bluuebunny/crossref_metadata_2025_split huggingface dataset:
432 Middle Meningeal Artery Embolization Reduces Recurrence Following Surgery for Septated Chronic Subdural Hematomas
Authors: Zeineddine Hussein A. , Martinez-Gutierrez Juan Carlos , Hugh Dawes Bryden , Wroe William , Dannenbaum Mark J. , Ciavarra Bronson , Blackburn Spiros L. , Chen Peng Roc , Chen Ching-Jen , Kitagawa Ryan Seiji 
Published: March 2024

INTRODUCTION:
Chronic subdural hematoma (cSDH) causes a significant burden of disease and plagued by hematoma recurrence after surgical evacuation, particularly in septated cSDH. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment both as an adjunct to surgery and as a primary treatment.

METHODS:
This a single center, retrospective cohort study of patients treated with surgery for septated cSDH. Patients in the surgery + MMAE cohort were identified from a prospectively collected MMAE registry and compared to a historical surgery cohort presenting over a 2-year period prior to the introduction of MMAE in our institution. Included patients had evacuation of septated cSDH with either burrholes or craniotomy. CT imaging was assessed hematoma width and midline shift perioperatively and at follow up. The primary outcome was reoperation and secondary outcome recurrence and change in hematoma depth and midline shift.

RESULTS:
A total of 34 cSDHs in 23 patients (MMAE + surgery) and 94 cSDHs in 76 patients (surgery) met the inclusion criteria. No significant differences of baseline characteristics was identified.The rate of reoperation was significantly higher in the surgery cohort (n = 16) compared with the surgery + MMAE cohort (n = 0) (p = 0.006).

CONCLUSIONS:
MMAE for septated cSDH was found to be highly effective in preventing recurrence and reoperation. MMAE is an adjunct to surgical evacuation may be of particular benefit in this patient cohort.
433 Orientation of the Lumbar Spine During Dynamic Compression Influences Fracture Characteristics
Authors: Cutlan Rachel , Shammout Nader , Khokhar Muhammad , Yoganandan Narayan , Frazer Lance , Jones Derek , Davis Matthew , Shender Barry S. , Sheehy James , Paskoff Glenn , Nicolella Daniel , Bentley Timothy , Shabani Saman , Stemper Brian D. 
Published: March 2024

INTRODUCTION:
Characteristics of lumbar spine fractures dictate patient outcomes and clinical treatment decisions. Understanding injury biomechanics associated with different fracture types can assist injury prediction and development of safety enhancements.

METHODS:
Twenty human lumbar spines (T12-L5) were isolated and attached to novel whole-column experimental dynamic compressive loading apparatus. Specimens were attached to the lower platform on a drop tower and a decoupled upper platform held a mass to simulate the torso inertially loading the lumbar spine as the lower platform was decelerated at the drop tower base. Each specimen was tested at increasing deceleration magnitudes until failure. Pre-test x-rays were used for the measurements to quantify spinal orientation. Fractures were classified using post-test x-rays and CT scans.

RESULTS:
Fractures were classified into six categories [Wedge (AO Spine A1): n = 8, Burst (AO Spine A3/A4): n = 7, Hyperextension (AO Spine B2): n = 5]. Spines that sustained hyperextension fractures had significantly larger Cobb angles compared to spines that sustained burst fracture (p = 0.03). Spines that sustained wedge fracture had significantly larger lumbar spine angles (i.e., closer to vertical orientation) compared to spines that sustained burst (p = 0.03) and hyperextension (p = 0.02) fracture. Spines that sustained wedge fracture also had a nearly significant longer horizontal distance between the T12 centroid and the load location compared to spines that sustained burst fracture (p = 0.07).

CONCLUSIONS:
This study demonstrated that orientation of the lumbar spine at the time of dynamic load application affected fracture characteristics and, therefore, post-injury spinal stability and patient outcomes. The clinical importance of these findings includes a better understanding of injury mechanisms and a recognition that a wide variety of injury outcomes (stable versus unstable; anterior versus middle versus posterior column) can result from identical loading situations with different spinal orientations.
434 Concurrent Vascular and Traumatic Brain Injury: Effect on Patient Outcomes
Authors: Johnson Mark D. , Ventre Giancarlo Javier , Kaye Joel M. , Patel Hemchandra , Naveed Asad , Prestigiacomo Charles J. , Ngwenya Laura Benjamin 
Published: March 2024

INTRODUCTION:
Dural venous sinus thrombosis (DVST) in select populations following traumatic brain injury (TBI), including those with blunt mechanism or depressed skull fractures, have been associated with an increased risk of mortality.

