bluuebunny/crossref_metadata_2025_split huggingface dataset:
226 Advancing Neurovascular Diagnostics for Abnormal Hemodynamic Conditions Through AI-Driven Physics-informed Neural Networks
Authors: Williams Kyle , Rudin Stephen , Bednarek Daniel , Baig Ammad , Siddiqui Adnan Hussain , Levy Elad I. , Ionita Ciprian 
Published: March 2024

INTRODUCTION:
Many studies have explored the application of machine learning and neural networks in extracting critical diagnostic information from structural and functional medical imaging. While these methods show potential for improving efficiency, concerns arise when interpreting subtle imaging features, especially when training data is limited. Physics-informed neural networks (PINNs) address these issues by incorporating governing equations from physical and mechanical models into the analysis.

METHODS:
We examined the use of a PINN that enforces the convection equation, relating contrast media propagation to blood velocity, the Navier-Stokes equations for velocity and pressure distributions, and the conservation of mass requirement to calculate velocity and pressure distributions within patient-specific blood vessels. We also implemented a boundary condition that accounts for real contrast-media propagation from 1000 fps high-speed angiographic (HSA) image sequences, allowing for an assumption-free problem space within a medical imaging framework. Velocity fields and pressure gradients were calculated for flow in aneurysms and carotid bifurcations.

RESULTS:
Our method demonstrates comparable results to computational fluid dynamics (CFD) without requiring manual data processing, significantly improving the efficiency of calculating high-resolution velocity and pressure fields. By integrating AI with physics modeling, this novel approach holds the potential for advancing neurovascular diagnostics and providing more accurate, personalized treatment plans for patients with neurovascular pathologies.

CONCLUSIONS:
This innovative approach, integrating physics modeling and artificial intelligence, offers more accurate and personalized diagnostics for patients with neurovascular pathologies. The PINN method not only achieves results comparable to computational fluid dynamics without the need for manual data processing but also greatly enhances the efficiency of calculating high-resolution velocity and pressure fields.
228 Expert Hand Motion During Microvascular Anastomosis Simulation: Big Data Analysis Using Machine Learning Hand Detection
Authors: Gonzalez Nicolas Ivan , Mignucci-Jiménez Giancarlo , Xu Yuan , Abramov Irakliy , Park Wonhyoung , Wanebo John E. , Tanikawa Rokuya , Lawton Michael T. , Preul Mark C. 
Published: March 2024

INTRODUCTION:
Microanastomosis is a complex surgical technique that demands delicate and coordinated hand movement. Advances in machine learning technology have enabled new methods to study human motion. Convolutional neural networks are algorithms specialized in visual tasks that enable discrete object detection and tracking including the hands of a surgeon.

METHODS:
A machine learning hand detector was developed using a pre-trained convolutional neural network capable of tracking 21 hand landmarks without sensors attached. En-to-side microanastomosis was simulated using 2 mm polyvinyl-alcohol vessels and 10/0 micro-suture and recorded with a video camera capturing hand movement in the surgical field. Participants (n = 4) were expert cerebrovascular surgeons with significant operative experience in cerebral bypass surgery. Calculation of motion of 14 hand joint angles was performed using a vectorization method from landmark detections. Time series analysis was performed to calculate the absolute angular motion for each joint of the hand.

RESULTS:
Four minutes of simulation for each surgeon yielded a total of 784.294 angular detections (14 hand joints total). For the dominant hand, the mean (SD) absolute angular motion was expert 1: 178.2 rad (98.3); expert 2: 261.8 rad (164.3); expert 3: 449.9 rad (307); expert 4: 380.1 rad (198.1).For the non-dominant hand, the mean (SD) absolute angular motion was expert 1: 132.9 rad (64.6), expert 2: 149.2 rad (72.3); expert 3: 389.2 rad (243); expert 4: 162.6 rad (87.2).

CONCLUSIONS:
A machine learning hand detector system can calculate hand joint motion during microvascular anastomosis. The absolute angular motion is a quantitative performance metric providing information about hand stability during microanastomosis simulation. Such studies using powerful artificial intelligence detection algorithms may have educational potential in the assessment of complex and delicate surgical skills and supervision of surgical training.
239 The Influence of Apolipoproteins E Gene Polymorphism on Cognitive Outcome in Patients with Moderate Degree Diffuse Brain Injuries
Authors: Grandhi Aditya 
Published: March 2024

INTRODUCTION:
APO-lipoproteins have a primary role in solubilizing and transporting lipids across cell membranes. APO-lipoprotein E isoform 4 (among APOE ε 1,2,3,4) is least efficient in clearing Aβ protein from the brain and is considered as a risk factor for Alzheimer disease.

