underwent SEEG at our institution from 2020-2022. We retrospectively reviewed each patient’s multidisciplinary discussions, history, imaging, and outcomes. We proposed four types of implantation hypotheses: temporal, temporal/basal/occipital, anterior perisylvian, and perisylvian. We quantitatively validated these types against anatomic coverage and semiology using unsupervised clustering and clinically by comparing classification to rates of successful localization of the epileptogenic zone (EZ) and seizure outcomes.

RESULTS:
Temporal (only) hypotheses were the least frequent (13.6%), followed by temporal/basal/occipital (25.4%), anterior perisylvian (30.5%), and perisylvian (30.5%). The hypotheses were not different in age at SEEG (p = 0.32), sex (p = 0.67), and handedness (p = 0.33). Frequent semiological features by type were: temporal – autonomic features, dÉjÀ vu; temporal/basal/occipital – visual and language disturbance; anterior perisylvian – oromotor; perisylvian – sensory manifestation. Clustering was validated against semiology (RI = 0.63) and lobar coverage (RI = 0.73). Successful localization of the EZ occurred in 79.7% and did not associate with hypothesis type (p = 0.22). Hypothesis type (p = 0.30) or EZ localization (p = 1.00) did not associate with the presence of an MRI lesion. 6-month Engel 1a rate was 71% and did not vary by hypothesis type (p = 0.29).

CONCLUSIONS:
The anatomo-clinico-electrical hypotheses in TLE must consider both temporal and extratemporal structures and not be limited by a medial vs. lateral TLE mindset. This proposed classification of TLE hypotheses can serve as starting point for multidisciplinary patient discussion as well as a tool to compare SEEG exploration and outcomes across centers.
1137 Prospective, Multicenter, International Registry of Deep Brain Stimulation for Dystonia: A Sub-analysis of Cervical Dystonia Patients
Authors: Albanese Alberto , Chen Lilly , Jain Roshini , Krauss Joachim K. 
Published: March 2024

INTRODUCTION:
Management of dystonia using Deep Brain Stimulation (DBS) is a well-established therapeutic approach. However, optimal DBS target sites in patients with cervical (focal) versus generalized dystonia are thought to diverge and be specific for particular connections (Horn 2022). DBS devices equipped with capabilities such as directionality and Multiple Independent Current Control (MICC) may offer potential for improved clinical outcomes.

METHODS:
This is a sub-analysis of patients with focal (cervical) dystonia only or cervical dystonia in the context of segmental or generalized dystonia assessed as part of a prospective, multicenter, international dystonia registry (NCT02686125). All patients receive an MICC-based, directional DBS system (Vercise, Boston Scientific). Patients are followed up to 3-years (post-implant). Several study assessments are being collected to evaluate their dystonia symptoms (e.g., TWSTRS), quality of life, and overall satisfaction. Adverse Events are also collected.

RESULTS:
A total of 43-patients (mean age 56.9-years, 58% females) with focal (cervical) dystonia only and 83 patients (mean 41.95-years, 61% females) with cervical dystonia in context of segmental or generalized dystonia have been evaluated. Both groups reported significant improvement in overall TWSTRS scores – however the extent varied. In the cervical-only cohort, a 19.9-point improvement was noted at 6-months (n = 25) and sustained up to 1-year (23.2-point improvement, n = 20). In those with cervical dystonia within frame of segmental or generalized dystonia, a 9.7-point and 7.3-point improvement in overall TWSTRS scores was noted at 6- (n = 50) and 12-months (n = 38), respectively. Updated data will be reported.

CONCLUSIONS:
This registry represents the first comprehensive, large-scale collection of real-world outcomes associated with dystonia patients implanted with a directional DBS system capable of MICC. Preliminary results demonstrate significant improvement in patients with cervical dystonia (alone or in context of segmental or generalized dystonia) following DBS.
118 Intraoperative Radiotherapy Combined With Spinal Stabilization Surgery. A Novel Treatment Strategy for Spinal Metastases. First Experiences at a Single Center
Authors: Krauss Philipp , Bonk Maximilian-Niklas , Stemmer Bastian , Wolfert Christina , Sommer Björn , Stüben Georg , Kahl Klaus-Henning , Shiban Ehab 
Published: March 2024

INTRODUCTION:
Contemporary treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, local control and functional status. It consists of spinal surgery followed by radio- and chemotherapy. Adjuvant therapy is performed after several weeks to prevent wound healing issues. Intraoperative radiotherapy (ioRT) is a solution to shorten treatment time, successfully applied in brain tumor, breast and colorectal surgery but not SM to date.

