bluuebunny/crossref_metadata_2025_split huggingface dataset:
755 Pathology in the Digital Era of Neuro-oncology: A Pathomics-Based Approach to Modeling Outcomes in Medulloblastoma
Authors: Mahtabfar Aria , Familiar Ariana , Kazerooni Anahita Fathi , Khanna Omaditya , Kiani Mahsa , Haldar Debanjan , Viswanathan Karthik , Resnick Adam C. , Viaene Angela , Storm Phillip B. , Nabavizadeh Ali 
Published: March 2024

INTRODUCTION:
Pathomics is an emerging data science technique that may be used to extract intricate, sub-visual histopathologic features using high-throughput digital image analysis.

METHODS:
Using the Children’s Brain Tumor Network database, pediatric medulloblastoma patients were evaluated for inclusion in the study. After tumor segmentation, 49 quantitative pathomic features were extracted using a digital pathology software package (Qupath). LASSO cox proportional hazard model with stratified 5-fold cross-validation was used to identify high-performing features and create a predictive survival model by identifying low-, medium- and high-risk OS cohorts. A classification model was developed using histogram gradient boosting classifier to perform binary classification of Group3/4 vs. SHH/WNT with leave-one-subject-out cross validation.

RESULTS:
84 patients with median age at diagnosis of 8.61 years (range 0.31-21.72), and median OS of 45.6 months (range 0.76-195.87) were included in the study. A survival model built using only clinical features yielded a concordance index (c-index) of 0.76 compared to actual outcomes (stratification: p < 0.001). However, a survival model built by combining clinical and high-performing pathomic features yielded the best performance, showing disparate outcomes between low-, medium- and high-risk groups (p < 0.001) with resultant c-index of 0.85. Furthermore, pathomic features classified subjects into Group 3/4 or SHH/WNT with classification accuracy of 71% (SEM = 0.06), and t-test against stratified chance accuracy (57%) showed significantly above-chance performance (p = .019).

CONCLUSIONS:
This study represents the largest pathomic-based machine learning analysis for predicting survival and molecular subtypes in medulloblastoma. The results demonstrate success in pathomic analysis using machine learning-based modeling to predict survival and molecular subtypes for patients with medulloblastoma. Further work will aim to perform our analysis on an external validation dataset to enhance model performance and improve its clinical applicability.
757 Machine Learning-Driven Web Application for Enhanced Clinical Decision Support in Thoracolumbar Spinal Cord Injuries
Authors: Karabacak Mert , Jagtiani Pemla , Margetis Konstantinos 
Published: March 2024

INTRODUCTION:
Thoracolumbar spinal cord injuries (tlSCI) can result in negative short-term in-hospital outcomes, underscoring the importance of precise prediction tools.

METHODS:
This retrospective cohort study included 147,826 patients from the American College of Surgeons Trauma Quality Program database. XGBoost, LightGBM, CatBoost, and Random Forest algorithms were utilized in combination with the Optuna optimization library for hyperparameter tuning. Models were evaluated graphically with receiver operating characteristic (ROC) curves, precision-recall curves, and numerically with precision, recall, F1 score, accuracy, area under ROC (AUROC), and area under PRC. The best-performing models were integrated into an open-access web application for individualized predictions.

RESULTS:
The best-performing models for each outcome were as follows: for predicting mortality, Random Forest achieved the highest AUROC (0.865, 95% CI 0.848-0.879); in predicting non-home discharges, LightGBM had the highest AUROC (0.801, 95% CI 0.794-0.804); and for predicting major complications, Random Forest performed best with an AUROC of 0.733 (95% CI 0.642-0.808). Algorithms' receiver operator curves for the outcomes: (A) mortality, (B) non-home discharges, and (C) major complications.

CONCLUSIONS:
This study successfully developed ML models to predict critical in-hospital outcomes for patients with tlSCI. By incorporating the top-performing algorithms into a user-friendly web application, these models have the potential to improve clinical decision-making and management strategies for tlSCI patients, ultimately enhancing patient care and outcomes.
758 An Appraisal of the Quality of Development and Reporting of Predictive Models in Neurosurgery
Authors: Khalid Syed Ibad , Massaad Elie , Roy Joanna , Thomson Kyle , Kiapour Ali , Shin John H. 
Published: March 2024

INTRODUCTION:
Overwhelming evidence indicates that the quality of reporting of predictive models is poor, often being confounded by small datasets, inappropriate statistical methods, a lack of validation, and reproducibility.

