bluuebunny/crossref_metadata_2025_split huggingface dataset:
336 Understanding the Unique Challenges Faced by Homeless Patients With Acute Traumatic Neurosurgical Injuries
Authors: Cole Kyril Lynn , Findlay Matt , Earl Emma , Sherrod Brandon , Cutler Christopher , Nguyen Sarah Elizabeth , Grandhi Ramesh , Menacho Sarah Tamara 
Published: March 2024

INTRODUCTION:
Homelessness is associated with high risk of acute neurotraumatic injury in the ∼600 000 Americans affected on any given night.

METHODS:
Adults hospitalized for acute neurotraumatic injuries between January 1, 2015, and December 31, 2020, were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, inhospital characteristics, discharge dispositions, readmissions, and adjusted readmission risk.

RESULTS:
Of 1308 patients, 8.5% (n = 111) were homeless on admission to neurointensive care. Compared with nonhomeless individuals, homeless patients were younger (P = .004), predominantly male (P = .003), and less frail (P = .003) but had similar presenting Glasgow Coma Scale scores (P = .85), neurointensive care unit stay time (P = .15), neurosurgical interventions (P = .27), and in-hospital mortality (P = .17). Nevertheless, homeless patients had longer hospital stays (11.8 vs 10.0 days, P = .02), more unplanned readmissions (15.3% vs 4.8%, P < .001), and more complications while hospitalized (54.1% vs 35.8%, P = .01), particularly myocardial infarctions (9.0% vs 1.3%, P < .001). Homeless patients were mainly discharged to their previous living situation (46.8%). Readmissions were primarily for acute-on-chronic intracranial hematomas (4.5%). Homelessness was an independent predictor of 30-day unplanned readmissions (odds ratio 2.41 [95% CI 1.33-4.38, P = .004]).

CONCLUSIONS:
Homeless individuals experience longer hospital stays, more inpatient complications such as myocardial infarction, and more unplanned readmissions after discharge compared with their housed counterparts. These findings combined with limited discharge options in the homeless population indicate that better guidance is needed to improve the postoperative disposition and long-term care of this vulnerable patient population.
339 Gender Concordance and Publication Productivity Within Neurosurgical Focus: A Ten-Year Review
Authors: Roy Joanna , Segura Aaron , Rumalla Kavelin , Estes Emily Marie , Iqbal Javed , Asjad Muhammad , Sidebottom Rachel , Schmidt Meic H. , Bowers Christian Andrew 
Published: March 2024

INTRODUCTION:
The “glass ceiling” phenomenon describes how female representation in leadership positions has remained stagnant despite an increase in the number of trainees. Mentorship from female role models has been hypothesized to influence academic productivity. To our knowledge, trends in gender representation among editorial boards of neurosurgical journals remain undescribed. Neurosurgical Focus publishes monthly issues which are peer-reviewed by an invited group of topic editors based on their expertise in the field.

METHODS:
Publicly available data were collected from the Journal of Neurosurgery: Focus website from January 2013 to December 2022. Themes were dichotomized into technical or non-technical themes. Female gender concordant publications were defined as publications having females in both first and senior authorship. Gender was assessed using pronouns based on authors’ university profile and an artificial intelligence platform in case of ambiguity. Odds ratios (ORs) were calculated using Chi-squared and Fisher’s exact test.

RESULTS:
The number of female editors and gender concordant authors increased over time (P < 0.05). Women accounted for =50% of the editorial board on non-technical themes relevant to education and gender diversity. Having a female senior author was associated with higher publication productivity for original research and review articles among female authors (OR = 13.73, 95% CI = 1.74-394.31, P < 0.05). The odds of having female gender concordant publications were higher with a female editor (OR = 4.05, 95% CI= 1.38-12.92, P < 0.01).

CONCLUSIONS:
Mentorship and representation among editorial boards play a crucial role in enhancing academic productivity among women. This paper provides evidence that Neurosurgical Focus increased female gender concordant publications by increasing female editors over time because of their efforts to increase female representation. Initiatives to increase female representation and mentorship will help overcome the glass ceiling phenomenon.
340 Effect of Worker's Compensation Status on Pain, Disability, Quality of Life, and Return to Work After Lumbar Spine Surgery: A One-Year Propensity-Matched Analysis
Authors: Hani Ummey , Monk Steve Hubert , Pfortmiller Deborah , Stanley Gerry , Kim Paul Keetae , Bohl Michael , Holland Christopher Michael , McGirt Matthew J. 
Published: March 2024

INTRODUCTION:
Compensation and litigation have been shown to adversely impact prognoses in a vast range of health conditions. Low back pain (LBP) is currently the most frequent reason for workers' compensation (WC) claims.

