bluuebunny/crossref_metadata_2025_split huggingface dataset:
368 Preoperative Soft Tissue Imaging Features Elucidated by Artificial Intelligence May Best Predict Radiographic Proximal Junction Kyphosis Following Adult Spinal Deformity Surgery
Authors: Johnson Graham Walter , Chanbour Hani , Chen Jeffrey , Metcalf Tyler , Doss Derek , Younus Iyan , Jonzzon Soren , Ali Mir Amaan , Roth Steven G. , Abtahi Amir , Stephens Byron , Zuckerman Scott L. 
Published: March 2024

INTRODUCTION:
Proximal junction kyphosis (PJK) following adult spinal deformity surgery (ASD) remains difficult to predict. In a cohort of patients undergoing ASD surgery, we used artificial intelligence to compare three models of preoperatively predicting PJK using: 1) traditional radiographic measurements and demographics 2) raw preoperative scoliosis x-rays, and 3) raw preoperative thoracic T1 MRIs.

METHODS:
A single-institution retrospective cohort study was undertaken for patients undergoing ASD surgery from 2009-21. PJK was defined as a sagittal Cobb angle of upper-instrumented vertebra (UIV) and UIV+2>10° and a postoperative change in UIV/UIV+2>10°. For Model-1, A support vector machine was used to predict PJK within 2 years postoperatively using clinical and traditional sagittal/coronal radiographic variables and intended levels of instrumentation. Next, for Model-2, a convolutional neural network (CNN) was trained on raw preoperative lateral/posterior-anterior scoliosis x-rays. Finally, for Model-3, a CNN was trained on raw thoracic T1 MRIs.

RESULTS:
A total of 187 patients underwent ASD surgery with at least 2-year follow-up and 89 (47.6%) developed radiographic PJK within 2 years. Model-1: Using clinical variables and traditional radiographic measurements, the support vector machine predicted PJK with a sensitivity:57.2% and specificity:56.3%. Model-2: a CNN with raw scoliosis x-rays predicted PJK with sensitivity:68.2% and specificity:58.3%. Model-3: a CNN with raw thoracic MRIs predicted PJK with sensitivity:73.1% and specificity:79.5%. Finally, an attention map outlined the imaging features used by Model-3 to predict PJK. Soft tissue features predominated all true positive PJK predictions.

CONCLUSIONS:
The use of raw MRIs in an artificial intelligence model improved the accuracy of PJK prediction compared to raw scoliosis X-rays and traditional clinical/radiographic measurements. The improved predictive ability using MRI may indicate that PJK is best predicted by soft-tissue degeneration and muscle atrophy.
372 Differences in Oligodendrogenesis Between Human and Rodent Spinal Cord Stem Cells
Authors: Sandarage Ryan Vimukthie , Galuta Ahmad , Tsai Eve C. 
Published: March 2024

INTRODUCTION:
Research in pre-clinical rodent models suggests that targeting the endogenous neural stem/progenitor cells (NSPCs) in the spinal cord may hold the key to stimulating oligodendrocyte regeneration. However, it remains to be seen whether human spinal cord NSPCs possess the same regenerative potential as their rat counterparts.

METHODS:
To assess the potential for oligodendrogenesis between human and rat spinal cord NSPCs, primary tissue from adult donors and female rats was harvested and cultured using the Neurosphere assay. To induce spontaneous differentiation, primary-derived NSPCs were treated with 1% fetal bovine serum (n = 15 humans, n = 10 rats). To further promote oligodendrocyte differentiation, pdNSPCs were treated with 40 ng/µL or 100 ng/µL of platelet-derived growth factor AA (PDGF-AA) (n = 3 humans, n = 3 rats). Immunocytochemistry and RNA sequencing were then employed to compare the transcriptomes, with the differentially expressed genes and gene sets analyzed via DESeq and GSEA.

