bluuebunny/crossref_metadata_2025_split huggingface dataset:
495 Optimizing Drug Delivery to the Brain for Breast Metastasis: A Novel Method for Tumor Targeting
Authors: Krishnamurthy Satish , Oh Justin , Gautham Shruti , Li J. , Shen Yimin 
Published: March 2024

INTRODUCTION:
Brain metastases are difficult to treat due to the blood-brain barrier limiting delivery of therapeutic agents to the brain effectively. Intraventricular drug delivery has not been well studied for intra-axial pathologies. However, our prior work demonstrated that intraventricular drug delivery in a hyperosmolar vehicle showed preferential accumulation of drug within breast cancer tissue compared to surrounding brain parenchyma.

METHODS:
We used an intracerebral breast cancer tumor model in adult female nude rats divided into six experimental groups. We examined three iron labeled dextran molecules (3 KD, 5KD, and 10 KD) in 337 mOsm/L solution and three different osmolarities of delivery solution (307, 353, 368 mOsm/L) with 10 KD dextran. 7T MR imaging was used to analyze dextran distribution at different time points. All animals were sacrificed after 2 hours and quantity of dextran particles was determined by histopathology.

RESULTS:
Breast cancer tumor cells were successfully implanted in all rats. MRI quantification of dextran concentration was well corroborated by histopathology. Varying the molecular size of dextran resulted in the smallest molecule reaching peak levels in tumor tissue earlier than the larger molecules but the larger molecules remained concentrated in tumor tissue for a longer time. Varying the osmolarity of the delivery solution resulted in preferential accumulation of 10 KD dextran in tumor tissue except for when dextran was delivered in 368 mOsm/L solution where no preferential distribution was seen.

CONCLUSIONS:
Hyperosmolar intraventricular delivery of chemotherapeutic drugs could be effective in preferentially delivering drugs to abnormal tumor tissues.
496 Impact of the Mean Cochlear Biologically Effective Dose on Hearing Preservation After Stereotactic Radiosurgery for Vestibular Schwannoma
Authors: Tuleasca Constantin , Toma-Dasu Iuliana , Duroux Sebastien , George Mercy , Maire Raphael , Daniel Roy , Patin David , Schiappacasse Luis , Dasu Alexandru , Faouzi Mohamed , Levivier Marc 
Published: March 2024

INTRODUCTION:
Stereotactic radiosurgery (SRS) is a useful alternative for small to medium size vestibular schwannoma (VSs).

METHODS:
This is a retrospective longitudinal single center study. Were analyzed 213 patients with useful baseline hearing. Risk of hearing decline was assessed for GR classes and pure tone average (PTA) loss. Mean follow-up period was 39 months (median 36, 6-84).

RESULTS:
Hearing decline (GR class) 3 years after SRS was associated with higher cochlear BEDGy2.47 mean (OR 1.39, p = 0.009). BEDGy2.47 mean was more relevant compared to BEDGy2.47 max (OR 1.13, p = 0.04). Mean (p = 0.91) and maximal (p = 0.66) cochlear doses were not statistically significant. Risk of PTA loss (continuous outcome, follow-up minus baseline) was significantly corelated with BEDGy2.47 mean at 24 (beta coefficient 1.55, p = 0.002) and 36 (beta coefficient 2.01, p = 0.004) months after SRS. Mean (p = 0.27) and maximal (p= 0.87) cochlear doses were not significant. Risk of PTA loss (> 20 dB versus <=20) was associated with higher BEDGy2.47 mean at 6 (OR 1.36, p= 0.002), 12 (OR 1.36, p = 0.007) and 36 (OR 1.37, p = 0.02) months. Mean cochlear dose was statistically significant only at 24 months. Risk of hearing decline at 36 months for BEDGy2.47 mean of 7-8, 10 and 12 Gy2.47 was 28%, 57% and 85%, respectively.

CONCLUSIONS:
Cochlear BEDGy2.47 mean is relevant for hearing decline after SRS and more relevant as compared with BEDGy2.47 max. Three years after SRS, this was sustained for all hearing decline evaluation modalities. Our data suggests BEDGy2.47 mean cut-off of <= 8 Gy2.47 for better hearing preservation rates.
497 Superficial MRI-guided Laser Interstitial Thermal Therapy (LITT) for Intracranial Metastasis Is Associated With a Significantly Higher Rate of Leptomeningeal Disease
Authors: Vohra Sanah , Torres Lisette , Harary Maya , Mozaffari Khashayar , Chow Ariana , Ivan Michael E. , Ellingson Benjamin , Kim Won , Yang Isaac 
Published: March 2024

INTRODUCTION:
Evolving brain metastases treatment standards has led to shifting intracranial recurrence patterns, especially with respect to pachymeningeal and leptomeningeal disease (PMD/LMD). As an emerging technique, it remains unclear if the depth of magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) is associated with frequency of iatrogenic PMD/LMD.