METHODS:
Complete datasets for patients who underwent 1 to 4-level lumbar spinal fusion or decompression alone were retrospectively mined from the National Quality Outcomes Database (QOD), which included one-year patient-reported outcomes (PROs) from over 200 hospital systems collected from 2012-2021. Population demographics, perioperative safety, facility utilization, patient satisfaction, disability, pain, EuroQol-5D (EQ-5D) quality-of-life, and return-to-work rates were compared between cohorts for both subgroups. Statistical significance was set at p < 0.05.

RESULTS:
29,652 patients were included: Laminectomy (16,939 non-WC, 615 WC); Fusion (11,767 non-WC, 331 WC). WC patients were more frequently male, minority race, younger, less educated, more frequently a smoker, healthier ASA grade, with greater baseline VAS and ODI scores (p < 0.001). One-year postoperative improvements in VAS, ODI, QALY, return to work rates, and satisfaction were all significantly worse for WC vs non-WC patients for both procedures. After adjusting for baseline differences via propensity matching, WC vs non-WC patients continued to demonstrate worse 3- and 12-month VAS and ODI, reduced 12-month QALY-gain, and delayed return to work after both procedure types.

CONCLUSIONS:
WC status was associated with significantly greater residual disability and pain post-operatively, lower quality of life, and delayed return to work. Utilizing resources to identify the negative influences on outcomes for WC patients may be of value in preoperative optimization and could yield better outcomes in these patients.
341 Racial Disparities in Incidence, Treatment, and Survival in Adult Brain Metastases: A 10-Year National Database Analysis
Authors: Jiang Sam Han , Sri Bhaskara Mounika Lalitha , Deysher Daniel , Souter John Robert , Sadeh Morteza , Mehta Ankit Indravadan 
Published: March 2024

INTRODUCTION:
Brain metastases are the most common central nervous system tumors in the United States. It is imperative to understand how prognosis and survival varies demographically to ensure equitable care for vulnerable populations and reduce financial burdens on the healthcare system.

METHODS:
Using the Surveillance, Epidemiology, and End Result Program (SEER) database, adults with non-primary brain metastases between 2010 and 2019 were identified. The primary outcome measure was all-cause mortality within 5 years. Chi-squared tests of independence and one way analyses of variance were used to compare group differences between White, Black, Asian/Pacific Islander (A/PI), and American Indian/Alaskan Native patients. A Cox proportional hazards model was developed to evaluate the risk of death within 5 years.

RESULTS:
A total of 65,154 patient records were identified following exclusion based on age (>84 years or <18 years), missing race data, and missing survival data. The incidence of brain metastases increased from 2.53 per 100,000 adults in 2010 to 2.71 per 100,000 in 2019. A/PI patients had the highest population-adjusted incidence, highest population proportion of high income, the longest time from diagnosis to treatment, lowest rate of radiation refusal, and highest rate of chemotherapy treatment. Subsequently, A/PI patients had the highest 5-year survival rate compared to White and Black patients (9.05% vs. 4.15% vs. 3.23% respectively, p < 0.001). Chemotherapy (OR = 0.44) and surgery (OR = 0.51) were the strongest protective factors against death while being widowed (OR = 1.15) and having primary lung cancer (OR = 1.14) strongest risk factors.

CONCLUSIONS:
A/PI patients also have a significant survival advantage compared to White, Black, and AI/AN patients, potentially due to higher rates of radiation and chemotherapy treatment. Patients of other races are recommended treatment at lower rates than A/PI patients, suggesting a discrepancy in services offered to these patients.
345 Analysis of the Caribbean Neurosurgery Workforce: Scope of Practice, Challenges and Ways Forward
Authors: Rolle Myron , Williams Ashley , Boeykens Annegien , Garba Deen L. , McLellan Rachel , Francis Michael , Santos Rubio Ellianne Dos 
Published: March 2024

INTRODUCTION:
There are close to 45 neurosurgeons for 16 million people in the Caribbean Community (CARICOM) region. The aim of our study is to understand the current scope of practice for neurosurgical providers in the Caribbean, as very sparse information has been published.

METHODS:
This study surveyed neurosurgeons within Caribbean and CARICOM countries online using qualitative and quantitative methods via Qualtrics.