RESULTS:
Human NSPCs showed a reduced potential for oligodendrocyte generation compared to rat NSPCs (0.013 ± 0.01% and 0.029 ± 0.01% O4+ after one and two weeks in humans; 4.9 ± 0.4% and 6.3 ± 0.6% O4+ after one and two weeks in rats). PDGF-AA treatment at 40 ng/µL for one week was able to effectively promote oligodendrocyte differentiation in rat NSPCs, but had a minimal effect on human NSPCs (8.5 ± 1.4 fold increase in O4+). OLIG1/2, SOX10, and CNP gene transcripts were enriched in rat NSPCs.

CONCLUSIONS:
We compared the potential of oligodendrogenesis between primary human and rat spinal cord NSPCs and found a significantly lower capacity in the human NSPCs both functionally and transcriptionally, which could be an obstacle to the successful application of myelinating techniques.
374 Feasibility of Postoperative Diffusion Weighted Imaging to Assess Neural Recovery in Cervical Spondylotic Myelopathy
Authors: Zhang Justin , Javeed Saad , Greenberg Jacob K. , Botterbush Kathleen , Benedict Braeden Christopher , Song Sheng-Kwei , Ray Wilson Zachary 
Published: March 2024

INTRODUCTION:
Following decompressive surgery for cervical spondylotic myelopathy (CSM), advanced diffusion-weighted MRI, such as diffusion basis spectrum imaging (DBSI), may hold significant value by quantifying and tracking spinal cord microstructure. However, there is a paucity of studies investigating this topic, likely due to challenges in resolving signal distortions from spinal instrumentation.

METHODS:
A single-center prospective study enrolled 50 CSM patients and 20 control patients. All patients underwent preoperative and repeat diffusion-weighted MRI at two-year follow-up. All CSM patients underwent decompressive cervical surgery. DBSI metrics were extracted from the C3 spinal cord level only to minimize image artifact and reduce partial volume effects. DBSI anisotropic tensors evaluated white matter tracts through fractional anisotropy, axial diffusivity, radial diffusivity, and fiber fraction. DBSI isotropic tensors assessed extra-axonal pathology through restricted and non-restricted fraction.

RESULTS:
Of 50 CSM patients, 27 patients underwent both baseline and postoperative diffusion-weighted MRI scans with sufficient quality for analysis. This included 15 mild, 7 moderate, and 5 severe CSM patients, who were followed up to 23.2 (5.6, range 11.1-32.8) months. All preoperative C3 DBSI measures were significantly different between CSM and control patients (p < 0.001), except DBSI fractional anisotropy (p = 0.31). At two-year follow-up, the same significance pattern was found, except DBSI radial diffusivity lost statistical significance (p = 0.75). When assessing change in C3 DBSI measures, CSM patients exhibited significant decreases in DBSI radial diffusivity (p = 0.02). Among control patients, there was no significant difference in DBSI metrics between timepoints.

CONCLUSIONS:
DBSI may have potential in the postoperative setting to inform clinicians of white matter tract recovery after decompressive cervical surgery for CSM.
379 Meningioma Molecular Groups Predict Response to Adjuvant Radiotherapy Following Surgery
Authors: Wang Justin Z. , Nassiri Farshad , Patil Vikas , Landry Alexander , Liu Jeffrey , Cohen-Gadol Aaron A. , Barnholtz-Sloan Jill , Tabatabai Ghazaleh , Chotai Silky , Sahm Felix , Aldape Kenneth , Zadeh Gelareh 
Published: March 2024

INTRODUCTION:
Aside from surgery, radiotherapy (RT) remains the only treatment for meningiomas. However, patient selection for adjuvant RT remains controversial.

METHODS:
We utilized publicly available molecular datasets of meningiomas and generated de novo DNA-methylation and RNA-sequencing data. Meningiomas were classified into different molecular and methylation groups based on the methodologies of their original publications (Nassiri et al. [2021], Bayley et al. [2022], Choudhury et al. [2022], Sahm et al.[2017]) and progression-free survival (PFS) following surgery with and without adjuvant RT were analyzed.