METHODS:
A single-institute retrospective analysis of patients who underwent LITT surgery between 2014 and 2022 was conducted to investigate the development of PMD/LMD. P-values <0.05 were considered statistically significant.

RESULTS:
Eleven patients undergoing thirteen LITT procedures were analyzed. Mean age was 62.6 (±11.7), and 69.2% of patients were female. PMD/LMD developed in 4/13 cases (30.8%). There was no significant difference between superficial vs. deep LITT ablation in terms of age, sex, follow-up time, and primary cancer site. Superficial LITT ablation had a significantly higher frequency of PMD/LMD compared to deep LITT ablation (p = 0.02). Time to PMD/LMD development among patients who underwent superficial LITT ablation was significantly shorter compared to that among patients who had deep LITT ablation (p = 0.02).

CONCLUSIONS:
Superficial LITT ablation was associated with significantly higher frequency and shorter time to PMD/LMD development compared to deep LITT ablation. These results suggest that iatrogenic PMD/LMD spread during superficial LITT ablation may increase the proportion of PMD/LMD and accelerate disease timeline.
500 Endoscopic Endonasal Resection of the Medial Wall of the Cavernous Sinus: Initial Experience and Impact on Pituitary Surgery Outcomes
Authors: Sanchez-Garavito Jesus Emiliano , Perez-Vega Carlos , Alvarez-Caicedo Diana , Figueredo Luisa Fernanda , Navarro Garcia de Llano Juan Pablo , Michaelides Loizos , Ramos-Fresnedo Andres , Donaldson Angela , Olomu Osarenoma , Samson Susan , Quinones-Hinojosa Alfredo , Chaichana Kaisorn L. , Almeida Joao P. 
Published: March 2024

INTRODUCTION:
Invasion of the medial wall of the cavernous sinus (CS) by pituitary tumors is a factor associated with persistence of disease and subtotal resection of these tumors. Resection of the medial wall of the CSis therefore an option for maximum resection of such tumors, however, there is concern with potential complications associated with this technique and at this time, limited data is available in the literature.

METHODS:
Single center retrospective study evaluating patients that underwent endoscopic endonasal resection of pituitary adenomas and resection of the medial wall of the CS, between January 2022 and February 2023. Extent of resection, remission rates, complications and histopathological diagnosis were assessed.

RESULTS:
Out of a population of 120 pituitary surgeries, sixteen cases were eligible for this study. 5 (31.2%) patients had non-functional adenomas, and 11 (68.7%) had functional adenomas, including 4 adrenocorticotropic hormone, 3 prolactin, 3 growth-hormone, 1 pluri-hormonal (GH and prolactin)—secreting tumors. Complete tumor resection, based on intraoperative impression and postoperative MRI, was achieved in all cases. At last follow-up, complete biochemical remission (using current criteria) was seen in 11 cases (100%) of functional adenomas. One case developed pulmonary embolism and another one sino-nasal infection postoperatively. No fatalities, carotid injuries or cranial nerve palsies were reported.

CONCLUSIONS:
Resection of the medial wall of the cavernous sins, performed when there is potential tumor extension into the medial wall, is associated with high rates of disease control. It is particularly useful in cases of functioning but also has a role in non-functional adenomas adherent to the medial wall of the CS. Long term follow up is necessary to evaluate the durability of these results.
502 Endoscopic Versus Microsurgery Resection of Third Ventricle Colloid Cysts: A Single-center Case-series of 140 Consecutive Patients
Authors: Mohammadi Esmaeil , Sharifi Guive , Jafari Ali , Bahranian Arefeh , Paraandavaji Elham , Daneshmand Yahya , Mohammadkhani Maryam 
Published: March 2024

INTRODUCTION:
The resection of colloid cysts of third ventricle can be done with either open microsurgery or endoscopy with each having different cons and pros.

METHODS:
Data of patients who underwent surgical resection of third ventricle colloid cyst via either endoscopic or microsurgery approach by a single surgeon between 2005-2020 were retrospectively collected. After administration of criteria, 140 records were retrieved (60 through endoscopic and 80 by trans-cranial microsurgery). Clinical and surgical measures were compared between approaches after adjustment for confounders with generalized linear multivariate regression.