METHODS:
We performed a retrospective case-control study of data from our institutional trauma registry from 2004-2021. Patients were divided into three groups: those with imaging confirmed DVST, those with imaging confirmed DVST and blunt cerebrovascular injury (BCVI), and a control group of TBI patients with cerebrovascular imaging without DVST or BCVI. All age groups and injury mechanisms were included with a head abbreviated injury score (AIS) of = 3. Demographics, injury characteristics, and patient outcomes were collected. Between group differences were compared with non-parametric tests as appropriate. Multivariate logistic regression was carried out to identify predictors of inpatient mortality.

RESULTS:
We identified 9,875 patients over the time-period with TBIs, with a 1.64% incidence of DVST and 23.4% incidence of concurrent BCVI. Despite a more severe presenting injury profile in those with DVST, the presence of DVST itself was not significantly associated with inpatient mortality (OR 1.02; 0.26-3.69). On regression analysis an occlusive DVST (OR 1.34; 1.15-1.56) and not receiving treatment (OR 1.27; 1.01-1.60) were independently associated with inpatient mortality. Significantly worse functional outcomes were observed in those with DVST+BCVI at 6-months, though a high proportion of patients achieved a GOSE of 7 or 8.

CONCLUSIONS:
We observed an incidence of traumatic DVST of 1.64% in a mixed population of head injured patients, with 23.4% of patients having concurrent BCVI. The presence of DVST alone was not significantly associated with inpatient mortality.
435 Use of Optic Nerve Sheath Diameter in Extraventricular Drain Weaning in Adults With Post-hemorrhagic Hydrocephalus
Authors: Duncan Michael A. , Hess Ryan M. , Khan Asham , Davies Jason , Abdelmalik Peter 
Published: March 2024

INTRODUCTION:
Optic nerve sheath diameter (ONSD) can be used as a noninvasive measurement of intercranial pressure. Few studies have evaluated the value of ONSD in predicting the need for ventriculoperitoneal shunt (VPS) placement after development of post-hemorrhagic hydrocephalus (PHH) in adults.

METHODS:
Adult patients 18 years or older, admitted with intracranial hemorrhage and hydrocephalus requiring EVD placement were included in the study. Demographics were recorded. CT imaging of ONSD was measured (mm) upon initial ED visit before EVD placement (pre-EVD), immediately after successful EVD removal (post-EVD), and if applicable, after EVD removal but immediately before VPS placement. Change in ONSD was calculated and groups were stratified by EVD only patients and EVD+VPS patients.

RESULTS:
Imaging for 30 patients were successfully retrieved and analyzed for bilateral ONSD values at all timepoints. A statistically significant convergence to a normally distributed mean ONSD was found for both groups (EVD and EVD+VPS). Additionally, a statistically significant increase was found in ONSD between the EVD+VPS group compared to the EVD only group. The EVD only group showed a mean EVD placement time of only 14 days (2 weeks) with an average decrease in ONSD (-0.905mm) compared with the EVD+VPS group who had an increase in ONSD at 14-days (+1.089 mm).

CONCLUSIONS:
Patients with hydrocephalus due to intracranial hemorrhage who went on to require VPS developed an increase in ONSD despite EVD use while patients who were successfully weaned from the EVD developed a decrease in ONSD. ONSD may be a useful adjunct tool to aid in the process of EVD weaning in this patient population.
437 Pressure Reactivity Index (PRx) as a Predictor for Outcome in Severe Traumatic Brain Injury
Authors: Chang Jason , Kepplinger David , Dowlati Ehsan , Felbaum Daniel , Mai Jeffrey C. , Mason Robert Bryan , Armonda Rocco , Aulisi Edward F. 
Published: March 2024

INTRODUCTION:
The pressure reactivity index (PRx) is a surrogate for vascular cerebral autoregulation that evaluates moving correlation coefficients between intracranial pressure (ICP) and mean arterial blood pressure (MAP). Ideal threshold PRx values for distinguishing between poor and good outcome in severe traumatic brain injury (sTBI) is unclear.

METHODS:
Retrospective evaluation of consecutive patients over a three-year period with sTBI and polytrauma who received continuous ICP, MAP, and PRx monitoring. Good outcome was defined as patients who upon hospital discharge had a modified Rankin score < 4 and were discharged to an acute rehabilitation facility or home.