RESULTS:
A total of 2029 meningiomas from 11 different institutions with adjuvant RT data were included. Adjuvant RT was associated with improved PFS in WHO grade 1 meningiomas following subtotal resection (STR), WHO grade 2 meningiomas following gross total resection (GTR) or STR, and immunogenic (COCA1) and NF2-wildtype (COCA2) meningiomas following STR. Multivariable analysis using Cox proportional hazards regression models showed that having a meningioma belonging to a hypermetabolic (COCA3) (HR 2.49, 95% CI 1.71-3.62), or proliferative (COCA4) (HR 3.77, 95% CI 2.78-5.10) group were associated with worse PFS when controlling for age, gender, extent of resection, and receipt of adjuvant RT. Meningiomas belonging to DKFZ MC-intermediate, MC-malignant, MenGC, and UCSF hypermitotic groups were also associated with worse outcomes. These relationships held true even in subgroup analysis with only WHO grade 2 meningiomas and following propensity score matching for the same clinical covariates above. Nearly all molecular and methylation classifications predicted 5-year PFS following surgery and adjuvant RT (area under the curve [AUC] 0.61-0.72) better than WHO grade (AUC 0.51).

CONCLUSIONS:
Molecular classification improves outcome prediction for meningiomas following surgery and adjuvant radiotherapy, supporting the rationale for molecularly informed treatment decisions and clinical trial stratification.
386 Seizure Presentation in IDH WT Glioma is Related to Upregulated Synaptic Signaling and Ionic Transport Genes
Authors: McDonald Malcolm F. , Khan Basit , Athukuri Prazwal , Lozzi Brittney , Harmanci Akdes , Deneen Benjamin , Mandel Jacob , Rao Ganesh 
Published: March 2024

INTRODUCTION:
IDH wildtype glioblastoma is the most common malignant brain tumor in adults and is universally lethal. Seizures often occur as a presenting sign of tumor. Recent studies have implicated tumor-neuron communication facilitating synaptic remodeling and peritumoral circuit hyperactivity influencing tumor growth.

METHODS:
63 tumor samples were analyzed for clinical characteristics. Bulk RNA sequencing data was used to identify differentially expressed genes (DEGs), gene sets enrichment analysis (GSEA), and gene ontologies (GO).

RESULTS:
24 IDH WT GBM patients presented with seizures compared to 39 patients presenting with other symptoms. There were no significant differences between age at presentation, sex, tumor lobe, tumor location, or grade of tumor. GSEA of gene ontologies revealed upregulated genes in the seizure cohort were largely related to synaptic signaling and ionic transport (a., p-val < 0.05). Alternatively downregulated gene sets were related to extracellular matrix organization, and inflammatory and immune response (b., p-val < 0.05). Focusing on significantly upregulated DEGs (padj < 0.05) biological processes related to glutamatergic synaptic transmission and cellular components related to synaptic structures were upregulated. Alternatively, significantly downregulated DEGs (padj < 0.05) were related to biological processes of immunity and extracellular matrix organization and cellular components related to the extracellular matrix. Upregulated genes include IGFN1 and THBS4 both involved in synapse assembly, and SLC17A3, involved in presynaptic glutamate sorting (LogFC > 1, padj < 0.05). The downregulated genes include numerous collagen related genes and immune related genes and KCNJ15 an inward rectifying potassium channel and GABRR1 a GABA-rho subunit.

CONCLUSIONS:
Using bulk RNA sequencing in a clinically similar set of IDH WT tumors, we found gene sets and gene ontologies related to synaptic signaling and glutamatergic signaling upregulated in patients with seizures while genes related to both extracellular matrix and immune inflammation were downregulated.
388 The First Endovascular Rat Glioma Model for Pre-clinical Evaluation of Intra-arterial Therapeutics
Authors: Lim Jaims , Baig Ammad , Donnelly Brianna M. , Chaves Lee , Pol Suyog , Koenigsknecht Carmon , Pionessa Donald , Levy Bennett Reuben , Gutierrez Liza , Tutino Vincent , Levy Elad I. , Siddiqui Adnan Hussain 
Published: March 2024

INTRODUCTION:
Several translational animal models have been described assessing intra-arterial (IA) treatments for malignant gliomas. We describe the first endovascular animal model that allows testing of IA drug delivery as first-line treatment, which is difficult to do in actual patients.