RESULTS:
Length of hospital stay, postoperative meningitis, and operation time, cyst size, and baseline comorbidities did not differ between groups. Gross total resection (GTR) was achieved for all cases in microsurgery group while in endoscopic group it was lower (90% vs 100%; p = 0.005). Intraoperative hemorrhage occurred in 14 (23.3%) of endoscopic patients while for microscopic group it was zero (p < 0.001). Post-operative shunt was required for two patients (one in endoscopic group and the other in microscopic group). Two patients had tumor recurrence, both being in endoscopic group. No mortality was detected in either group. Multivariate analyses were insignificant for the effects of clinical and demographic factors in occurrence of worse surgical outcomes (non-GTR and hemorrhage).

CONCLUSIONS:
Rate of intra-operative hemorrhage was higher in endoscopic method and GTR was lower, even after adjustment for other factors. This could be due to technologic shortcomings and limited space for resection maneuvers and complication management.
503 Engineering GBM-specific T Cells Using Photothermal Prussian Blue Nanoparticles
Authors: Sanchez Carlos Esmond , Sweeney Elizabeth , Sekhri Palak , Muniraj Nethaji , Chen Jie , Bollard Catherine , Cruz Conrad Russell , Fernandes Rohan 
Published: March 2024

INTRODUCTION:
Adoptive T cell therapy (ATCT) has successfully treated hematological malignancies and is currently under investigation for solid tumor therapy. In contrast to existing chimeric antigen receptor (CAR) T cell and/or antigen-specific T cell approaches, which target defined antigens, our PBNP-based approach can target a broad repertoire of antigens in GBM in an antigen-agnostic manner.

METHODS:
We treated GBM cells with PBNP-based photothermal therapy (PBNP-PTT) prior to culturing with dendritic cells (DCs), and subsequent stimulation of T cells.

RESULTS:
When PBNP-PTT was administered to U87 cells at an immunogenic thermal dose, we effectively expanded U87-specific T cells. DCs cultured ex vivo with PBNP-PTT-treated U87 cells enabled 15- 30-fold expansion of CD4+ and CD8+ T cells. Upon co-culture with target U87 cells, these T cells secreted IFN-G in a specific and dose-dependent manner (up to 647-fold over controls). T cells manufactured using PBNP-PTT elicited specific cytolytic activity against target U87 cells (33-93% killing at an E:T ratio of 20:1), while sparing normal human astrocytes. Similarly, PBNP-PTT on SNB19 cells resulted in a 7-39-fold expansion of T cells, which elicited 25-66% killing of SNB19 cells at an E:T ratio of 20:1. U87-luc cells were then orthotopically inoculated into NSG mice to establish xenograft GBM, and U87-specific T cells developed via PBNP-PTT were intracranially injected. These T cells eliminated U87 tumors in vivo and significantly improved mouse survival compared to mice treated with PBS (p = 0.0047) or non-specific T cells (p = 0.0123) from the same donor.

CONCLUSIONS:
These findings provide proof-of-concept data supporting the use of PBNP-PTT to stimulate and expand tumor-specific T cells ex vivo for potential use as an ATCT approach for patients with GBM. We are currently using patient-derived tumor samples to generate IND-enabling data.
504 Anterior-posterior Diameter Is a Key Driver of Resectability and Complications for Pituitary Adenomas With Suprasellar Extension in Endoscopic Transsphenoidal Surgery
Authors: Park Jung , Golub Danielle , White Timothy G. , Ruelle Marianne , Yang Kaiyun , Shah Harshal , Eisenberg Mark B. , Dehdashti Amir R. 
Published: March 2024

INTRODUCTION:
As endoscopic transsphenoidal approaches are more routinely selected for larger pituitary adenomas with parasellar extension, understanding potential anatomical factors that limit resection and contribute to complications becomes increasingly important.

METHODS:
A single-center retrospective review of all endoscopic transsphenoidal surgeries for pituitary adenomas with suprasellar extension from 2015-2020 was performed. Preoperative MRIs were systematically assessed to assign a Knosp classification, a Zurich Pituitary Score (ZPS), and to measure lesional suprasellar dimensions. Univariate comparisons and multivariate regression models were employed to assess the influence of these factors on extent of resection (EOR) and postoperative complications.