METHODS:
Articles reporting prediction models published in the top five neurosurgery journals by SJR2-rank (Neurosurgery, Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of NeuroInterventional Surgery, and Journal of Neurology, Neurosurgery, and Psychiatry) between January 1st, 2018, and January 1st, 2023, were identified via a PubMed search strategy that combined terms related to machine learning and prediction models. The identified original research articles were analyzed against the TRIPOD criteria.

RESULTS:
110 articles were included and analyzed against the TRIPOD checklist. Among the articles screened, the median compliance was 57.4% (50.0-66.7%). Models utilizing machine learning-based models exhibited lower compliance on average compared to conventional learning-based models (57.1%, 50.0-66.7% vs. 68.1%, 50.2-68.1%, p = 0.472). Among the TRIPOD criteria, the lowest compliance was observed in blinding the assessment of predictors and outcomes (n = 7, 12.7% and n = 10, 16.9%, respectively), including an informative title (n = 17, 15.6%) and reporting model performance measures including confidence intervals (n = 27, 24.8%). Few studies provided sufficient information to allow for the external validation of results (n = 26, 25.7%).

CONCLUSIONS:
Published machine learning models predicting outcomes in neurosurgery often fall short of meeting the established guidelines laid out by TRIPOD for their development, validation, and reporting. This lack of compliance may indicate the extent to which these models have been subjected to external validation or adopted into routine clinical practice in neurosurgery.
817 Promoting Durable Well-Being Among Neurosurgical Professionals via an Interactive, Online, Wellness Educational Initiative
Authors: Kazemi Foad , Mukherjee Debraj Raj 
Published: March 2024

INTRODUCTION:
Burnout is increasingly recognized as a source of worse job satisfaction and well-being within neurosurgery. We initiated a 10-week department-wide wellness course (Peace Education Program, PEP) with the goal of improving well-being.

METHODS:
We utilized PEP, a free, interactive, online wellness course focusing on 10 domains (hope, appreciation, inner strength, self-awareness, clarity, understanding, dignity, choice, peace, and contentment). Two weeks before and 6 months after the course, we distributed de-identified surveys based upon the validated Schwartz Outcome Scale-10 (SOS) with Likert scale scores 0-6 to assess participant wellness. Completion of the course was defined as attending >7 of 10 sessions. Mann-Whitney U testing analyzed statistical differences between post-and pre-course data. p-values <0.05 were considered statistically significant.

RESULTS:
Sixty-nine faculty, trainees, and staff registered to participate, 41 joined >1 session, and 15 completed the course. Twenty-one and ten participants completed the pre- and post-course survey, respectively. Pre-course mean(+SD) SOS-10 score was 4.32 ± 1.23, which improved to 5.10 ± 0.75 post-course (p < 0.001). Pre-course, the lowest domain score related to “appreciation” (3.95 ± 1.46); post-course the highest domain score related to “hope” (5.30 ± 0.48). Overall, all 10 domains demonstrated improved mean scores over time, with 5 domains [“inner strength” (p = 0.008), “understanding” (p = 0.030), “hope” (p = 0.020), “choice” (p = 0.026), and “peace” (p = 0.048)] demonstrating statistically significant score improvements six months after course completion. Focusing on participants who completed >7 sessions, we additionally found statistically significant score improvements in the domains of “clarity” (p = 0.019), “contentment” (p = 0.030), and “appreciation” (p = 0.029) six months after course completion.

CONCLUSIONS:
Our findings demonstrate improved wellness in participants up to 6 months after wellness course completion. Participants attending >7 sessions benefited more than counterparts. This free, interactive, online course can be utilized at other neurosurgical training programs to combat burnout and improve wellness.
818 Prevalence of and Risk Factors for Depression, Anxiety, and Burnout in U.S. Neurosurgical Residents
Authors: Tavakol Sherwin , Nawaz Samia , Oumar Coulibaly Nangorgo Jean , Shakir Hakeem Jon 
Published: March 2024

INTRODUCTION:
Rates of mental illness are disproportionately higher among medical residents. Neurosurgical trainees are no exception and may be more likely to suffer from depression, anxiety, and/or burnout than other residents. An assessment of the prevalence of mental illness in U.S. neurosurgical residents in the post-COVID-19 era is lacking in the literature and understanding the risk factors is vital to combating these mental health disorders.

