bluuebunny/crossref_metadata_2025_split huggingface dataset:
189 Describing a Novel Diagnosis Pathway for Cluneal Neuropathy
Authors: Vinjamuri Shreya , Trivedi Jay , Queenan Natalia , Reyes Maikerly , Sathe Anish , Shelley India , Gonzalez Ozuna Glenn Arturo , Harrop James S. , Heller Joshua E. 
Published: March 2024

INTRODUCTION:
Sacroiliac (SI) pain is frequently experienced by individuals who have undergone lumbosacral surgery, with a quarter of cases due to SI joint dysfunction (SIJD). Diagnosing SIJD involves following rigorous NASS guidelines. If these criteria are not met, cluneal neuropathy (CN), a rare cause of SI pain, should be considered. In this study we describe a novel diagnostic pathway for identifying CN as there are currently no formal diagnostic criteria.

METHODS:
A single institution’s medical records were queried for patients who underwent US testing for CN from 2018-2022. Data was extracted for the following variables: SI provocative maneuvers (PM), PSIS tenderness, SIJD injection pain relief, CN ultrasound, and CN injection pain relief. Demographic information and surgical history were recorded. SIJD negative patients were evaluated using proposed diagnostic pathway and data was analyzed using descriptive statistics.

RESULTS:
24 patients (mean age 58.8 years, 62.5% female) were included. All patients presented with comorbid spinal pathology. 87% were positive for both CN (positive entrapment on ultrasound + <75% pain relief on SI injection) and Thigh Thrust, 78% for FABER, 86% for Compression, 100% for Sacral Distraction, 89% for Gaenslen’s. 79% had tenderness upon PSIS palpation. 92% of patients with >3 positive PMs had positive CN.

CONCLUSIONS:
This novel pathway effectively showcases cluneal neuropathy as a potential etiology for low-back-pain. Ultimately, SIJD provocative maneuvers were positive in patients with CN, likely because these maneuvers cause compression of the cluneal nerves. Thus, a diagnosis of CN should be considered, particularly in patients with PSIS tenderness or previous SI fusion.
190 Do Fractional Anisotropy and Apparent Diffusion Coefficient From Diffusion Tensor Imaging Correlate to Symptoms of Radiculopathy? A Case Series From BACPAC MRI
Authors: Park Christine , Liu Felix , Han Misung , Cummings Jennifer , Bharadwaj Upasana , Mummaneni Praveen V. , Majumdar Sharmila , Chin Cynthia 
Published: March 2024

INTRODUCTION:
Quantitative diffusion tensor imaging (DTI) parameters such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) are used to detect axonal pathology in nerve injuries.

METHODS:
Ganglia of the lumbar plexus nerves (L1-5) were input as seeds to track the nerve fibers using Constant Solid Angle reconstruction. Fiber tracts and values of FA and ADC were extracted along the lumbar plexus nerve profiles. Change in pain (VAS) and disability (ODI) after interlaminar epidural steroid injection at site of compression was compared to the changes in FA and ADC values.

RESULTS:
Five exams from three patients with bilateral L4-5 foraminal narrowing were included in this study. Two patients were imaged at two time points, three months apart. The average age of the cohort was 62.6 ± 5.3 years. Mean FA values were lowest at L3 (left: 0.32 ± 0.08; right: 0.35 ± 0.05) and L4 (left: 0.39 ± 0.06; right: 0.38 ± 0.03). Correspondingly, mean ADC values were highest at L3 (left: 0.0017 ± 0.0002; right: 0.0016 ± 0.0001) and L4 (left: 0.0.0013 ± 0.0001; right: 0.0015 ± 0.0002). For one patient, pain did not change in severity and ODI improved from severe to moderate disability after steroid injection: FA increased with no significant change in ADC. For another patient, pain increased from moderate to severe and ODI stayed the same after injection: FA decreased and ADC did not significantly change.

