bluuebunny/crossref_metadata_2025_split huggingface dataset:
476 Technical and Clinical Outcomes in Concurrent Multivessel Occlusions Treated With Mechanical Thrombectomy: Insights from the STAR Collaboration
Authors: Saad Hassan Wajih , Eshraghi Sheila , Howard Brian M. , Buster Bryan Edward , Akbik Feras , Maier Ilko , Goyal Nitin , Starke Robert M. , Rai Ansaar , Fargen Kyle Michael , Psychogios Marios , Jabbour Pascal , DeLeacy Reade , Dumont Travis Michael , Kan Peter , Arthur Adam S. , Crosa Roberto , Gory Benjamin , Spiotta Alejandro M. , Alawieh Ali M. , Grossberg Jonathan Andrew 
Published: March 2023

INTRODUCTION:
Endovascular thrombectomy(EVT) has become the mainstay treatment of large vessel occlusion, however its role in the treatment of patients with simultaneous multi-territory occlusions(MVOs) has not been established.

METHODS:
We reviewed the STAR registry and included patient data from 35 stroke centers for EVT performed to treat bilateral anterior or concurrent anterior and posterior circulation occlusions from 2017-2020.

RESULTS:
We included a total of 7723 patients who underwent EVT for acute ischemic stroke. 54 patients (0.7%) underwent EVT for MVOs (mean age 69 ± 12.5; Female 50%). 28% had bilateral and 72% had concurrent anterior and posterior circulations occlusions. We used propensity score matching to match patients with MVOs to another group with single vessels occlusions by age, gender, race, admission NIHSS, baseline mRS score, onset to groin, use of IV-tPA. The rate of recanalization (TICI2B/3), complications, modified Rankin score at 90 days, and mortality was not significantly different between the 2 groups. Multivariate analysis confirmed that MVOs was not a predictor of poor functional outcome, increased symptomatic hemorrhage, or longer procedure time.

CONCLUSIONS:
Compared to single vessel occlusions, EVT in appropriately selected MVOs has similar efficacy and safety profile.
480 Cerebrospinal Fluid Volume Assessed From Clinical T1w-MRI Predicts Functional Outcomes Post-Thrombectomy
Authors: Shamulzai Ahmad , Kawas Mohammad , Kittel Carol , Curry Brian Patrick , Kim Jeongchul , Atcheson Kyle , Whitlow Christopher , Wolfe Stacey Q. 
Published: March 2023

INTRODUCTION:
Endovascular treatment (EVT) is recognized as the standard of care for patients with acute ischemic stroke caused by large vessel occlusion (LVO). However, many patients do not achieve functional independence after successful EVT, which may be due to the pre-existing brain atrophy and higher total cerebrospinal fluid volume (CSFV). Prediction of patients who will highly benefit from EVT may be possible using baseline total CSFV as a marker of brain health and reserve.

METHODS:
We performed a retrospective analysis of Wake Forest Baptist Health’s Stroke Thrombectomy and Aneurysm Registry (n = 602), collected between 2015 - 2021. We selected 213 patients (mean age 67.5 ± 14.6, 49.3% female) who had adequate MRI within 14 days of EVT and a record of the modified Rankin scale (mRS) at 90 days post EVT. Clinical T1w images were transformed into high-resolution images using the convolutional neural network SynthSR. Then, FreeSurfer was used to estimate total cranial CSFV including the ventricles and choroid plexus. To correct for head size, total CSFV was adjusted to the estimated total intracranial volume.

RESULTS:
Baseline total CSFV significantly predicted 90-day mRS in an ordinal regression model adjusted for baseline mRS (p < 0.001). After further adjustment for age, sex, smoking history, prior stroke, hypertension, congestive heart failure, hemoglobin A1c, atrial fibrillation, ASPECT score, and other confounders, total CSFV remained an independent predictor of 90-day mRS (p = 0.007).