RESULTS:
Of 38 countries within the Caribbean, 26 (68%) were surveyed of which 18 (69%) replied. In total 61 neurosurgeons were identified, with a majority of general neurosurgeons (56%). Remarkably, the majority of countries failed to meet the threshold workforce density for safe health care - either expressed by FTE neurosurgeons or neurosurgical centers. Most neurosurgical practices denied receiving or sending medical referrals. If otherwise, most referrals took longer than 8 hours without significant difference regarding the destination. Lastly, challenges confronting neurosurgical advancement were found in: technology and equipment (40%), trained personnel (31%), hospital or medical center infrastructure (14%), neurosurgical education and training (44%).

CONCLUSIONS:
To our knowledge, this is the first comprehensive qualitative and quantitative study exploring the current status of the Caribbean neurosurgery workforce, the challenges and the potential ways forward. Arming the local providers with improved resources and support would only serve to add value to the region thus making excellent patient care the standard for a region in need of just that.
347 Short-Term Pain Outcomes and Pain Medication Utilization Among Urine Toxicology-Identified Opioid and Marijuana Users Following Elective Spine Surgery
Authors: Singh Manjot , Bajaj Ankush , Shlimak Anna , Kanekar Samika , Rampichini Margherita , Gokaslan Ziya L. , Scarfo Keith-Austin , Leary Owen P. , Guglielmo Maria 
Published: March 2024

INTRODUCTION:
Postoperative pain outcomes may be influenced by preoperative substance use, which is often underreported due to associated stigma.

METHODS:
Patients undergoing elective spinal surgery between September 2020 and May 2022 were recruited for this prospective cohort study. Detailed chart review was completed to collect demographic, urine toxicology, VAS, and pain medication regimen data. Comparisons between self-reported and urine toxicology-identified substance use, pre- and post-operative VAS ratings, and postoperative pain medication use were made using χ2 tests, student’s t-tests, and logistic regression, respectively. Models were adjusted for age, sex, and race.

RESULTS:
Among 111 participants (mean age 58 years, 59% female, 95% with >1 comorbidity), urine toxicology overestimated drug use (47% vs 16%, p < 0.001) and underestimated alcohol use (16% vs 56%, p < 0.001) at preoperative baseline relative to patient reports. Two-weeks postoperatively, participants on preoperative opioids as determined by urine toxicology reported no significant improvements in pain from baseline (6.67 preop vs 5.92 postop, p = 0.288) unlike non-users (6.56 preop vs 4.61 postop, p < 0.001). They also had worse postoperative VAS (5.92 vs 4.61, p = 0.030) and heavier reliance on opioid medications (OR = 3.09, 95% CI = 1.21-7.89, p = 0.019). Conversely, participants on preoperative marijuana reported similar improvements in pain from baseline (users: 6.88 preop vs 4.36 postop, p = 0.001; non-users: 6.49 preop vs 5.07 postop, p = 0.001), similar postoperative pain (4.36 vs 5.07, p = 0.238), and similar postoperative reliance on opioid medications (OR = 0.96, 95% CI = 0.38-2.44, p = 0.928).

CONCLUSIONS:
While urine toxicology-identified preoperative opioid use was associated with poor postoperative pain relief and continued reliance on postoperative opioids for pain management following elective spinal surgery, preoperative marijuana use was not. Preoperative marijuana use, hence, should not delay or be a contraindication to elective spinal surgery.
353 Comparison of Brain Diffusion-Weighted Imaging of Cerebral Pain Regions Using DTI and MAP to Clinical Scores of Pain in Chronic Low Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation
Authors: Ashok Arjun Balaji , Oghli Yazan Shamli , Ailes Isaiah , Syed Mashaal , Kang KiChang , Naghizadehkashani Sara , Fayed Islam , Matias Caio M. , Mohamed Feroze , Krisa Laura , Alizadeh Mahdi 
Published: March 2024

INTRODUCTION:
Thoracic spinal cord stimulation (SCS) may be an effective treatment option for patients with chronic low back pain (cLBP), and pain levels can be assessed using subjective clinical scores. The use of diffusion-derived imaging of brain regions involved in pain has yet to be studied.

METHODS:
DTI and MAP data was gathered from five cLBP patients (4 M, 1F) post-tSCS scanned at a 3.0T scanner. Four DTI measures and four MAP measures were extracted and registered against a pain-ROI atlas. The following clinical pain scores were assessed in the same five patients: Numerical Pain Rating Scale (NPRS), Visual Analogue Scale (VAS), Central Sensitization Inventory (CSI), Oswestry Disability Index (ODI), Pain Catastrophizing Scale (PCS), Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS). The associations between clinical scores and pain ROIs were investigated using linear regression.