METHODS:
Cross-sectional study analyzing responses to a 28-question survey from March-May 2023 distributed to U.S. neurosurgery residents. The survey included demographic and program-specific information, as well as Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) screening questions. PHQ-9 and GAD-7 scores >5 represent at least mild depression and anxiety, respectively.

RESULTS:
Forty-eight responses were included in the analysis, which consisted of 35 males (74%), 36 married respondents (77%), and 27 junior residents (56%, PGY-1 to 4). Twenty-four residents (50%) screened positive for depression, 19 residents (40%) screened positive for anxiety, and 26 residents (54%) reported feeling burned out. Depressed residents were highly more likely to also suffer from anxiety (70%, p < 0.0001) and burnout (79%, p = 0.001). Further, junior residents (63%, p = 0.042), female residents (83%, p = 0.008), and residents on a neurosurgical rotation (60%, p = 0.036) were more likely to screen positive for depression. However, being married (p = 0.318), practicing in one’s home state (p = 0.724), having a 24-hour call system (0.188), having formal didactic time (p = 0.125), and having program-led wellness initiatives (p = 0.069) were not protective.

CONCLUSIONS:
Half of U.S. neurosurgery residents who responded screened positive for depression, 40% screened positive for anxiety, and 54% felt burned out. Depression was strongly correlated with both anxiety and burnout. Neurosurgery residents who were female, in their junior years, and on-service were at particularly high risk for depression.
819 Pre-residency Research Output Amongst U.S. Neurological Surgery Residents
Authors: Gupta Rishabh , Chen Jeffrey , Roth Steven G. , Kamal Naveed , Reisen Breanne , Ortiz Alex , Feldman Michael , Mummareddy Nishit , Jo Jacob , Chambless Lola Blackwell 
Published: March 2024

INTRODUCTION:
Research productivity is often used in evaluating candidates for neurosurgery residency. Official Match data report successful candidates have on average ∼25 pre-residency research products; however, average number of indexed publications, the highest-valued research product, is not reported separate from other research products.

METHODS:
A list of all US neurosurgery residents who successfully matched between 2017-2021 was generated and narrowed to US MD seniors who applied to the authors’ institution. Each resident’s pre-residency publication quantity was extracted using Scopus. Additional variables were extracted from residency applications.

RESULTS:
93.2% of all matched neurosurgery applicants from 2017 through 2021 were captured. Distribution of publication quantity was right skewed. Mean ± SD total, neuroscience-specific, and first-author pre-residency publications for applicants who matched in 2021 were 8.1 ± 10.0, 6.6 ± 8.7, and 2.3 ± 3.8 respectively. Median (IQR) total, neuroscience-specific, and first-author pre-residency publications were 5.0 (2.0, 11.0), 4.0 (1.5, 9.0), and 1.0 (0.0, 3.0) respectively. There was a statistically significant increase in average total, neuroscience-specific, and first-author publications from 2017 to 2021 (p < 0.001). Multivariable analysis demonstrated an independent, positive association between class year and publication quantity (1.07 (0.71-1.42), p < 0.001).

CONCLUSIONS:
Indexed publications constitute a small portion of total research products successful neurosurgery candidates apply with. A high number of publications is not necessary to match with approximately 50% of all applicants who successfully matched having fewer than five publications and 25% having fewer than two. That said, average pre-residency publication quantity is increasing over time at a rate of approximately one publication per year.
870 Middle Meningeal Artery Embolization Does Not Confer Protection Against Symptomatic Recurrence in Patients With Early Anticoagulation Following Surgery for Chronic Subdural Hematomas
Authors: Zeineddine Hussein A. , Dawes Bryden Hugh , Martinez-Gutierrez Juan Carlos , Wroe William , Blackburn Spiros L. , Chen Peng Roc , Ciavarra Bronson , Chen Ching-Jen , Kitagawa Ryan Seiji 
Published: March 2024

INTRODUCTION:
Chronic subdural hematoma (cSDH) is a prevalent condition that carries a significant burden. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment both as an adjunct to surgery and as a primary treatment. A number of patients suffering from cSDH have concurrent comorbidities necessitating early introduction of antithrombotic medications. The question of whether adding MMAE to surgically evacuated cSDH confers protection against recurrence in this subgroup of patients is unclear.