CONCLUSIONS:
The tractography generated from the segmentation model demonstrated lowest FA and highest ADC values corresponding to the level of compression. For patient outcomes, the FA values were observed to be more sensitive to changes in pain and disability compared to the ADC values.
193 Price Transparency and Cash Discounts for Implantable Pulse Generator Implantation in the United States
Authors: Koester Stefan Wolfgang , Bishay Anthony , Paulo Danika Lea , Triana Austin , Dambrino Robert J. , Feldman Michael , Liles Campbell , Ball Tyler Joseph , Bick Sarah K.B. , Chambless Lola Blackwell , Englot Dario J. 
Published: March 2024

INTRODUCTION:
Since the Healthcare PRICE Transparency Act (January 2021), hospitals are required to publicly disclose standard prices for care and procedures.

METHODS:
This is a cross-sectional study conducted with data obtained from Turquoise Health from January to April 2021. Current procedural terminology (CPT) code 61885 was used to query cases of DBS IPG connected to a single electrode. Inclusion criteria required reporting of both commercial and cash prices. Hospitals were filtered for cash to commercial price ratios <2. The Healthy Marketplace Index (HMI) was used to assess city-level hospital competition and the 2022 Lown Institute Hospital Index (LIHI) was used to assess hospital bed size. Differences in continuous variables were analyzed with a Kruskal-Wallis test.

RESULTS:
Eight-hundred forty-six centers met inclusion criteria, of which 98 (11.6%) provided commercial and cash prices and a cash to commercial ratio of <2. Of those 98, the median commercial price was $18,562 (IQR $1,572-28,476) and the median cash price was $4,340 ($1,596-27,223), with a median intrahospital cash to commercial price ratio of 0.78. Sixty-eight of those 98 (69.4%) hospitals provided a discount for cash payments (cash:commercial ratio<1) of 41% relative to commercial and 39% discount relative to Medicare prices (p<0.001). Medicaid prices significantly differed between hospital sizes. Univariate analysis demonstrated that hospital size and market share were not significant predictors of providing a fair cash estimate. Twenty-eight (56%) states provided a cash discount.

CONCLUSIONS:
Prices for IPG implantation varied greatly, with self-pay cash pricing providing significant discounts relative to commercial pricing. Cost data should be systematically analyzed and leveraged to increase cost awareness of the procedure, inform hospital reimbursements, and broaden patient accessibility to this valuable therapy.
204 Laster Interstitial Thermal Therapy for Primary and Recurrent Meningioma: A Prospective and Retrospective Multi-institutional Study
Authors: Pugazenthi Sangami , Leidig William , Chiang Veronica , Rodriguez Analiz , Prabhu Sujit S. , Haskell-Mendoza Aden Pepe , Fecci Peter Edward , Placantonakis Dimitris G. , Abram Steven R. , Lega Bradley Charles , Kim Albert H. 
Published: March 2024

INTRODUCTION:
Meningiomas are a common central nervous system tumor, and a subset are aggressive lesions resistant to standard therapies. Laser interstitial thermal therapy (LITT) has been successfully applied to other brain tumors, but its role in meningioma treatment is understudied.

METHODS:
Eight United States-based hospitals enrolled patients with meningioma in the prospective multicenter registry and pooled additional retrospective enrollments for this cohort study. Demographics, procedural, safety, and outcomes data were collected and analyzed using standard statistical methods.

RESULTS:
Twenty adult patients (12 prospective, 8 retrospective) with LITT-targeted meningiomas were accrued. Patients underwent LITT for primary (6 patients) and recurrent tumors (14 patients, ranging from 1st to 12th recurrence). Twenty percent of patients (4/20) had exhausted all other treatment options. Median length of follow-up was 1.3 years. One-third of primary (2/6) and one-half of recurrent meningiomas (7/14) recurred during follow-up. Of those with grading information, grade 2 meningiomas were most common (9/18), followed by Grade 1(5/18), and Grade 3 (4/18). Sixty percent (60%) of patients (12/20) had convexity meningiomas treated with LITT. 2 patients (10%) had post-procedural complications, of which one resolved. One-year estimated local control (LC), progression-free survival, and overall survival were 55.3%, 48.4%, and 86.3%, respectively. In the 10 patients who had 91% ablative coverage, 1-year estimated LC was 64.8%. High grade (Grades 2 and 3) patients (n = 13) treated with LITT had a 1-year LC of 46.3%.