RESULTS:
Of the 96 patients with suprasellar pituitary adenomas who underwent endoscopic transsphenoidal surgery, 74 patients (77%) had a gross total resection (GTR). Neither Knosp grade nor ZPS were associated with GTR (Knosp 3A-4 versus Knosp 0-2, p = 0.069; ZPS III-IV versus ZPS I-II, p = 0.079). Multivariate regression identified suprasellar anterior-posterior tumor diameter (SSAP) as the only significant predictor of EOR (OR 0.951, 95% CI 0.905-1.000, p = 0.048*). Higher SSAP also showed the strongest association with an increased overall complication rate (p = 0.0003*) and intraoperative CSF leaks (p = 0.0012*). Further analysis of the regression model for GTR suggested an optimal cut point value for SSAP of 23.7 mm, above which predictability for failing to achieve GTR carried a sensitivity of 89% and specificity of 41%.

CONCLUSIONS:
This study is unique in its examination of endoscopic transsphenoidal surgical outcomes for pituitary adenomas with suprasellar extension. Our findings suggest that previously established grading systems based on lateral extension into the cavernous sinus lose their predictive value in lesions with suprasellar extension and, more specifically, with increasing suprasellar anterior-posterior diameter.
508 Preparing Physicians For Failures: A Needs Assessment
Authors: Williamson Theresa , Wang Keying , Hadis Syntia , Duerr Emily , Mitchell Taylor , DeGaetano Aimee , Lovett Ben , Levy Elad I. , Lin Xiaodong 
Published: March 2024

INTRODUCTION:
Although anecdotal evidence points to high levels of stress among neurosurgeons and trainees, there is little systematic research documenting the nature of stress in detail.

METHODS:
We conducted a detailed survey of neurosurgeons and trainees, obtaining 22/26 responses (85% response rate) with 2 responses removed for missingness. Participants were purposefully sampled from two academic center neurosurgery programs.

RESULTS:
Participants reported more high-arousal negative emotions (particularly frustration and anxiety) than low-arousal negative emotions (e.g., helplessness, discouragement), suggesting relatively high levels of motivation. Within training levels, sources of stress varied considerably, suggesting the need for tailored approaches to stress management. Attendings reported quite a lot of stress from patient expectations and administrative constraints, whereas trainees focused more on teamwork and difficult patients. A focus on processes and specific mechanisms of problems at work was associated with more high-arousal emotions, whereas a focus on outcomes was associated with low-arousal emotions; this pattern is consistent with prior research on other populations. As expected, residents were most likely to use coping strategies that reflected a lack of control over one’s schedule (e.g., immersing oneself in work) whereas attendings were most likely to use healthy strategies, particularly physical exercise. Only one of the 20 participants reported seeking professional support due to stress; residents were most likely to attribute this to a lack of time or resources but most participants did not feel a need to seek professional help. Attendings were least likely to report ideas for what education or training they could have benefited from to better cope with stress.

CONCLUSIONS:
This work points to key ways dealing with failure and stress contributes to individual well-being as well as neurosurgical culture.
688 Stratified Assessment of Treatment Approach for Craniocervical Junction Arteriovenous Fistulas: A Multicenter Cohort and Pool Analysis
Authors: Li Zongze 
Published: March 2024

INTRODUCTION:
Cranio-cervical junction arteriovenous fistulas (CCJ-AVFs) are complex vascular shunts that present a challenge for treatment.

METHODS:
We conducted a retrospective analysis of 132 patients who underwent microsurgery or endovascular embolization for CCJ-AVF. The baseline characteristics, angioarchitectural features, and clinical outcomes were compared between the two treatment groups. A subgroup analysis was also performed in CCJ-AVF with carotid artery feeders.

RESULTS:
The complete obliteration rate was 97.1% in the microsurgery group, 85.3% in the embolization via carotid artery (CA) approach group, and 62.5% in the embolization via vertebral artery (VA) approach group. After adjusting for baseline and confounding features, the occlusion rate was significantly lower in embolization via VA approach (adjusted OR, 0.04; 95% CI, 0.005-0.40, p = 0.006). None of the patients in the microsurgical group appeared new-onset infarction, while 1 (2.9%) in CA embolization and 3 (12.5%) in VA embolization suffered new-onset infarction after treatment. The neurological improvement rate of microsurgery was similar to that of embolization via CA approach. Embolization via VA was associated with less neurological improvement (adjusted OR, 0.11; 95% CI, 0.03-0.38, p = 0.001). In the subgroup analysis of CCJ-AVF with CA feeders, the occlusion rate and neurological improvement of embolization via CA approach were comparable to those of microsurgery.