CONCLUSIONS:
This study elucidates the clinical implications of pre-existing brain health and reserve in the setting of acute ischemic strokes to aid clinicians in treatment decisions impacting prognosis. Increased total CSFV correlates with increased brain frailty and poorer functional outcomes after mechanical thrombectomy, which may ultimately attenuate its benefit.
485 Evaluating Surgical Arthrodesis With Novel MRI Grading Score
Authors: Mazur-Hart David , Larson Erik Werner , Gerges Christina , Nugent Joseph Girard , Pettersson David , Ross Donald A. 
Published: March 2023

INTRODUCTION:
Diagnostic imaging following cervical fusion often involves magnetic resonance imaging (MRI) to evaluate neural structures and computed tomography (CT) and/or dynamic radiographs to evaluate instrumentation and arthrodesis. CT and radiographs use ionizing radiation that increases risk for malignancy. Using MRI alone would protect patients and decrease healthcare utilization.

METHODS:
Single institution retrospective study evaluating patients who received postoperative CT and MRI following ventral cervical fusion procedures. Radiographic standards were used to evaluate for arthrodesis or pseudo-arthrosis. Blinded observers evaluated signal intensity using a region of interest (ROI) over the instrumented disc space, homogenous cerebral spinal fluid (CSF), and distal uninstrumented vertebral body (VB). A quotient (ROIinterspace/ROICSF and ROIinterspace/ROIVB) was used to create T1- and T2-interspace interbody scores (IIS). Additionally, T1 hypointense lines along endplates and facet joints were evaluated for degree of discontinuity.

RESULTS:
Study included 60 patients (50% female) with 110 instrumented levels and mean age 51.7 years-old. For T1-weighted MRI, median T1-IISCSF for arthrodesis was 176.2 compared to 130.9 for pseudo-arthrosis (p < 0.0001) while T1-IISVB for arthrodesis was 68.5 and pseudo-arthrosis was 52.7 (p < 0.0001). For T2-weighted MRI, median T2-IISCSF for arthrodesis was 27.7 and 14.2 for pseudo-arthrosis (p < 0.0001) while T2-IISVB for arthrodesis was 67.9 and 41.0 for pseudo-arthrosis (p < 0.0001). Median T1 hypointense discontinuity was graded at the endplates, left facet, and right facet as 1.5, 0.25, and 0.5 compared to pseudo-arthrosis as 1.0, 0.0, and 0.0, respectively (p < 0.0001, p = 0.002, and p = 0.001). The greatest area under the curve (AUC) after receiver operator characteristic (ROC) analysis was T1-IISVB (0.7743).

CONCLUSIONS:
We describe a novel scoring system that may help determine arthrodesis versus pseudo-arthrosis on MRI following ventral cervical fusion. Postoperative symptomatic patients may only require MRI for workup, which would protect patients from harm while decreasing healthcare utilization.
495 Impact of Postoperative Fatigue Following Minimally-Invasive Lumbar Spine Surgery
Authors: De Biase Gaetano , Chen Selby G. , Bojaxhi Elird , Garcia Diogo P. , Quinones-Hinojosa Alfredo , Abode-Iyamah Kingsley O. 
Published: March 2023

INTRODUCTION:
Postoperative fatigue, a feeling of debilitating tiredness and loss of energy, is a distressing symptom and can have a major impact on the patient’s quality of life after surgery. Fatigue may be one of the main complaints after surgery and may last much longer than pain, preventing return to normal function and activity.

METHODS:
We surveyed patients that underwent minimally-invasive lumbar spine surgery under general anesthesia (laminectomy with or without fusion) within the past year. A five-point Likert scale (very much, quite a bit, somewhat, a little bit, not at all) was used to assess the extent of fatigue during the first postoperative month, its impact on QOL, and ADLs.

RESULTS:
The survey was completed by 100 patients, 61% were male, with mean age 64.6 ± 12.5 years (range 28-87), 31% underwent an MIS-TLIF, 69% a lumbar laminectomy. During the first postoperative month 45% of patients referred significant fatigue (very much or quite a bit); for 31% of patients fatigue significantly impacted their QOL; and significantly limited their ADLs in 43% of patients. MIS-TLIF was associated with higher rate of postoperative fatigue compared to laminectomy, 61.3% versus 37.7%, p=0.02. Patients 65 years old or older had higher rates of fatigue compared to younger patients, 55.6% versus 32.6%, p = 0.02. We did not observe a statistically significant difference in postoperative fatigue between male and female patients.