RESULTS:
36 patients received continuous monitoring. Nine patients were excluded for the following reasons: early palliative withdrawal, early death through multi-organ dysfunction not related to the sTBI, and continuous neuromonitoring < 24 hrs. Of the 27 patients evaluated, average PRx values for the good outcome group was 0.18 (+0.17) and 0.37 (+0.24) for the poor outcome group. Receiver operating characteristics (ROC) analysis showed that a PRx threshold value > 0.34 had the highest combined sensitivity and specificity for predicting poor outcome with an AUC (95% CI) = 0.775 (0.583-0.967). When dichotomized using ROC curve analysis, a threshold PRx value of greater than 0.34 was independently associated with higher odds of poor outcome (OR 18.63, 95% CI 1.17-297.21, p = 0.038) after adjustment for potential confounders.

CONCLUSIONS:
Higher mean PRx is an independent predictor for poor outcome in patients with sTBI. Further study is required to evaluate the temporal role of PRx changes to improve neuroprognostication.
438 Lesion Combination on Susceptibility-Weighted MRI Predicts Functional Recovery After Diffuse Axonal Injury
Authors: Walek Konrad , Trang Annie , Bodanapally Uttam , Olexa Joshua Robert , Chen Chixiang , Morales Will , Sansur Charles A. , Simard J. Marc , Crandall Kenneth M. , Woodworth Graeme , Eisenberg Howard M. , Oliver Jeffrey , Han Nathan , Caffes Nicholas , Abdulkareem Ahmed , Sharma Ashish , Serra Riccardo , Labib Mohamed , Cherian Jacob , Parker Whitney , Diaz Cara , Scarboro Maureen , Schwartzbauer Gary , Aarabi Bizhan 
Published: March 2024

INTRODUCTION:
Early prediction of long-term functional outcome after diffuse axonal injury (DAI) remains controversial.

METHODS:
In a retrospective observational study, axonal injuries on MRI were correlated with long-term functional outcome. The predictive value of poor functional outcome (GOSE < 5) was determined by ROC analysis for clinical factors and location of combinations of DAI lesions in the connectome.

RESULTS:
Over a 10-year period, 451 patients underwent MRI within 30 days of severe blunt TBI of which 322 (71.4%) survived to = 6-month clinical follow-up. The mean age was 38.4 and 242 (75%) patients were male. Mechanisms of injury were motor vehicle crash (53%) and falls (26%). Mean Glasgow coma scale (GCS) score was 4.7. At 6-24 months, quality MRI and functional outcome data were available for 213 and 104 patients, respectively. The best single-area predictors of early and late long-term functional outcome were the ventral midbrain (AUC6mo 0.65 (95% CI 0.56-0.74), p = 0.010) and dorsal pons (AUC24mo 0.68 (95% CI 0.51-0.86) p = 0.001). The best multiple-lesion predictors of poor long-term functional outcome (GOSE < 5) were dorsal pons and splenium of corpus callosum (AUC24mo 0.92 (95% CI 0.84-0.99), p < 0.0001) and the dorsal and ventral pons (AUC24mo 0.91 (95% CI 0.79-1.00), p < 0.0001). The strength of these combinations’ predictive value was not improved by considering three or more areas. The 6-area cluster of internal capsule, corpus callosum genu, body, and splenium; and dorsal and ventral midbrain lesions was a good predictor of outcome at 24 months (AUC24mo 0.82 (95% CI 0.66-0.98), p < 0.0001).

CONCLUSIONS:
In patients with severe TBI, the strongest predictors of poor long-term functional outcome were combined lesions in the splenium and dorsal pons and the dorsal and ventral pons.
440 Retrospective Assessment of the Clinical Timeline and Predictors for Vasospasm Severity in Traumatic Brain Injury Within a Safety-Net Hospital Population
Authors: Windermere Sonora , Young Sara , Tran Dominic , Morris Sarah , Daneshmand Ali , Cervantes-Arslanian Anna 
Published: March 2024

INTRODUCTION:
Unlike aneurysmal subarachnoid hemorrhage, vasospasm following traumatic brain injury (TBI) is poorly understood and no guidelines-based recommendations for surveillance exist.

METHODS:
TBI patients admitted to the surgical ICU 11/2014-12/2020 with 2+ instances of TCD-diagnosed vasospasm were included. Clinical timelines, TBI severity by Glasgow Coma Score (GCS) (mild = 13-15, moderate = 9-12, severe = 3-8), presence of subarachnoid hemorrhage (tSAH), and vasospasm severity (mild, moderate, or severe) were extracted from records. One-way ANOVA analysis compared the highest severity of vasospasm noted with date of onset and total days of vasospasm. Significant differences in means were further analyzed with Games-Howell post-hoc test. Stata® determined the dependence of vasospasm severity upon imaging findings or the GCS via Chi2 analysis.