METHODS:
Wistar rats underwent left femoral artery catherization with a Balt Magic 1.2F catheter or Marathon Flow directed 1.5F Microcatheter with an Asahi Chikai 0.008 micro-guidewire which was navigated to the left internal carotid artery under x-ray. 25% mannitol was administered to test blood brain barrier breakdown (BBBB). Additional rats were implanted with C6 glioma cells in the left frontal lobe. C6 Glioma-Implanted Rats were monitored for overall survival and tumor growth. Tumor volumes from MRI images were calculated utilizing 3D slicer. Additional rats underwent femoral artery catheterization with Bevacizumab, carboplatin, or irinotecan injected into the left internal carotid artery to test feasibility and safety.

RESULTS:
A successful endovascular access and BBBB protocol was established. BBBB was confirmed with positive Evans-blue staining. 10 rats were successfully implanted with C6 gliomas with confirmed growths on MRI. Overall survival was 19.75 ± 2.21 days. 5 rats were utilized for development of our femoral catheterization protocol and BBBB testing. With regards to IA chemotherapy dosage testing, control rats tolerated targeted 10 mg/kg of bevascizumab, 2.4 mg/kg of carboplatin, and 15 mg/kg of irinotecan IA ICA injections without complications.

CONCLUSIONS:
We present the first endovascular IA rat glioma model that allows selective catheterization of the intracranial vasculature and assessment of IA therapies for gliomas without need for access and sacrifice of proximal cerebrovasculature.
395 A History of Smoking Is Not an Independent Risk Factor for Perioperative Outcomes in Nontraumatic Subarachnoid Hemorrhage
Authors: Rienas William , Li Renxi , Lee SeungEun 
Published: March 2024

INTRODUCTION:
Nontraumatic Subarachnoid Hemorrhage (NSAH) is a rupture leading to blood accumulating in the subarachnoid region. Smoking contributes to vascular pathogenesis which can ultimately end in an aneurysm. Smoking and history of smoking often is a risk factor for complications perioperatively for vascular procedures, however patients receiving treatment for NSAH may have different perioperative outcome profiles.

METHODS:
Patients with NSAH who underwent neurosurgery were identified using ICD codes (ICD10, I60; ICD9, 430) in the ACS-NSQIP database from 2005-2021. Subjects were stratified into two study groups based on documented prior history of smoking: smokers or non-smokers. Significant preoperative differences were present between groups so a multivariable logistic regression was performed between patients with and without a prior history of smoking. The 30-day perioperative outcomes of patients with a prior history of smoking were compared to that of control. Perioperative outcomes included death, major adverse cardiovascular events (MACE), cardiac complications, stroke, wound complications, renal complications, sepsis, clot formation, pulmonary complications, return to the operating room, operation time greater than four hours, length of stay longer than 7 days, discharge not to home, and bleeding.

RESULTS:
There were 626 patients with a prior smoking history and 1336 patients with no prior smoking history. We found no significant difference between these two groups across all adverse outcomes analyzed.

CONCLUSIONS:
This study shows that although history of smoking is commonly a risk factor for vascular diseases and perioperative complications, it is not a risk factor for the perioperative variables analyzed when treating NSAH. Additional research should be done to determine if different procedures to treat NSAH may have different outcomes among smokers.
397 Rehemorrhage of Brainstem Cavernous Malformations: A Benchmark Approach to Individualized Risk and Severity Assessment
Authors: Li Zongze , Ma Li 
Published: March 2024

INTRODUCTION:
Brainstem cavernous malformations (BSCMs) represent a unique subgroup of cavernous malformations with more hemorrhagic presentation and technical challenges.