CONCLUSIONS:
Our study revealed a substantial incidence of postoperative fatigue in patients that underwent minimally-invasive lumbar spine surgery under general anesthesia, with a significant impact on their QOL and ADLS. There is a need to research new strategies to reduce fatigue after spine surgery.
503 Stimulation of the Paraventricular Nucleus Activates Brown Adipose Tissue via Local GABA Release: A Novel Target for the Treatment of Obesity
Authors: Siler Dominic Aaron , Mota Clarissa , Morrison Shaun , Burchiel Kim J. , Madden Chris 
Published: March 2023

INTRODUCTION:
Sympathetic activation of brown adipose tissue (BAT) has shown significant promise in preclinical studies to elicit long term weight loss and reversal of type 2 diabetes however it is inhibited in obese individuals.

METHODS:
Rats were anesthetized and monitored for body temperature, BAT temperature, expired CO2, mean arterial pressure, and heart rate. Postganglionic BAT sympathetic nerve activity (SNA) was recorded from the interscapular BAT pad. Stimulating electrode and micropipette were placed steroeotactically in the PVN. Stimulation pulses at an intensity of 100 µA at 100 Hz for 5 minutes were delivered. Changes in BAT SNA and physiology were compared with and without stereotactically injected 500 µM bicuculline, a GABAA receptor antagonist.

RESULTS:
Stimulation of the PVN increased BAT SNA compared to no stimulation (411.7 ± 75.8% baseline vs 98.18 ± 1.4% baseline n = 5; P < 0.05) along with BAT temperature (35.8 ± 0.8°C vs 34.2 ± 0.7°C, n = 5, P < 0.001), expired CO2 (4.7 ± 0.6% vs 4.2 ± 0.5%, n = 5, P < 0.05) indicating increased metabolic rate. There was no change in blood pressure, body temperature, or paw temperature suggesting no change in sympathetic tone. Heart rate increased (476 ± 21 bpm vs 429 ± 23 bpm, n = 5, P < 0.01) consistent with increased metabolic demand. Microinjection of 500 µM bicuculline into the PVN prevented stimulated activation of BAT SNA.

CONCLUSIONS:
Stimulation of the PVN increases BAT activation and basal metabolic activity in the absence of cold-stimulus with minimal off-target effects on systemic sympathetic tone and may be a viable therapeutic target for stimulation of BAT activity to treat obesity and type 2 diabetes.
515 Conserved Theta-Gamma Coupling During Speech Production in Glioma
Authors: Surapaneni Akhil , Aabedi Alexander Arash , Kaur Jasleen , Brang David , Kuo John S. , FAANS FACS , Millán José del R. , Hervey-Jumper Shawn L. 
Published: March 2023

INTRODUCTION:
It has been shown recently that infiltration of gliomas into healthy neural tissue alters local neuronal spiking patterns, leading to circuit dysfunction. It is unknown, however, if glioma infiltration also impacts the coordination of local neuronal computations with other networks during behavioral tasks. Cross-frequency coupling of high gamma (HG) (80-150 Hz) amplitude with theta (Th) (4-7Hz) phase is a well-established mechanism for this type of neural integration.

METHODS:
Patients (n = 13) with dominant hemisphere perisylvian gliomas were intraoperatively implanted with an ECoG grid and performed a picture naming task. Electrodes overlying regions of tumor infiltration and those overlying normal parenchyma were identified using the T2-FLAIR signal. Following a widely accepted method, Kullback–Leibler (KL) divergence of HG amplitude distribution over Th phases from a uniform distribution was used to quantify Th-HG coupling of each electrode during speech production. Statistical significance was determined by comparing to a null distribution of KL divergence values corresponding to the original HG time series randomly cut in ten places and permuted, while preserving the theta time series. This destroys the cyclostationarity of theta-gamma coupling while preserving other non-stationarities.