METHODS:
After institutional ethics committee clearance, a prospective cohort study was done from 2017 to 2021 on adult patients who sustained moderate degree diffuse brain injury. APOE gene analysis were carried out on them. Patients who went on to subsequently develop focal lesions, those who died or were lost to follow up were excluded. Fifty consecutive patients who fulfilled the criteria, subsequently participate in a Mini Mental State Examination at the end of 1 month and 3 months were analysed.

RESULTS:
In our study, the allele frequencies for APOE gene ɛ2, ɛ3, ɛ4 were 36%, 53%, 11%, respectively. Patients were categorized into group A (who had at least one APOE ɛ4 allele) and group B (who did not have any APOE ɛ4 allele). In our study patients in group A had a prolonged hospitalisation and increased risk of convulsion than group B. The lack of improvement in MMSE scores (language and praxis subdomains) in group A as compared to group B after 3 months was statistically significant. The difference between the two groups in the rest of subdomains (attention, calculation, memory, orientation) and total MMSE scores at 3 months compared to that at discharge were insignificant.

CONCLUSIONS:
The presence of the APOE ɛ4 allele affects language and praxis during recovery. It increases the risk of post-traumatic seizures and increases the length of hospital stay but does not have a significant outcome on overall cognition after a course of 3 months.
243 Intracranial Theta-burst Stimulation Modulates Cortical Excitability in a Dose and Location-dependent Fashion
Authors: Huang Yuhao (Danny) , Cash Sydney , Keller Corey , Paulk Angelique 
Published: March 2024

INTRODUCTION:
Direct electrical stimulation is a powerful therapeutic approach to treating a wide range of brain disorders. In particular, theta-burst stimulation (TBS) which delivers electrical pulses in rhythmic bursts of 3-8 Hz to mimic endogenous brain rhythms, has been increasingly used to improve cognitive processes and relieve symptoms of depression. However, how TBS alters underlying neural activity is poorly understood.

METHODS:
In nine neurosurgical epilepsy subjects undergoing intracranial monitoring, we applied direct cortical TBS at varying stimulation amplitudes and locations (prefrontal, temporal, parietal). We obtained single-pulse corticocortical evoked potentials (CCEPs) prior to stimulation to map functional connectivity. Intracranial EEG (iEEG) was recorded from non-stimulated electrodes before, during and after TBS.

RESULTS:
We found that TBS evoked consistent responses after each burst. These responses were observed in regions with high amplitude CCEPs and resting spontaneous delta (1-4 Hz) phase-locking to the stimulation site, consistent with our hypothesis that the underlying functional brain architecture guides information flow after stimulation. Furthermore, we observed changes in cortical excitability over time as measured by changes in amplitude of the TBS evoked responses both within stimulation burst trains and across burst trains. The degree of change in cortical excitability was modulated by anatomical location, proximity of the stimulating electrode to white matter, and current amplitude.

CONCLUSIONS:
These results indicate that direct cortical TBS produces neural effects that can be measured over time and correlate with baseline biophysical parameters. Thus, personalizing stimulation parameters might be critical to predictably maximize our ability to alter disease-relevant brain networks.
244 The Inaugural “Century” of Mixed Reality in Cranial Surgery: Virtual Reality Rehearsal/Augmented Reality Guidance and Its Learning Curve in the First Single-Surgeon, 100-Case Series
Authors: Jean Walter C. , Piper Keaton , Saez-Alegre Miguel 
Published: March 2024

INTRODUCTION:
Virtual reality (VR) and augmented reality (AR), together called Mixed reality (MxR) gaining importance in Neurosurgery as it helps to select apporaches and identify key anatomic landmarks intraoperatively.

METHODS:
The first 100 consecutive cases of a single surgeon for which MxR was intended for use were retrospectivaly analyzed for specific contributions to the opeation. Seventeen cases in the study cohort were matched with historical non-MxR cases for comparison of outcome parameters. The cases in which MxR failed were plotted over time to determine the nature of the “learning curve.”