METHODS:
Results on morbidity and mortality of ioRT combined with stabilization surgery in SM in a first single center series are described. Stabilization is performed as CT-navigated open or percutaneous procedure using a carbon screw-rod system followed by 50kV photon-ioRT using the ZEISS Intrabeam during a single session in prone position. The ioRT probe is placed through a guide canula via navigation and positioning is controlled by ioCT to enable RT isodose planning in the OR. Patient characteristics, perioperative specifications and postoperative follow up along with adverse events (AE) are reported.

RESULTS:
11 (7 female) patients (69 ± 9.4y) received treatment from 07/22-04/23. Median SINS was 8 [7-10] IQR, with metastasis located in thoracic (n = 9) and lumbar (n = 2) spine. 6 patients receive open, 4 percutaneous stabilization and 1 decompression only. Mean length of surgery was 153±52 min. with 2 Patients receiving 4 and 8 patients receiving 8 screws respectively. In 2 Patients radiotherapy was not completed due to bending of the guide canula with consecutive security abortion of ioRT. All other patients received 8Gy isodoses during 2-6 min. Patients treated had ESCC 1a-2. Mean follow up was 63 ± 49 days. 4 patients experienced AEs including 1 case of fatal surgical site infection.

CONCLUSIONS:
50 kV photon ioRT for SM can be a promising technique for selected cases of SM.
119 A Hook Effect-based Lateral Flow Immunoassay Sensor for Cerebrospinal Leak Detection
Authors: Sonstein William , Oh Hyun-Kyung , Park Jinhee , Maher Simon , Navarro Mario , Vargas Angel , Kim Min-Gon 
Published: March 2024

INTRODUCTION:
A rapid test for the presence of cerebrospinal fluid (CSF) would be ideal in the management of postoperative fluid collections after spinal surgery. In order to ascertain the nature of the fluid the gold standard has been to send the fluid for gel electrophoresis which is time consuming and expensive in order to determine the presence or absence of beta-2 transferrin.

METHODS:
A cassette containing a lateral flow strip was used with two conjugates: a gold nanoshell-anti-TF antibody conjugate (conjugate 1) and a gold nanoshell-lectin conjugate (conjugate 2).After a sample is applied, a chromatographic sandwhich forms in two detection zones to yield a detectable dark line: Test line 1 (T1) where anti-TF antibodies are embedded form a sandwich reaction with analyte (TF) and with conjugate 1 and test line 2 (T2) where embedded serum glycoproteins react with conjugate 2. A control line with anti-mouse IgG antibody is embedded to form a reaction with conjugate 1. We availed the well-known hook effect as both T1 and T2 detection zone development was inhibited by the saturation of binding sites of the conjugates and embedded material.

RESULTS:
18 clinical samples of either CSF or postoperative drain fluid (serum) were tested using a third generation LFI. There were 7 CSF samples and 11 serum samples and one with buffer only. The hook effect-based LFI successfully discriminated positive clinical CSF samples from negative samples in all cases.

CONCLUSIONS:
This novel hook effect-based LFI sensor offers a fast, highly accurate and easy to use POC test for CSF leak.
1228 Comprehensive T-cell Profiling in Chordomas: Single-cell RNA-Seq and TCR Profiling Analysis Uncover Antitumor and Exhaustion Phenotypes for Targeted Immunotherapies
Authors: Arrieta Victor Andrés , Benotmane Jasim K. , Zhao Junfei , Dhiantravan Silpol , Hou David , Katz Joshua L. , Wang Si , Castro Brandyn , Pandey Surya , Cholak Meghan E. , Han Yu , Bettegowda Chetan , Horbinski Craig , Miska Jason , Stupp Roger , Lesniak Maciej S. , Sonabend Adam M. , Wolinsky Jean-Paul , Heiland Henrik , Chang Catalina Lee 
Published: March 2024

INTRODUCTION:
Chordomas, a rare type of tumor, originate from residual notochord tissue. These tumors present important challenges due to the limited treatment options. Investigating the intricacies of T-cell composition and function in chordoma immunity holds the potential to advance immunotherapy strategies for these patients.

METHODS:
We generated a comprehensive single-cell atlas of T cells of chordomas, incorporating paired single-cell transcriptomic samples from the tumor and blood of five patients and single-cell TCR sequencing data to assess T-cell clonality. Additionally, we analyzed T cells in 33 chordomas (22 newly diagnosed and 11 recurrent tumors) using multiplex immunofluorescence.

RESULTS:
Our results demonstrate that CD8+ T-cell antitumoral immunity originates in the periphery, marked by clonal expansion of cytotoxic and memory T cells in the blood. However, this immunity experiences progressive exhaustion upon tumor infiltration. Notably, a large percentage of CD8+ T-cells from the tumors and blood shared their TCRs with exhausted CD8+ T-cells known for tumor specificity, confirming the origin of a peripheral antitumor response. We identified specific antigen peptide sequences through TCR analysis that were enriched in exhausted T cell receptors' binding sites that uncovered shared motifs within the reactive tumor-infiltrating compartment. Moreover, we observed that CTLA-expressing central memory and Tregs made up most of the CD4 T-cell tumoral landscape. Interestingly, multiplex immunofluorescence showed a higher abundance of CD3+ T cells in newly diagnosed chordomas compared to recurrent cases.