METHODS:
A total of 123 consecutive BSCM patients with symptomatic hemorrhage were identified between 2015 and 2022, with untreated follow-up > 12 months or subsequent hemorrhage during the untreated follow-up. Nomograms were proposed to individualize the assessment of subsequent hemorrhage risk and neurological status (determined by the modified Rankin Scale [mRS] score) after future hemorrhage. The least absolute shrinkage and selector operation (LASSO) regression was used for feature screening. The calibration curve and concordance index (C-index) were used to assess the internal calibration and discrimination performance of the nomograms. Cross-validation was further performed to validate the accuracy of the nomograms.

RESULTS:
Prior hemorrhage times (adjusted OR [aOR] 6.78 per ictus increase) and Zabramski type I or V (OR 11.04) were associated with rehemorrhage within 1 year. A lower mRS score after previous hemorrhage (aOR 0.38 for a shift to a higher mRS score), Zabramski type I or V (OR 3.41), medulla or midbrain location (aOR 2.77), and multiple cerebral cavernous malformations (aOR 11.76) were associated with worsened neurological status at subsequent hemorrhage. The nomograms showed good accuracy and discrimination, with a C-index of 0.80 for predicting subsequent hemorrhage within 1 year and 0.71 for predicting neurological status after subsequent hemorrhage, which were maintained in cross-validation.

CONCLUSIONS:
An individualized approach to risk and severity assessment of BSCM rehemorrhage was feasible with clinical and imaging features.
400 Brain AVMs-Related MicroRNAs: Machine Learning Algorithm for Expression Profiles of Target Genes
Authors: Lucifero Alice Giotta , Luzzi Sabino 
Published: March 2024

INTRODUCTION:
microRNAs (miRNAs) are a class of non-coding RNAs playing a myriad of important roles in regulating gene expression. Of note, recent work demonstrated a critical role of miRNAs in the genesis and progression of brain arteriovenous malformations (bAVMs).

METHODS:
A PRISMA-based literature review was performed using PubMed/Medline database with the following search terms: "brain arteriovenous malformations", "cerebral arteriovenous malformations", "microRNA", and "miRNA". All preclinical and clinical studies written in English, regardless of date, were selected. For our bioinformatic analyses, miRWalk and miRTarBase machine learning algorithms were employed; the Kyoto Encyclopedia of Genes and Genomes (KEGG) database was quired for associated pathways/functions.

RESULTS:
4 studies were ultimately included in the final analyses. Sequencing data consistently revealed the decreased expression of miR-18a in bAVM-endothelial cells, resulting in increased levels of vascular endodermal growth factor (VEGF), Id-1, matrix metalloproteinase, and growth signals. Our analyses also suggest that the downregulation of miR-137 and miR-195* within vascular smooth muscle cells (VSMCs) may foster the activation of inflammation, aberrant angiogenesis, and phenotypic switching. In the peripheral blood, the overexpression of miR-7-5p, miR-629-5p, miR-199a-5p, miR-200b-3p, and let-7b-5p may contribute to endothelial proliferation and nidus development. The machine learning algorithms employed confirmed associations between miRNA-related target networks, vascular rearrangement, and bAVM progression.

CONCLUSIONS:
miRNAs expression appears to be critical in managing bAVMs' post-transcriptional signals. Targets of microRNAs regulate canonical vascular proliferation and reshaping. Although additional scientific evidence is needed, the identification of bAVM miRNA signatures may facilitate the development of novel prognostic/diagnostic tools and molecular therapies for bAVMs.
406 Long-term Outcomes of Lumbar Facet Arthroplasty versus Spinal Fusion in the Treatment of Degenerative Spondylolisthesis and Stenosis
Authors: Shaffer Annabelle , Arnold Paul M. 
Published: March 2024

INTRODUCTION:
Facet arthroplasty is a proposed alternative to lumbar fusion for treating degenerative lumbar spondylolisthesis and stenosis. Facet arthroplasty provides stabilization and preserves range of motion.