CONCLUSIONS:
This cohort represents the largest series of patients with meningioma undergoing LITT and supports the safety of the procedure in this tumor type. LITT can offer a much-needed treatment option, especially for those with multiply recurrent meningiomas and where heavy pretreatment limits remaining treatment options. LITT should be considered in the armamentarium of treatment options for meningiomas.
206 Spinal Meningioma: An Institutional Case Series With Preliminary Results of Molecular Profiling
Authors: Nandoliya Khizar Rehan , Youngblood Mark W. , Chaliparambil Rahul , Wolinsky Jean-Paul 
Published: March 2024

INTRODUCTION:
Spinal meningiomas have historically been considered similar entities to intracranial meningiomas, but recent developments in molecular profiling have identified unique features.

METHODS:
Retrospective study of patients undergoing resection of spinal meningioma between 2010–2022 at our institution. Patient, radiographic, and clinical characteristics were reviewed and analyzed with standard statistical methods. Molecular profiling was conducted on three tumors.

RESULTS:
A total of 33 tumors were resected in 26 patients. Median follow-up was 39.5 (0–149) months. Twenty-five (89.3%) procedures were in female patients. The median age at surgery was 62 (18–84) years. The median tumor was 1.9 (0.9–9) cm. Six tumors (18.2%) were in the cervical region, 28 (48.5%) were thoracic, and 2 (6.1%) were lumbar. Sixteen (48.5%) tumors were located dorsally, 11 (33.3%) ventrally, and six (18.2%) extended dorsoventrally. Gross total resection was achieved in 25 (75.8%) tumors. Median progression-free survival was 139 months. On histological analysis of 28 tumors, 26 (92.9%) were WHO grade 1 and 2 (7.1%) were WHO Grade 3 with a median Ki-67 of 3 (1–20)%. Fourteen (50.0%) tumors were psammomatous, seven (25%) were meningothelial, two (7.1%) were anaplastic, and one was transitional. Molecular profiling was available for three tumors. All three were negative for TERT promoter mutations and exhibited loss of chromosome 22. Chromosomal microarray analysis also detected gains in chromosomes 3p, 9, 11, 12, and 20 and loss of chromosomes 16 and 19 in Tumor 1. Tumor 3 also showed loss of chromosomes 12p and X, with copy-neutral loss of heterozygosity affecting chromosomes 5q, 7q, and 14q.

CONCLUSIONS:
Preliminary molecular profiling studies of spinal meningiomas show features distinct from intracranial meningiomas, so there is a need for their further molecular characterization.
210 Defining the Learning Curve for Cerebral Angiography Using a Novel Web-Based Feedback Application and Head-Mounted Video Review
Authors: Nguyen Vincent , Motiwala Mustafa , Dallas Jonathan , Parikh Kara , Hopkins Benjamin , Khahera Anadjeet Singh , Sorenson Jeffrey M. , Arthur Adam S. , Mack William J. , Khan Nickalus 
Published: March 2024

INTRODUCTION:
The milestones that a resident or fellow should reach to achieve competence in cerebral angiography have yet to be defined.

METHODS:
Two neurosurgical residents were given a written knowledge exam before and after rotating on the endovascular service. Cerebral angiography diagnostic and treatment cases were prospectively collected in a novel web-based, multi-institutional feedback application. These residents performed cerebral angiography cases under graduated supervision while wearing head-mounted cameras for subsequent review with direct feedback. Residents and reviewers independently utilized CaseCurve, a novel neurosurgical resident performance tracking application, as a platform for performance rating. Numerical scores were assigned ranging from 1 (novice) to 5 (masterful) in the following categories: access, catheter navigation, table operation, closure, efficiency, finesse, angiographic interpretation, and catheter knowledge. The number of times the supervising surgeon had to take over the case was recorded. Arch anatomy and vessel tortuosity were graded. Operative videos were analyzed for operator inefficiencies and time metrics for sheath insertion and target vessel selection. Angiographic efficiency was assessed with fluoroscopic doses/times and procedural durations.

RESULTS:
Both residents demonstrated improvement in cognitive performance as measured by written assessment scores. Significant improvements were observed in technical performance as measured by numerical scores assigned by self-evaluation, faculty review, objective measures of angiographic efficiency, and the number of times the supervising surgeon had to take over the procedure. Concordance between faculty and resident self-evaluations was 74.2%, with residents underestimating their performance in 21% and overestimating in 5%.