CONCLUSIONS:
Our study suggests that microsurgery and embolization via CA approach can achieve similar clinical outcomes for CCJ-AVF. Embolization via VA approach may result in a lower occlusion rate and less neurological improvement. In CCJ-AVF with CA feeders, embolization via CA approach may be a safe and effective alternative to microsurgery.
689 Technical Success and Occlusion Rates of eCLIPs Bifurcation Remodeling System for Treatment of Wide-neck Bifurcation Aneurysms: Summary of the Early Experience
Authors: Ghozy Sherief , Abdelghaffar Mariam , Motawei Ahmed Sallam , Kallmes David , Kadirvel Ramanathan 
Published: March 2024

INTRODUCTION:
Wide-necked bifurcation aneurysms (WNBA) are among the most difficult aneurysms to treat. Very low dome-to-neck and aspect ratios provide an even greater challenge in the management of WNBAs.

METHODS:
A systematic review and meta-analysis was conducted following the PRISMA recommendations. On April 4, 2022, we searched for eligible papers in Pubmed, Web of Science (ISI), Scopus, and Embase databases. The meta-analysis was done using R software version 4.3.0. and the "meta" package. Pooled prevalence (%) and their corresponding 95% confidence intervals (CI), random-effects model based and the generalized linear mixed models (GLMMs) method. On the presence of multiple follow-up points, we included the last available in the analysis. Complete occlusion was defined as Raymond–Roy occlusion classification (RROC) class I, and adequate occlusion was defined as RROC class I or II.

RESULTS:
Four studies were finally included following the double-reviewer screening of the retrieved literature. The patients' mean age ranged from 56 ± 5.4 to 60±9.2 years, and 82.5% were females. The mean follow-up duration ranged from 8 ± 6.6 months to 28.8 ± 17.6, with all studies giving dual antiplatelet regimens and one added heparinization to their anticoagulation protocol. Technical success was achieved in 88.61% (95% CI = 75.54-95.15) of the cases, while successful adjunctive coiling was obtained in 91.38% (95% CI = 70.71-97.90) of them. The complete occlusion rate was 50.65 (95% CI = 39.63-61.60), while the adequate occlusion rate was 84.42 (95% CI = 74.53-90.93). There was no significant heterogeneity in all pooled outcomes.

CONCLUSIONS:
The early experience of the device shows an efficacy profile comparable with the currently available devices in treating WNBAs.
692 Impact of Dual Antiplatelet Therapy After Stent-assisted Coiling of Unruptured Aneurysms on Risk of Complications
Authors: Ringer Andrew J. , Hanel Ricardo , Baig Ammad , Siddiqui Adnan Hussain , Lopes Demetrius K. , Levitt Michael Robert , Naylor Ryan M. , Lanzino Giuseppe , Crowley R. Webster , Serrone Joseph , Kan Peter T. , Binning Mandy Jo , Veznedaroglu Erol , Boulos Alan S. , Tawk Rabih G. 
Published: March 2024

INTRODUCTION:
Despite some consensus on the need for perioperative dual antiplatelet therapy (DAPT) after stent-assisted coiling (SAC), the ideal duration of therapy is not clear.

METHODS:
Ten institutions retrospectively reviewed data from databases prospectively maintained as part of a collaborative research group. Patients with unruptured intracranial aneurysms treated with DAPT following SAC (excluding flow diverters) between January 1, 2016 and December 31, 2020 with at least 6 months follow-up. Records were reviewed for type and duration of DAPT before and after SAC, type of stent, outcome (mRS), follow-up duration, peri-procedural and delayed complications, and rate of significant in-stent stenosis. Complications were considered “during period of risk” if they occurred during DAPT when short term had completed (hemorrhagic) or after completing DAPT when long term continued (thrombotic).

RESULTS:
556 patients were reviewed. 450 met all inclusion criteria. Nine patients treated for fewer than 29 days after SAC and 10 treated 43-89 days were excluded from analysis. 80 were treated with short-term DAPT (30-42 days), 188 with medium term (90-179 days), and 163 with long term (180+ days). There were no significant differences in the rate of thrombotic complications during the period of risk in short (1/80; 1.25%), medium (2/188; 1.1%) or long (0/163; 0%) term groups, but rates of hemorrhagic complications were lower in the short-term group (0/80; 0%) versus medium (3/188; 1.6%) or long (1/163; 0.6%). Longer duration DAPT did not reduce the risk of in-stent stenosis (0%; 2.5%; 3.2%).

CONCLUSIONS:
Continuing DAPT beyond 42 days after SAC did not reduce the risk of thrombotic complications or in-stent stenosis and may increase the risk of hemorrhagic complications. It may be reasonable to discontinue DAPT after 42 days following SAC.