RESULTS:
Within these eight measures, 16 significant linear associations were found between pain ROIs and clinical pain scores. The regions involved are areas of the cerebrum and thalamus involved in pain perception and processing: the secondary somatosensory cortex, the ventral posterolateral and mediodorsal nuclei of the thalamus, and the anterior long, anterior inferior, and middle short gyri of the insula.

CONCLUSIONS:
Diffusion-derived imaging, using DTI and AMURA/MAP techniques, shows microstructural changes in brain regions involved in pain with significant linear associations with clinical pain scores. As a result, diffusion-derived indices show potential to be used as a complementary quantitative measure to assess pain in cLBP patients receiving tSCS.
354 Feasibility and Clinical Imaging of Pain States Based on Multi-Delay Arterial Spin Labeling in Chronic Low Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation
Authors: Oghli Yazan Shamli , Ashok Arjun Balaji , Ailes Isaiah , Syed Mashaal , Fayed Islam , Matias Caio M. , Mohamed Feroze , Talekar Kiran , Feeko Kristofer , Krisa Laura , Alizadeh Mahdi 
Published: March 2024

INTRODUCTION:
Multi-delay, pseudo-continuous arterial spin labelling (PCASL) is a novel technique capable of perfusion imaging without contrast. It overcomes the limitation of a low signal-to-noise ratio of pulsed-ASL, and multiple post-label delays allow it to account for and measure arterial transit time (ATT). This makes it a suitable tool for the perfusion assessment. To date, there have been no studies to assess changes in ASL-measured perfusion in chronic low-back pain (cLBP) patients treated with thoracic spinal cord stimulation (tSCS).

METHODS:
PCASL data was acquired in five patients post-tSCS and five healthy subjects. ATT was estimated using weighted delays from multiple delay times, and it was used to calculate cerebral blood flow (CBF) and cerebral blood volume (CBV). Maps were normalized into MNI space and smoothed. Averaged values of ATT, CBF and CBV from pain ROI atlas were extracted and compared between cLBP and healthy control groups. Statistics comparing perfusion changes between patients and healthy subjects were conducted after Box-Cox transformation of data using Wilcoxon rank sum.

RESULTS:
Our results demonstrated the feasibility of MRI scanning with ASL sequence in patients with SCS. Specific absorption rates ranged from 0.031–0.042W/kg. Wilcoxon test indicated that ATT was significantly greater in cLBP patients within the supplementary motor area, posterior short gyrus, and the orbitofrontal cortex. There were no significant differences in patients and controls in CBF or CBV.

CONCLUSIONS:
Rate of perfusion as indexed by PCASL-derived ATT is reduced in cLBP treated with SCS patients in regions associated with pain processing, cognition, and motor planning. Insignificant results in CBF and CBV measures are likely due to low sample size of patients.
355 Risk Factors for Intrathecal Baclofen Pump Implantation Infections: A Retrospective Database Analysis
Authors: Wilding Hannah Eloise , Sciscent Bao Yue , Hallan David , Harbaugh Thaddeus , Bhanja Debarati , Rizk Elias Boulos 
Published: March 2024

INTRODUCTION:
Baclofen, a GABAB receptor agonist, can be delivered via intrathecal baclofen (ITB) pumps for patients with intractable spasticity. Prior literature has shown infection rates ranging between 10-30%.

METHODS:
A multi-institutional de-identified database TriNetX was queried to identify patients with: 1) implantation of ITB pump + infection within 6 months or 2) implantation of ITB pump without infection within 6 months. Two populations were analyzed: only pediatric patients, then patients of all ages. Characteristics were compared using log-rank tests and independent-sample t-tests.

RESULTS:
1,880 patients were identified in the pediatric cohort, of which 236 (12.6%) developed infection. 13,936 patients of all ages were identified, of which 1955 (14.0%) developed infection. In pediatric patients who developed infection, there were higher rates of diagnoses of overweight and obesity, malnutrition, and hypokalemia; the prevalence of diabetes was also higher, but this analysis was limited by small sample size. In patients of all ages, all medical diagnoses assessed were significantly more prevalent in patients with infection. Erythrocyte sedimentation rates and platelets were significantly higher in all patients with an infection. Additionally, the number of emergency department visits within 6 months was significantly higher in the infection group for pediatric (t = 3.571, p = 0.0004) and all-age (t = 7.882, p < 0.0001) patients.