RESULTS:
Forty-four patients were identified (31 male, 13 female, median age 40 (15-92) years). Amongst mild TBIs (13), vasospasm was mild (9), moderate (1), and severe (3). For moderate TBIs (2), vasospasm was mild (1), moderate (0), and severe (1). For severe TBIs (29), vasospasm was mild (16), moderate (6), and severe (7). Thirty-two patients had tSAH, 19 with mild, 6 moderate, and 7 with severe vasospasm. Of the 12 patients without tSAH, 7 had mild, 1 moderate, and 4 with severe vasospasm. Median time to onset did not differ between mild (Hospital Day (HD) 3), moderate (HD 4), and severe (HD 3) vasospasm (p = 0.47). Mean duration of mild vasospasm (2.35 days) differed from severe vasospasm (6.73 days), (p < 0.05). Neither presence of tSAH nor severity of TBI was related to severity of vasospasm (p = 0.11 and p = 0.61).

CONCLUSIONS:
Our study found that post-traumatic vasospasm can impact TBI patients, early, regardless of TBI severity or the presence of tSAH, suggesting early and routine surveillance for PTV may be warranted in all critically ill TBI patients.
442 A Ventriculomegaly Feature Computation Pipeline to Improve the Screening of Normal Pressure Hydrocephalus on Computed Tomography
Authors: Sridhar Sharada Kadaba , Gupta Rishabh , Kuang Rui , Samadani Uzma 
Published: March 2024

INTRODUCTION:
Normal pressure hydrocephalus (NPH) commonly presents with a triad of gait disturbance, incontinence, and memory impairment. Shunt placement effectively treats symptoms; however, NPH is commonly misdiagnosed with below 20% of patients receiving a diagnosis. Given undiagnosed NPH elderly patients often present to the emergency room (ER) with falls, algorithmic identification of NPH using non-contrast CT (NCCT) may improve diagnosis rate.

METHODS:
NCCTs for 84 patients with NPH, 72 headache controls (HC), 97 Alzheimer’s Disease (AD) patients, and 61 post-traumatic encephalomalacia (PTE) patients were identified using Veterans Affairs Informatics and Computing Infrastructure. Image processing pipelines were developed to extract a novel feature capturing lateral ventricle eccentricity (MaxEccLV), a proxy-Splenial Angle (p-SA), the Evans indices (EI-x, y, z), Callosal angle (CA), third ventricle width (NMax-3VW), and CSF to brain volume ratio (CSF2BVR). T-tests were used to examine group differences and logistic regression to classify between NPH, AD, PTE, and HC.

RESULTS:
The AUC, sensitivity, and specificity for NPH versus AD+HC+PTE was 0.94, 83.0%, and 87.0% respectively. For NPH versus HC, it was 0.98, 98.8%, and 98.6% respectively. For NPH versus AD, it was 0.90, 84.5%, and 82.5% respectively. For NPH versus PTE, it was 0.95, 91.7%, and 86.9% respectively. Significant differences were seen between NPH and HC, AD, and PTE in MaxEccLV and all other features.

CONCLUSIONS:
The computational pipeline proposed here can identify NPH from HCs and ventriculomegaly-causing conditions using NCCT with a high sensitivity and specificity. This may help capture undiagnosed NPH patients receiving a NCCT due to presentation to the ER as a fall.
446 Management of Orbital Schwannomas, to Operate or Not? A Population-Based Case Series
Authors: El-Hajj Victor Gabriel , Singh Aman , Bohman Elin , Norin Cecilia , Edström Erik , Elmi-Terander Adrian 
Published: March 2024

INTRODUCTION:
Schwannomas of the orbit (OS) are rare occurrences with no more than 500 cases documented worldwide. Traditionally, once discovered radical excision of the tumor, often requiring a multidisciplinary neuroophthalmological and neurosurgical approach, is sought to prevent tumor invasion of the delicate neuro-ophthalmic structures. However, inherent surgical risks, due to the complexity of the neurovascular configuration in the orbital region, warrant further investigation of a more conservative approach in the management of these benign entities.

METHODS:
The study center is the primary referral center for multidisciplinary evaluation, discussion, and management of orbital tumors, including schwannomas, in Sweden. During the period of 2005-2010, 16 patients with an OS diagnosis were identified and managed at the center.

RESULTS:
After weighing the risks and benefits of surgical and conservative treatment, four patients underwent immediate surgery where gross total resection (GTR) was achieved in 3 cases (75%). The remaining 12 patients were treated conservatively by watchful waiting and re-evaluation. Surgery with subtotal resection (STR) was later performed after an average of 17 months in three of these patients (25%). No recurrences or regrowth were detected on radiographic follow-up (mean 50 months), and all patients experienced postoperative improvement at clinical follow-up (mean 65 months). The remainder of the conservatively treated patients (n = 9) experienced no clinical progression (mean 30 months). A slight radiological tumor progression was only detected in one patient after 17 months.