RESULTS:
43 out of 114 electrodes overlying normal parenchyma and 104 out of 300 electrodes overlying tumor-infiltrated regions exhibited significant Th-HG coupling after FDR correction. Electrodes overlying tumor regions and normal parenchyma had similar spatial coverage at the group level. Electrodes with Th-HG coupling at a preferred theta phase of π radians exhibited greater coupling. No significant difference in KL divergence was found between tumor-overlying electrodes and non-tumor overlying electrodes at the group level.

CONCLUSIONS:
Th-HG phase-amplitude coupling is preserved in glioma-infiltrated brain tissue during speech production. This suggests that glioma-infiltrated tissue participates in the coordination of spatially and temporally distributed processes during complex behaviors.
527 Multicentric Evaluation of Stereotactic Radiosurgery for Koos Grade IV Vestibular Schwannoma in Young Patients
Authors: Dumot Chloe , Pikis Stylianos , Mantziaris Georgios , Xu Zhiyuan , Lunsford L. Dade , Sheehan Jason P. ,   International Radiosurgery Research Foundation contributors
Published: March 2023

INTRODUCTION:
Koos IV vestibular schwannoma (VS) are preferably treated by surgery. However, SRS can be an alternative for patients with contraindications or who refuse surgery. SRS for Koos IV patient younger than 45 years old has not been previously studied and could be associated with more complications.

METHODS:
This is a retrospective multicentric study, performed under the International Radiosurgery Research Foundation. Patients 45 years old, treated primarily for a Koos IV VS with single-session SRS, presenting with non life-threatening or incapacitating symptoms, with a follow-up ≥1 years were included.

RESULTS:
176 patients with a median age of 36 years (IQR 9) and a median tumor volume of 9.3 cm3 (IQR 4.7) were included. Before SRS, serviceable hearing, facial nerve weakness (House-Brachman >1) and trigeminal neuropathy was present in 51.7%, 8.5%, and 34.1% respectively. The median prescription dose was 12Gy (IQR 0.5). At a median follow-up of 3.1 years (IQR 4.5), tumor stability and regression were 38.9% and 54.3%, respectively. The 5- and 10-year progression-free rate was 90.9% and 86.7%. Early tumor enlargement occurred in 10.9% of cases. The probability of serviceable hearing preservation at 5- and 10-years was 56.8% and 45.2%, respectively. The probability of improvement or preservation of facial nerve function was 95.7% at 5 and 10-years. Adverse radiation effects were noted in 19.9%, 6 of them where managed with surgical resection of the VS. New-onset hydrocephalus occurred in 4.0%.

CONCLUSIONS:
Single-session SRS in selected Koos IV VS can be an alternative to surgery in a selected group of patients 45 years old. Long-term follow-up is warranted.
554 Cerebral Emboli Detection Using Robotic Transcranial Doppler With Artificial Intelligence During Transcatheter Aortic Valve Replacement - A Novel and Autonomous Neuromonitoring Tool
Authors: Baig Ammad , Manion Christopher , Khawar Wasiq , Donnelly Brianna , Monteiro Andre , Iyer Vijay , Levy Elad I. , Siddiqui Adnan Hussain 
Published: March 2023

INTRODUCTION:
Periprocedure ischemic stroke remains a serious complication in patients undergoing transcatheter aortic valve replacement (TAVR).

METHODS:
Consecutive patients undergoing TAVR were prospectively enrolled in the study. Basic demographics and procedural details, such as protection device used, type of aortic valve used, and any intraprocedure or postprocedure (<30 days) complications, were recorded. Continuous variables were analyzed by two-sample Mann-Whitney t-test and categorical variables by chi-square or Fisher test.

RESULTS:
Thirty-one patients were prospectively enrolled (mean age=79.9±7.6 years; men=16 [51.6%]). Hyperlipidemia was present in 27 patients (87.1%), followed by hypertension in 25 (80.6%). Mean aortic valve area was 0.7 cm2. Mean aortic-ventricular gradient was 43 mmHg (interquartile range 31.5-50 mmHg). The protection device was used in 16 cases. A significantly lower emboli count was observed in the protection group (means of 470.38 vs. 693.33 in the non-protection group; P=0.01). Emboli counts during valve positioning and implantation were significantly different as well (means of 249.92 protection vs. 387.5 non-protection; P=0.01). One (4%) nonfatal stroke was seen postoperatively in the protection group.