CONCLUSIONS:
This study sheds light on the composition and function of T cells in chordomas, revealing the origin and exhaustion of CD8+ T-cell antitumor immunity. These findings contribute to our understanding of chordoma immunity to guide the development of targeted immunotherapies for both newly diagnosed and recurrent cases.
1230 Intraventricular Meningioma Resection and Visual Outcomes
Authors: Andrews John P. , Cummins Daniel Dighton , Morshed Ramin , Kinde Benyam , Aghi Manish Kumar , McDermott Michael William , Berger Mitchel S. , Theodosopoulos Philip V. 
Published: March 2024

INTRODUCTION:
Intraventricular meningiomas (IVMs) of the lateral ventricle are rare tumors that present surgical challenges due to their location. Visual field deficits (VFDs) are one risk associated with these tumors and their treatment. VFDs may be present preoperatively due to the tumor and mass effect (i.e. tumor-VFDs) or may develop postoperatively due to the surgical approach (surgical-VFDs).

METHODS:
Patients who received IVM resection at one academic institution (1996-2021) were retrospectively reviewed. Diffusor tensor imaging (DTI) reconstructions of the optic radiations around the tumor were performed from preoperative imaging. VFD course and resolution were documented. A systematic review was conducted for studies on surgical resection for IVMs that included >5 patients and reported postoperative neurologic outcomes.

RESULTS:
In the institutional series, thirty-two adult patients underwent IVM resection, with gross total resection in 30 patients (93.8%). Pre-operatively, tumor-VFDs were present in 6 patients, resolving after surgery in 5. Five other patients (without pre-operative VFD) had new persistent surgical-VFDs postoperatively (5/32 patients, 15.6%) that persisted to most recent follow-up. Of the 5 patients in the institutional cohort with persistent surgical-VFD, 4 had trans-temporal and 1 had a trans-parietal approach, and all of these occurred prior to regular use of DTI in preoperative imaging. In the systematic review, 14 studies met inclusion criteria and 12 commented on visual outcomes postoperatively. Median rate of tumor-VFDs improving postoperatively was 50% (range 0 to 100%) and median rate of new postoperative surgical-VFDs was 11% (range 0 to 23%).

CONCLUSIONS:
Half of presenting tumor-VFDs from IVMs improve with surgery. However, new surgical-VFDs are a common neurologic deficit after IVM resection. Preoperative DTI may demonstrate distortion of the optic radiations around the tumor, thus revealing safe operative corridors to prevent surgical-VFDs.
1232 Outpatient Stereotactic Needle Biopsy Is a Cost-effective Strategy for Brain Tumor Patient Decision-making That Enhances Clinical Trial Accrual
Authors: Hartke Joelle Nicole , Furey Charuta Gavankar , Asher Anthony Michael , Nidamanuri Sreecharita , Catapano Joshua , Zavala Baltazar , Sanai Nader 
Published: March 2024

INTRODUCTION:
Although neuroradiological techniques have expanded, stereotactic needle biopsy is a simple, ubiquitous,and immediate strategy for established or potential brain tumor patients with atypical clinical and/or radiographic findings.

METHODS:
Outpatient stereotactic needle biopsies performed by a single surgeon from August 2020 through November 2022 were retrospectively reviewed. Electronic medical records were queried for clinical, perioperative, and tumor demographics. Financial records were queried for insurance and payment reports. Descriptive statistics were used to characterize comparisons among collected variables.

RESULTS:
107 consecutive stereotactic needle biopsy procedures were conducted in adult brain tumor patients. All biopsies were performed using a single needle-pass in the outpatient setting, targeting supratentorial lesions in 89.7% of cases. Tissue diagnosis was established in 96% of procedures, with glioma being the most common histology. No intraoperative or perioperative complications occurred. Four patients (3.7%) were admitted overnight due to urinary retention (n = 2) and asymptomatic tract hemorrhage (n = 2), respectively. Insurance approval was sought preoperatively from non-commercial (31.7%) and commercial (68.3%) payors and approved in all cases. Postoperatively, 30.8% of patients received an experimental therapeutic on the basis of tissue analysis.

CONCLUSIONS:
We report the largest experience to date with outpatient stereotactic needle biopsy in newly-diagnosed and recurrent brain tumor patients. Our findings identify this strategy as a cost-effective alternative to advanced imaging that facilitates clinical trial accrual through tissue acquisition.