RESULTS:
The nadir of the blue line is at case 44. The inflection point of the trend line (black) occurred at approximately case 63.This provides some evidence of proficiency acquisition in between. MxR helped to limit the size of the opening in 44 cases, enhanced precise placement of the craniotomy in 64 cases, increased the guidance efficiency to target or marker in 58 cases, and protected anti-targets from surgical incursion in 12 cases. Cases where MxR had above-expectation performances will be highlighted. Comparing MxR cases with matching non-MxR, the average EBL (106.8 mL vs. 142.4 mL), LOS (5.4 d vs. 8.2 d) and surgery duration (218.4 mins. 252.8 min) were all smaller for the MxR group. However, no statistically significant differences were found for all three comparisons.

CONCLUSIONS:
MxR enhances surgical planning and can supplant probe-and-monitor navigation for efficient intraoperative guidance without additional time for surgery or hospitalization
245 Linking Cervical Spinal Cord White Matter Magnetization Transfer Ratio to NIH Toolbox Based Analyses of Motor Function in Degenerative Cervical Myelopathy
Authors: Muhammad Fauziyya , Weber Kenneth Arnold , Rohan Michael , Haynes Grace , Khan Ali Fahim , Hameed Sanaa , Mohammadi Esmaeil , Omini Michael , Smith Zachary Adam 
Published: March 2024

INTRODUCTION:
Traditional spine imaging technique present disparity between degenerative cervical myelopathy (DCM) disease severity and prognosis. Advancement in spine neuroimaging has unveiled key changes that enhance our understanding of DCM pathogenesis. We investigated region- and tract-specific SC white matter (WM) damage and their relationship to motor deficit in DCM.

METHODS:
A cohort of 20 DCM and 23 age-matched HC participants were recruited in a cross-sectional study. We utilized a consensus MT-imaging protocol, Spinal cord Toolbox, and objective motor assessment tool battery to assess the extent of WM injury and functional deficits in DCM. The SC WM region- and tract-based MTR were calculated in three different ROIs: maximum compressed level (MCL), caudal uncompressed level (C7), and central region of compression.

RESULTS:
DCM patients demonstrated significant functional deficits compared to HC in motor assessments. DCM exhibited reduced MTR measures denoting WM injury in the anterior region of the SC and within selected motor tracts in the ROIs. MTR values in reticulospinal, vestibulospinal, and lateral corticospinal tracts were significantly associated with dexterity and grip strength measures.

CONCLUSIONS:
Our methodology enables precise mapping of ROIs within the SC allowing us to demonstrate an association between tract-specific WM damage and functional motor deficits in DCM patients. Additionally, the observation of decreased MTR measures in seemingly uncompressed SC regions indicates the pathophysiology of DCM that may provide insight into the varying presentations of DCM. Identification of specific WM injury may help better understand DCM deficits that can be targeted for effective interventions to improve patient outcomes
247 Novel Automated Active Irrigation With Drainage Leads to Significantly Faster Hematoma Clearance and Lower Catheter-related Infections Compared to Passive Drainage Alone for cSDHA Propensity Score-matched Comparative Study with Volumetric Analysis
Authors: Baig Ammad , Hess Ryan M. , Khan Asham , Cappuzzo Justin Mark , Hashmi Eisa , Bregy Amade , Kuo Cathleen , Nyabuto Elizabeth , Goyal Aditya , Davies Jason , Levy Elad I. , Siddiqui Adnan Hussain 
Published: March 2024

INTRODUCTION:
Passive drainage post-surgical evacuation of symptomatic chronic subdural hematoma (cSDH) is currently standard of care. High rates of infection, drain occlusion, and recurrence are associated complications.

METHODS:
A prospectively maintained database was retrospectively searched for consecutive patients presenting with cSDH. One-to-one PSM of covariates (including baseline comorbidities and presentation hematoma volume) in active and passive irrigation groups was performed to adjust for treatment selection bias. Rates of hematoma clearance, catheter-related occlusion, and infection; number of revisions; and length of hospital stay were recorded.

RESULTS:
This study included 55 patients: active continuous irrigation-drainage-21 (21 post-PSM); passive drainage-34 (21 post-PSM). For PSM groups, a significantly higher rate of hematoma clearance was obtained in the active irrigation-drainage group (0.5±0.4 vs. 0.4±0.5 ml/day in the passive drainage group; odds ratio [OR] = 1.291 (confidence interval [CI]:1.062-1.570, P = 0.002) and a significantly lower rate of catheter-related infections (OR = 0.051; CI: 0.004-0.697, P = 0.039). A non-significantly lower hematoma expansion rate at discharge was noted in the active irrigation-drainage group (4.8% vs. 23.8%; OR = 0.127; P = 0.186). No statistical difference in all-cause in-hospital mortality or discharge GCS score was observed between groups.