METHODS:
Patient-reported outcomes (PROMS), including Oswestry disability index (ODI), visual analog pain scales (VAS), and Zurich claudication questionnaires (ZCQ), were assessed at baseline and at multiple timepoints postoperatively. Flexion/extension range of motion (ROM) were radiographically evaluated at baseline, 12 months, and 24 months. Data were analyzed following an intention-to-treat model.

RESULTS:
A total of 299 patients were included (TOPS = 206, TLIF = 93). There were no significant differences at baseline. At 2 years, the TOPS group had a significantly greater proportion of patients report =30% improvement for ODI (93.8% versus 74.3%, p = 0.004) and =20-point improvement for VAS back (84.4% versus 61.8%, p = 0.014). At 1 year, TOPS group had a significantly greater proportion of patients report clinically significant improvements in all ZCQ categories (91.6% versus 78.5%, p = 0.012). In patients <65 years, the TOPS group had significantly improved PROMS compared to TLIF at 2 years; however, these differences were not observed in patients =65 years old. The TOPS groups preserved significantly more ROM at 12 (2.8° 95% CI [1.87; 3.74], p < 0.0001) and 24 (2.99° 95% CI [1.82; 4.15], p < 0.0001) months postoperatively compared to TLIF. ROM was similarly preserved in patients aged <64 and =65. The rate of adverse events did not differ significantly between groups (65.2% TOPS versus 61.5% TLIF).

CONCLUSIONS:
Facet arthroplasty preserves significantly more ROM and leads to improved PROMS compared to TLIF, particularly in younger patients. In older patients, the procedure improved outcomes significantly from baseline.
411 Perioperative Complications and Radiographic Outcomes Following Cervical Laminoplasty: A Review of 105 Cases From a Single Academic Center
Authors: Paul David , Liu Serena , Phan Amy , Shah Shalin , Silberstein Howard J. , Puvanesarajah Varun , Rubery Paul T. , Mesfin Addisu 
Published: March 2024

INTRODUCTION:
With advancements in technology, the safety and efficacy of cervical laminoplasty have increased, leading to a reduction in complications frequently associated with posterior cervical surgical approaches, including C5 nerve palsy, axial neck pain, loss of lordosis, and loss of motion. However, the impact of these advancements on cervical radiographic parameters remains poorly documented, and the prevalence of complications in North American populations has not been adequately studied.

METHODS:
We evaluated patients undergoing cervical laminoplasty between 2011 to 2022 at an academic medical center. Patient demographics, intraoperative and postoperative complications, preoperative and post-operative radiographic parameters were recorded.

RESULTS:
150 patients undergoing cervical laminoplasty during this study period were identified. 105 patients met the inclusion criteria. We identified a total of 22 (21.0%) adverse events in 20 patients. There were 4 intra-operative (3.8%), 10 peri-operative (9.5%), and 8 delayed post-operative (7.6%) adverse events. Amongst them, 13 (12.4%) were judged to be minor and 9 (8.6%) were judged to be major complications. Six (5.7%) patients required revision surgery. Forty-seven (44.8%) of the 105 patients had both pre-and post-operative cervical spine radiographic imaging. The average pre-and post-op C2-7 cobb angles were 14.7 degrees and 12.3 degrees (p-value of 0.04). The pre-and post-op SVA was 29.2 mm and 33.3 mm (p-value of 0.07). The pre-op and post-op T1 slopes were 32.3 and 30.2 deg (p-value of 0.07).

CONCLUSIONS:
Cervical laminoplasty carries a significant risk of adverse events, the majority of which are minor and has a low rate of re-operation (5.7%). The procedure does not result in significant changes in SVA or T1 slope. Cervical laminoplasty remains a valuable surgical option for selected patients with cervical myelopathy.