CONCLUSIONS:
There were no differences in outcome between patients undergoing immediate surgery and those operated later after watchful waiting. Conservatively treated patients had minimal to no symptoms and remained clinically stable throughout the follow-up period. Based on these findings, watchful waiting, may successfully be adopted in cases whit mild symptoms and no imminent risk of neuro-ophthalmic impairment.
459 Outcome of Surgeries of Pan Brachial Plexus Injuries - Our 10 Years Experience
Authors: Agrawal Rati , Agrawal Deepak , Satyarthee Guru Datta , Mishra Shashwat , Kumar Hitesh , Meena Rajesh , Doddamani Ramesh S. , Jagdevan Amandeep , Verma Satish , Garg Kanwaljeet , Singh Pankaj Kumar 
Published: March 2024

INTRODUCTION:
Brachial plexus injuries are very much devastating and lead to significant socioeconomic and mental burden to the affected person and his family. In the early days of 20th century many authors were in favour of conservative management even the amputation of affected limb. But in later decades due to development in technological advancement of operating microscope, intraoperative electrophysiological monitoring, biological tissue glue etc. the results of surgical repair are beyond the imagination that could be done previously.

METHODS:
Our study is a Retrospective observational analytical study in which we included patients of Pan brachial plexus injury operated under the Department of Neurosurgery from April 2011 till February 2023 (excluding covid period from March 2020 to September 2021) at apex trauma center AIIMS Delhi, India. Demographic details, mode of injury, surgery performed and outcome were analyzed. Data was extracted from patient’s casualty, ICU and OT records and analyzed using SPSS version 29.0.0.0. Analysis of outcome was taken in terms of improvement in motor power and quality of life.

RESULTS:
There were 113 patients diagnosed to have Pan brachial plexus injury by clinical examination and supported with brachial plexus MRI, NCV and EMG of the affected limb. 24 (21.24%) cases underwent Neurolysis only, 17 (15.04%) cases underwent Supraclavicular neurotization only, 24 (21.24%) cases were operated by infraclavicular neurotization and 48 (42.48%) patients were operated by supraclavicular and infraclavicular neurotization both. Respectively 25%, 23.52%, 25% and 35.42% cases had motor and sensory improvement and were able to perform few of their daily activities with lesser support.

CONCLUSIONS:
In our study at least 25% Patients of Pan brachial plexus injury after surgery got benefited in their routine activity and quality of life thus lesser affected in socioeconomic and psychological front.
460 Frame Navigation Guided Percutaneous Balloon Compression for Intractable Trigeminal Neuralgia Secondary to Multiple Sclerosis
Authors: Valerio Jose E. , Farfan Penelope Mantilla , Velandia Felipe Ramirez , Fernandez Gomez Maria Paula , Alvarez-Pinzon Andres M. 
Published: March 2024

INTRODUCTION:
Patients with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) compared to the regular population, due to scarring of the nerve and the development of a demyelination plaque. Despite treatment, approximately 10% of MS patients treated for TN experience symptom recurrence, including the development of MS-like symptoms such as optic neuritis and bilateral facial pain.

METHODS:
A computed tomography (CT) scan was performed preoperatively on two patients diagnosed with multiple sclerosis (MS) who experienced secondary trigeminal neuralgia (TN). The acquired images were then introduced into a navigation system for intraoperative navigation. The preliminary CT images were registered using the navigation system and the bony landmarks were set. Fluoroscopy-guided cannulation was performed under general anesthesia to complete the procedure.

RESULTS:
Two patients diagnosed with multiple sclerosis (MS) who experienced refractory trigeminal neuralgia (TN) underwent percutaneous balloon compression. The patients were 38 and 56 years old and complained of facial pain in the V1-V2 and V3 distribution. Initial conservative treatment and one dosage of Gamma Knife Radiosurgery (GKR) resulted in symptom control for a few weeks. However, both patients had an acute recurrence of pain; thus, percutaneous retrogasserian balloon compression was performed. During follow-up, the patients reported a 70% decrease in pain after the procedure, with minimal recurrence of shooting episodes.

CONCLUSIONS:
The management of trigeminal neuralgia secondary to drug-resistant multiple sclerosis presents a persistent challenge. The percutaneous technique for retrogasserian balloon compression may offer a solution for some patients, but it can be technically challenging. Microvascular decompression remains a debated approach for this population, given the complexity of the pathogenesis, target identification, and the potential absence of neurovascular conflict, while stereotactic radiosurgery may be a promising alternative.