CONCLUSIONS:
Active and automated continuous irrigation plus drainage following cSDH surgical evacuation results in faster hematoma clearance and led to favorable clinical outcomes and low complication and revision rates compared to passive irrigation.
251 A Comparison of Neurosurgical Intervention and In-hospital Mortality in Patients With Intracranial Gunshot Wounds From Long Guns Versus Handguns: A Propensity-matched National Database Analysis
Authors: Jiang Sam Han , Neves Teresa , Hewins Bryson , Chiu Ryan Guan , Marotta Dario Alfredo , Mehta Ankit Indravadan 
Published: March 2024

INTRODUCTION:
Intracranial gunshot wounds (IC-GSW) are an understudied cause of mortality with indications for neurosurgical intervention. Historically, handguns have accounted for the majority of IC-GSW, but incidents involving long guns (rifles/shotguns) are rising. A comparison of neurosurgical intervention and in-hospital mortality by firearm type has yet to be fully explored.

METHODS:
The National Trauma Data Bank was queried from 2017-2019 for patients with IC-GSW presenting to a hospital with signs of life. Propensity score matching was performed between LG and HG groups based on demographics, comorbidities, Glasgow Coma Scale (GCS), and insurance type. Group differences were compared using paired Student’s t-tests and Pearson’s chi-square tests. A logistic regression model was developed to identify predictors of mortality.

RESULTS:
A total of 6,585 patients met inclusion criteria. Following one-to-one propensity score matching, 510 patients were identified and compared in each group. Seventy percent of patients with IC-GSW arrived with a GCS < 8 (68.43% LG vs. 72.16% HG, p=0.19). Rates of neurosurgical intervention were similar between the LG and HG groups (20.49% vs. 23.53%, p = 0.26), however LG patients had a lower rate of in-hospital mortality (34.51% vs. 42.55%, p < 0.01). Neurosurgical wound debridement (OR = 0.46, p<0.001), foreign body removal (OR = 0.44, p < 0.001), craniectomy (OR = 0.48, p < 0.001), and ventriculostomy (OR = 0.58, p < 0.01) were associated with lower odds of mortality.

CONCLUSIONS:
Patients with IC-GSW often present to the hospital in critical neurologic condition. Neurosurgical intervention is associated with lower odds of in-hospital mortality. Though both groups undergo neurosurgery at similar rates, patients with LG IC-GSW have a lower mortality rate. This study identifies a subset of patients who may particularly benefit from neurosurgery. Further research is needed to quantify the rationale behind these findings.
252 Chronic Subdural Hematoma Drainage Under Local Versus General Anesthesia: Systematic Review and Meta-analysis
Authors: Liu Eva , Zhou Amy , Tilbury Natalie , Radic Julia 
Published: March 2024

INTRODUCTION:
Chronic subdural hematoma (CSDH) is one of the most encountered conditions seen in neurosurgery. Although mainstay treatment of cSDH has been burr hole drainage, no consensus yet exists on optimal anesthetic technique for surgical treatment between general (GA) and local (LA) anesthesia.

METHODS:
A search was conducted in MEDLINE (1946 to November 11, 2022), Embase (1974 to November 11, 2022), and PubMed (up to November 11, 2022). We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to systematically screen studies.

RESULTS:
Our literature search identified 521 studies, out of which 20 were included. There were a total of 1750 patients in the LA group and 699 patients in the GA group. Our meta-analysis found that the LA group had significant shorter operative time (mean difference -29.28 minutes, p <0.0001), length of admission (Mean difference -1.58 days, 95% CI = -2.40 to -0.76 days, p = 0.0002), and postoperative complications rate (odds ratio 0.38, 95% CI = 0.25 to 0.59, p < 0.0001) compared to GA. There was no significant difference between the two groups in revision rate (odds ratio 2.71, 95% CI 0.89 to 8.25, p = 0.08) and mortality rate (odds ratio 1.23, 95% CI 0.63 to 2.43, p = 0.55).