METHODS:
This a single center study. 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 cSDH with either burrholes or craniotomy. Patients were included if they had a clinical indication requiring early antithrombotics within 5 days of surgery. The primary outcome was reoperation.

RESULTS:
A total of 16 cSDHs in 13 patients (MMAE + surgery) and 32 cSDHs in 27 patients (surgery) met the inclusion criteria. No significant differences of baseline characteristics was identified. There was a total of 2 recurrences in the group that underwent MMAE with no reoperation. In the group of surgery alone, there was 4 recurrence and 3 reoperations. The rate of reoperation however was not significantly different in the two cohort neither was the rate of recurrence. (p = 0.54 and 0.7 respectively).

CONCLUSIONS:
This study analyzed a specific subset of patients requiring ultra-early administration of antithrombotic medications. While MMAE is gaining momentum as an adjunct to surgery, or even as sole treatment, it is unclear whether addition of MMAE to surgery confers any protection against recurrence or surgery in this particular subset.
880 Extraction of a Metal Arrow Entering the Skull Base Using a Three-Surgeon Combined Microscopic and Endoscopic Approach
Authors: Gatdula Francis James , Piatos del Rosario Jose Nicanor 
Published: March 2024

INTRODUCTION:
Low velocity penetrating brain injuries (PBI) present both a diagnostic and therapeutic challenge in management particularly in operative planning for the extraction of the impaled foreign body.

METHODS:
A 3-surgeon combined microscopic-endoscopic approach with the use of intraoperative ultrasound, angiogram, and C-arm localization was done. This involved a 5-part procedure: internal carotid angiography; parieto-occipital vertex craniotomy with ultrasound-guided localization; right transciliary cranio-orbito-zygomatic osteotomy transciliary approach; endoscopic guided advancement and extraction of foreign body and endoscopic endonasal transsphenoidal repair of skull base defect.

RESULTS:
The rationale for the procedures borders on obtaining information on the relationship of the arrow to the major vessels at the base of the brain, visualization of the arrow’s entry into the skull, guidance on the point of exit as the arrow was pushed upwards towards cortex and extracted it from the surface, and the integrated use of a basal approach for actual visualization of the shaft of the arrow. The patient remained clinically and neurologically stable post-operatively and was discharged after 10 days. He was back to pre-morbid functional status during follow-up at the outpatient two weeks after surgery.

CONCLUSIONS:
Presented is a successfully managed case of low-velocity PBI. The knowledge of surgical anatomy combined with the different concepts and principles of neurosurgery led to the development of combined techniques that can be used and may further be improved in the management of these injuries.
892 Pain Intensity Is Characterized by Theta Band Dynamics and Opioid Pain Medication Effect at Gamma Band Dynamics Within the Human Subcortical Structures
Authors: Ryu Jihye , Bari Ausaf A. 
Published: March 2024

INTRODUCTION:
Chronic pain is a multifaceted condition that involves processes of sensation, cognition, and emotion. Given its complexity, characterizing the dynamic changes in pain intensity for patients with chronic pain has remained a challenge. Several EEG studies have shown chronic pain patients to exhibit an increased theta and alpha band power, and acute pain to induce an increased gamma power. However, these do not inform the dynamical changes in pain fluctuations, and critically at the subcortical hubs that modulate the processes of sensation, cognition, and emotion.

METHODS:
The patients continuously rated their pain level for approximately 10 minutes, and we characterized the pain reduction that occurred spontaneously and that occurred via opioid pain medication. We used a novel method coined variance of auto-information (VAI), that would parameterize the stochasticity (i.e., randomness) of the theta and gamma bandpass filtered LFP.

RESULTS:
In all four patients, the theta VAI (randomness) was found to be lower as pain was relieved both spontaneously (p = 0.01) and via fentanyl (p = 0.03). The gamma VAI was higher when pain was relieved via fentanyl (p = 0.03).