CONCLUSIONS:
There is significant educational value for the trainer and trainee offered by our novel web-based feedback application and head-mounted video review. This data allows for accurate assessments of skill acquisition and delineation of appropriate milestones/learning categories for trainees in endovascular neurosurgery.
220 Outcome Evaluation of Repeat Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations
Authors: Mantziaris Georgios , Dumot Chloe , Liscak Roman , Lee Cheng-Chia , Lunsford L. Dade , Niranjan Ajay , Peker Selcuk , Mathieu David , Kondziolka Douglas S. , Tripathi Manjul , Palmer Joshua , Zada Gabriel , Cifarelli Christopher Paul , Pikis Stylianos , Dayawansa Sam , Sheehan Jason P. 
Published: March 2024

INTRODUCTION:
Repeat stereotactic radiosurgery (SRS) for persistent cerebral arteriovenous malformation (AVM) has generally favorable patient outcomes. However, reporting studies are limited by small patient numbers and single-institution biases.

METHODS:
This multicenter, retrospective cohort study included patients treated with repeat, single-fraction SRS between 1987 and 2022. The primary outcome was a favorable patient outcome, defined as a composite of nidus obliteration in the absence of hemorrhage or radiation-induced neurological deterioration. Secondary outcomes were obliteration, hemorrhage risk, and symptomatic radiation-induced changes. Competing risk analysis was performed to compute yearly rates and identify predictors for each outcome.

RESULTS:
The cohort comprised 505 patients [254 (50.3%) males; median (IQR) age, 34 (15) years] from 14 centers. The median clinical and MRI follow-up was 52 (61) months and 47 (52) months, respectively. At last follow-up, favorable outcome was achieved by 268 (53.1%) patients (5-year probability = 50%, 95% CI = 45%-55%). Obliteration was achieved by 300 (59.4%) patients (5-year probability = 56%, 95% CI = 51%-61%). Twenty-eight patients (5.6%) experienced post-SRS hemorrhage with an annual incidence rate of 1.38 per 100 patient-years. Symptomatic radiation-induced changes were evident in 28 (5.6%) patients, with most occurring in the first 3 years. Larger nidus volumes (between 2 and 4cm3, subdistribution hazard [SDH] 0.61, 95% CI 0.44-0.86, p = 0.005; >4 cm3, SDH 0.47, 95% CI 0.32-0.7, p < 0.001) and brainstem/basal ganglia involvement (SDH = 0.6, 95% CI = 0.45-0.81, p < 0.001) were associated with reduced probability of favorable outcome.

CONCLUSIONS:
Repeat stereotactic radiosurgery confers reasonable obliteration rates with a low complication risk. With most complications occurring in the first three years, extending the latency period to 5 years generally increases the rate favorable patient outcomes and reduces the necessity of a third intervention.
225 SpineTrak: The First Randomized Controlled Trial Using the Apple Watch to Objectively Track Spine Surgical Patients
Authors: Tang Megan , Leung Christopher , Fatemi Parastou , Desai Atman , Tomkins-Lane Christy , Zygourakis Corinna Clio 
Published: March 2024

INTRODUCTION:
Early mobilization after surgery is associated with reduced complications, shorter hospitalization, and improved psychological well-being. Current methods for evaluating spine surgery outcomes rely on subjective, patient-reported outcome measures (PROMs). Wearable activity monitors, including the Apple Watch (AW), allow for real-time tracking of objective activity metrics.

METHODS:
Eligibility: Adult patients undergoing elective spine surgery. Patients are randomized 1:1 to the intervention vs control group. All patients complete PROMs pre-operatively and at 6-weeks, 3-months, 6-months, and 1-year post-operatively. Only intervention patients receive AW and download a study-specific app to collect AW data. AW health measures are visualized in reports provided to patients and surgeons.

RESULTS:
To date, we have enrolled 200 patients (n=100 intervention; n=100 control). Among patients past 1-year post-operation (n=129), 74% reached the minimal clinically-important difference in improvement for ODI/NDI, SF-36 PCS, and/or EQ-VAS relative to pre-operation. Intervention patients (n=95) have worn AW 81.3%±21.1% of the days for 14.6±4.7 hours/day. At 6-weeks post-operation, 73% of patients responded that they were very satisfied with using the AW in their spine care. 61% found seeing their AW activity data helpful. 96% of neurosurgeons agreed that AW reports help them understand their patients’ recovery. Preliminary analyses of patient recovery profiles have predicted the requirement for revision surgery in some participants.