CONCLUSIONS:
In this meta-analysis, LA shows benefits in shorter operative time, shorter admission length, and fewer postoperative complications. This makes local anesthesia a less invasive alternative to general anesthesia especially in elderly patients.
253 Tissue Partial Pressure of Oxygen During Spreading Depolarization in Malignant Stroke is Associated With Outcome
Authors: Hecht Nils , Haddad Daisy , Schumm Leoni , Dömer Patrick , Meinert Franziska , Major Sebastian , Lemâle Coline , Dreier Jens , Vajkoczy Peter , Woitzik Johannes 
Published: March 2024

INTRODUCTION:
Spreading depolarization (SD) describes a propagating neuronal mass depolarization within the cerebral cortex that likely represents a relevant mechanism of secondary lesion progression.

METHODS:
This prospective observational study included 25 patients with MHS that underwent decompressive hemicraniectomy (DC) followed by subdural placement of an electrocorticography (ECoG) strip electrode and cortical implantation of a PtiO2 probe within in the periinfarct tissue. Continuous ECoG and PtiO2 recordings were obtained at bedside for five days and analyzed for the occurrence of SD and SD-associated PtiO2 changes, as well as their association with clinical outcome at 6 months.

RESULTS:
The overall simultaneous ECoG and PtiO2 recording time was 2603 hours, during which 796 SDs were detected. The overall SD duration and SD frequency did not correlate with outcome. During the observation period, the overall PtiO2baseline changed significantly with an almost linear increase that reached a peak around 100 hours (*p=0.0055), followed by a PtiO2 drop until the end of the monitoring period (*p = 0.0048). Accordingly, low baseline PtiO2 (<15 mmHg) was mainly noted during the first 24 hours but did not correlate with outcome (p = 0.916). Conversely, 20 out of 25 patients showed SD-associated PtiO2 changes in 363 out of 796 SDs (45.6%), which were categorized as biphasic (222), hypoxic (119) and hyperoxic (22). Among these SD-associated PtiO2 responses, a high occurrence rate, biphasic response pattern and high amplitude correlated significantly with favorable outcome (mRS 1-3) at 6 months.

CONCLUSIONS:
SD-associated PtiO2 coupling in patients suffering hemispheric stroke appears to be associated with clinical outcome and could reflect the presence of viable and metabolically less impaired peri-infarct tissue.
257 Breaking the Mold: An International, Multicenter Study on Active and Continuous Irrigation With Cerebrospinal Fluid Exchange for Improving Outcomes in Cerebral Ventriculitis
Authors: Baig Ammad , Hess Ryan M. , Sprau Annelise , Kemeny Hanna , Nazari Pouya , Turner Ryan C. , Brandmeir Nicholas James , Jahromi Behnam Rezai , Jahromi Babak S. , Levy Elad I. , Siddiqui Adnan Hussain 
Published: March 2024

INTRODUCTION:
Cerebral ventriculitis remains one of the most challenging neurosurgical conditions, with poor outcome and a long course of treatment and duration of hospital stay. Despite the current conventional management plans, i.e., using antibiotics in addition to CSF drainage, the outcome remains unsatisfactory in some cases, with no definitive therapeutic guidelines.

METHODS:
We conducted a multicenter, international, retrospective study of ventriculitis patients treated with a novel automated active irrigation, and drainage system. Data collected included patients’ demographics, comorbidities, admission Glasgow Coma Scale (GCS) score, and pre-hospital modified Rankin Scale (mRS). Catheter occlusions, infections, and shunt placement was recorded for outcome assessment, along with discharge mRS, and in-hospital mortality.

RESULTS:
Four centers (3 from U.S and 1 from Finland) contributed data for a total of 21 ventriculitis patients who had IRRAflow placement. Thirteen (61.9%) were males (mean age = 49.8 ± 14.87 years). The baseline median mRS was 1 and the median GCS at time of ventriculitis diagnosis was 13. Etiology of ventriculitis was iatrogenic in 12 (57.4%), and secondary to abscess in 9 (42.6%). No cases reported hemorrhage, or failure of IRRAflow placement. Antibiotics were administered in through the IRRAflow in 13 (61.9%) cases in addition to systemic dosing. Sixteen (76.19%) patients had significant clinical improvement and resolution of ventriculitis. Seven (33.33%) patients required shunt placement after resolution. There were 6 (28.6%) in-hospital mortalities reported.

CONCLUSIONS:
Use of active and continuous irrigation with drainage for continuous delivery of intraventricular irrigation fluid with antibiotics led to dramatically lower mortality when compared to literature (mortality approx. 70%). In our case series, it led to marked improvement in neurologic status, imaging findings, and CSF profiles making it technically feasible and safe treatment for ventriculitis.