CONCLUSIONS:
The results demonstrate characterizing pain intensity using the human neuronal oscillatory activity from the subcortical structures. We also introduce the VAI method that consistently characterize pain relief among chronic pain patients. These findings may help to identify biomarkers for pain intensity, and potentially guide stimulation targets for closed-loop neuromodulatory treatment.
894 Comparison of Intraoperative Neural Changes During Tonic Versus High-Frequency Spinal Cord Stimulation in Chronic Pain Patients
Authors: Gopal Jay , Bao Jonathan , Paniccioli Steven , Grey Rachael , Briotte Michael , McCarthy Kevin , Pilitsis Julie G. , Telkes Ilknur 
Published: March 2024

INTRODUCTION:
Chronic pain is a prevalent issue that may affect up to 34% of US adults, and spinal cord stimulation (SCS) is a promising therapy. However, SCS device selection remains a challenge because there are currently no objective biomarkers to evaluate chronic pain, or to predict which patients will be responders.

METHODS:
Intraoperative EEG signals were recorded in 24 chronic pain patients (14 women) during permanent SCS electrode placement surgery. Neural responses were captured with respect to tonic (60 Hz/300 µs) and high-frequency (1 kHz/30 µs) SCS paradigms in a randomized manner and correlated to Numeric Rating Scale (NRS) scores. All data were analyzed offline in MATLAB and SPSS v28.0.1.1.

RESULTS:
Our analyses for the main effects demonstrated a significant difference between cortical regions (F(2.88,57.7) = 7.60 , p < 0.001) and a marginal difference between stimulation conditions (F(2,40) = 2.970, p = 0.063). The post hoc analysis for these factors revealed that alpha/theta peak power ratio was significantly different between in central regions (C3-C4) between tonic and HF stimulation (p = 0.006) and temporal regions (T3-T4) between baseline and HF stimulation (p = 0.049). The comparison of NRS scores before and 3 months after surgery indicated a significant improvement in pain intensity (p < 0.001) at the group level. The neural features found to be significantly correlated with preoperative NRS scores in PFC (p = 0.036 and p = 0.025) and temporal regions (p = 0.041 and p = 0.012) under both stimulations.

CONCLUSIONS:
Our preliminary results support the possibility that different stimulation patterns affect the electrophysiological activity differently in various cortical regions. Such differences might account for the variability in pain suppression in patients with chronic pain treated with SCS. Future work will utilize this dataset to develop a machine learning classifier to support objective device selection strategies.
929 Outcomes in Pediatric Spinal Cord Injuries Based on Time to Surgery
Authors: Deaver Courtney , Nosova Kristin , Pico Annemarie Campbell , Bauer Isabel L. , Bates Bryan , He Jack , Keric Natasha , Nakaji Peter , Bina Robert Wagner 
Published: March 2024

INTRODUCTION:
Early surgery in individuals with traumatic spinal cord injury (SCI) has been associated with improved neurological recovery, lower risk of complications, and reduced resource utilization. Patient and healthcare-related factors may contribute to delay in surgery. This study aimed to determine factors contributing to longer time-to-surgery in pediatric patients with complete and incomplete SCI.

METHODS:
Patients with SCI were identified in the National Trauma Data Bank based on AIS codes. Patients who died in the ED or were transferred to another hospital were excluded. Procedure codes were used to identify patients who underwent spinal surgery. Patients were grouped by time to surgery less than or greater than 12 hours.

RESULTS:
549 patients were identified with 235 incomplete and 314 complete SCI. 399 patients underwent surgery (177 incomplete; 222 complete). Of patients who underwent surgery, 55% of incomplete and 52% of complete SCI went to surgery after 12 hours. SCI patients with greater than 12-hour time-to-surgery had worse injury severity scores (32 vs 28, p < 0.05). Additionally, ICU LOS, total ventilation days, and total LOS were longer. Time-to-surgery greater than 12 hours was statistically associated with unplanned ICU stay (incomplete), unplanned OR (complete), ventilator associated pneumonia (complete), and delirium (incomplete). Time-to-surgery was not significantly associated with race, gender, or mechanism of injury. pneumonia (complete), and delirium (incomplete). Time-to-surgery was not significantly associated with race, gender, or mechanism of injury.

CONCLUSIONS:
Greater time-to-surgery is associated with higher risk of complications and longer hospital stays in patients with complete and incomplete SCI in the pediatric population. This data raises the question as to whether earlier surgery could reduce complications.