CONCLUSIONS:
Preliminary results indicate patients are compliant with wearing the AW, and both patients and surgeons are satisfied with its use in their spine care. Initial analyses show poor correlation between AW measures and PROMs, emphasizing the need for a metric that combines objective and subjective measures to better track spine surgery recovery.
227 Spine-tuned Natural Language Models and Bespoke Regular Expression Classifiers for Automated Spinal Surgery Registry Development
Authors: Alber Daniel Alexander , Cheung Alexander , Kurland David B. , Lee Sangwon Karl , Jiang Lavender , Liu Chris , Oermann Eric Karl 
Published: March 2024

INTRODUCTION:
Surgical research demands the development of clinical registries, often through time-intensive manual chart review. Natural language processing (NLP) may accelerate registry development, and an ideal automatic registry (autoregistry) algorithm would be highly accurate while requiring minimal manual data annotation. NLP approaches including bespoke Regular Expression (RegEx) classifiers and Large Language Models (LLM) possess distinct strengths and weaknesses and have not been compared in the setting of autoregistry development.

METHODS:
We used an institutional data lake to retrieve 31,502 neurosurgical operative notes. A standardized set of spinal procedures was chosen for inclusion in the autoregistry. 200 manually annotated notes were used for training and testing purposes. RegEx classifiers were engineered to retrieve procedural info from unprocessed notes. A family of 110-million parameter BERT models, including LLM pre-trained on clinical text, was fine-tuned for the same tasks. We also tested a open-source 7-billion parameter LLM chatbot, Vicuna, without fine-tuning.

RESULTS:
The RegEx classifiers were able to identify spinal procedures and associated vertebral levels in nearly 99% of operative notes. Fine-tuned LLM identified common procedures (e.g. spinal fusion and laminectomy) with greater than 95% accuracy but performed poorly for rarer procedures (e.g. XLIF, corpectomy) and vertebral body identification. Qualitative evaluation of the Vicuna chatbot showed potential for the same tasks, following iteratively refined prompting.

CONCLUSIONS:
The goal of autoregistry development is to minimize time- and labor-intensive manual chart review. We found that fine-tuned LLM could not match the accuracy and efficiency of the RegEx classifier. However, LLM may be well-suited to expand existing clinical databases that provide a robust training set. Further work combining NLP approaches will attempt to develop a pipeline for autoregistry development from natural language (plain English) queries.
234 Predictive Radiomics in Glioblastoma: A Machine Learning Approach for Personalized Survival Outcomes and a Novel Web Application
Authors: Karabacak Mert , Margetis Konstantinos 
Published: March 2024

INTRODUCTION:
Diverse characteristics of glioblastomas (GBMs) complicate survival predictions, requiring personalized approaches.

METHODS:
From The Cancer Imaging Archive (TCIA) database, 611 patients from the UPENN-GBM collection and 500 patients from the UCSF-PDGM collections were included in this study. UPENN-GBM collection was used as the training set and for 5-fold internal cross-validation, whereas the UCSF-PDGM collection was used for external validation. Survival at 3, 6, 12, and 24 months were the outcomes of interest. Necrotic tumor core, enhancing tumor, and whole tumor segmentation masks for T1 with contrast, T1, T2, and FLAIR images were obtained automatically with a pre-trained Swin UNETR model. From these regions of interest, radiomic features were extracted using the PyRadiomicsLibrary. The LASSO (least absolute shrinkage and selection operator) method was employed for radiomic feature selection. The ML algorithms TabPFN, XGBoost, LightGBM, Support Vector Machine (SVM), and Random Forest (RF) were utilized to predict the survival outcomes of interest.

RESULTS:
The highlight of our study, our web application is available for use via the following link: https://huggingface.co/spaces/MSHSNeurosurgeryResearch/Radiomics_Based_Glioblastoma_Survival_Prediction_Tool.

CONCLUSIONS:
This study not only provides a radiomics pipeline for predicting the GBM survival outcomes, but it also contributes to the clinical adoption of these models by developing a fully automatic and user-friendly web application which make them available to clinicians worldwide.