CONCLUSIONS:
This study suggests that patients with certain comorbidities are at increased risk for infection post-ITB implantation. Since prevalence of diabetes, abnormal coagulation profile, tracheostomy, and B-vitamin deficiency remained significantly different between infection vs. no-infection cohorts as sample size increased with the addition of adults, these diagnoses should be considered when calculating the infection risk of ITB pump. Studies are underway to investigate the time of highest infection risk post-ITB implantation and the optimal time for ITB reimplantation after removal for infection.
356 Nervus Intermedius Sectioning for the Treatment of Geniculate Neuralgia: A Single-Surgeon Case Series
Authors: Ren Alexander Liang , Wu Janet , Hall Jennifer , Zhang Michael , Kim Lily H. , Xu Risheng , Lim Michael 
Published: March 2024

INTRODUCTION:
Geniculate neuralgia (GN) is a rare pain condition involving the nervus intermedius (NI), a branch of the facial nerve. The current standard for surgical intervention consists of a retrosigmoid craniotomy with sectioning of the NI. However, few case reports/series exist detailing the outcomes of GN surgical treatment.

METHODS:
We reviewed patient charts involving craniotomies for GN performed by a single surgeon between November 2020 and December 2022.

RESULTS:
Three patients underwent two craniotomies for GN. GN patients were largely female (91.30%) and White, non-Hispanic/Latino (78.26%). Nearly all GN patients had a concurrent diagnosis of trigeminal neuralgia (n = 22, 95.65%) and some also had a concurrent diagnosis of glossopharyngeal neuralgia (n = 9, 39.13%). Vascular contact with cranial nerves VII and VIII was reported in four procedures. 22 procedures (84.62%) resulted in profound pain relief, with BNI pain score decreasing from 5 to 1 between pre-op and latest follow-up. No patients experienced unexpected hearing loss compared to baseline at latest follow-up. One patient experienced facial paralysis on the side of surgery and two patients experienced some form of vestibular dysfunction at latest follow-up. Of 26 total procedures, 20 included NI sectioning. Initial craniotomies in which the NI was sectioned (n = 18) resolved GN pain 88.89% of the time whereas craniotomies without NI sectioning (n = 5) resolved GN pain 60% of the time.

CONCLUSIONS:
NI sectioning is an effective means of achieving GN pain relief. Post-operative complications including unexpected hearing loss, facial paralysis, and vestibular dysfunction were infrequently observed in our series.
358 Quantifying Cognitive and Affective Dysfunction in Chiari Malformation Type I Patients With the Cerebellar Cognitive Affective Syndrome Scale and the Cerebellar Neuropsychiatric Rating Scale
Authors: Shao Belinda , Wirth Lella , Ma Kevin , Sayied Shanzeh , Kozel Olivia , Nieves Natalie Amaral , Klinge Petra Margarete , Trask Christine 
Published: March 2024

INTRODUCTION:
Cognitive and affective dysfunction in Chiari Malformation Type I (CM1) patients are well-documented, but often rely on extensive neuropsychological tests.

METHODS:
Symptomatic CM1 patients considering surgical decompression were assessed by a board-certified neuropsychologist using the 105-point CNRS (N = 87) and the 10-task CCAS (N = 23), as well as a full neuropsychological battery (N = 24: Wechsler Full Scale IQ, Digit Span, Coding; WRAML Finger Windows; DKEFS Trail Making; verbal list learning; Grooved Pegboard). Descriptive and correlative measures were computed.

RESULTS:
The study included 66 adults and 21 children. A neuropsychological battery revealed impairment in 29% of patients on 1 test, 12.8% on 2 tests, and 20.8% on 3 or more tests. The CCAS indicated 26% with "possible CCAS" (1 task), 27% with "probable CCAS" (2 tasks), and 18% with "definite CCAS" (3 or more tasks). The median CNRS composite score was 31.0 (IQR: 18.5, 49.0), with positive and negative symptom sub-scores of 18.0 (10.0, 26.5) and 14.0 (7.5, 23.5), respectively. Moderate correlation with the neuropsychological battery was found between impairment detected by CCAS (Spearman rank coefficient ρ = 0.67, p = 0.002) and CNRS (ρ = 0.56, p = 0.003).

CONCLUSIONS:
A high prevalence of cognitive and affective impairments in pre-operative CM1 patients was observed by all three testing batteries. In this first report of CNRS and CCAS usage in CM1 patients, increased CNRS and CCAS impairment correlated with impairment on standard neuropsychological testing. These tools show promise for future studies CM1, providing a more concise alternative to traditional testing for cognitive and affective dysfunction.