CONCLUSIONS:
We describe use of a novel real-time intraoperative neuromonitoring tool in patients undergoing TAVR. Significantly fewer HITS were detected in the protection group. Valve positioning and implantation was identified as the most significant stage in terms of intraprocedural HITS.
562 Investigation of Cerebral Vessel Geometric Morphometrics for Prediction of Mechanical Thrombectomy First Pass Outcome
Authors: Santo Briana , Monteiro Andre , Sarayi Seyyed , Donnelly Brianna , Baig Ammad , Waqas Muhammad , Siddiqui Adnan Hussain , Levy Elad I. , Tutino Vincent 
Published: March 2023

INTRODUCTION:
Vessel tortuosity is a major factor in successful first pass outcomes for mechanical thrombectomy (MT), but previous methods to quantify tortuosity are not accurate enough to predict outcome. We investigated a new method for vessel characterization and outcome prediction based on geometric morphometrics (GMM).

METHODS:
Vessels and clots were manually segmented and reconstructed from pre-treatment CTA and nCCT images (n=5 cases). The vasculature corresponding to the ICA and MCA from the affected hemisphere was isolated, and centerlines were engineered as curved landmarks. MorphoJ, a GMM software, was used to complete generalized Procrustes and principal component (PC) Analysis that included registration of patient geometries, calculation of average morphology and landmark variation, and identification of anatomical landmarks differentiating MT outcomes. Morphometrics were compared against local and overall tortuosity by measuring the separability of and cohesion within outcome classes.

RESULTS:
GMM produced two PCs, which described local variation in M1 (PC1) and the ICA (PC2). When compared against vessel tortuosity features, GMM PCs increased the distance between outcome classes (first pass effect vs. no first pass effect), improving separability by 23.6%. Further, GMM PCs increased the compactness/cohesion of outcome classes, reducing cumulative distance between failures by 50% and successes by 9.4%.

CONCLUSIONS:
GMM analysis of pre-treatment vessel characteristic highlights regional variation in M1 as a strong indicator of MT failure, and suggests that GMM has the potential to better predict MT outcome than ICA tortuosity alone. Investigation of more complex vessel morphometry through feature engineering is needed.
622 Differences in Healthcare Resource Utilization After Surgery for Metastatic Spinal Column Tumors in Safety-Net Hospitals
Authors: Elsamadicy Aladine A. , Koo Andrew B. , David Wyatt , Reeves Benjamin , Sherman Josiah , Craft Samuel , Hersh Andrew , Duvall Julia , Lo Sheng-fu , Shin John H. , Mendel Ehud , Sciubba Daniel M. 
Published: March 2023

INTRODUCTION:
Safety Net Hospitals (SNH) are those which serve an especially high proportion of Medicaid, uninsured, and charity care patients, though few have studied the impact of SNH status on healthcare resource utilization for patients with metastatic spinal column tumors.

METHODS:
A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. Adult patients undergoing surgery for metastatic spinal column tumors were identified using ICD-10-CM codes. Admissions were dichotomized by SNH status, defined as the top quartile of Medicaid and uninsured burden. Hospital characteristics, patient demographics, comorbidities, intraoperative variables, and outcomes were assessed. Multivariate logistic regression analyses were used to identify predictors of extended LOS, non-routine discharge, and increased cost.

RESULTS:
Of the 11,505 patients identified, 24.0% (n = 2,760) were treated at a SNH and 76.0% (n = 8,745) were treated at a Non-SNH (N-SNH). Compared to patients treated at N-SNH, a greater proportion of patients at SNH were African American, male, and of lower income quartile. Number of comorbidities (p = 0.324), intraoperative complications (p = 0.488) and postoperative complications (p = 0.064) were similar between cohorts. Patients treated at SNH typically experienced greater LOS (SNH: 12.3 ± 11.3 days vs. N-SNH: 10.1 ± 9.5 days, p<0.001), though total cost of admission (SNH: $58,804 ± 39,088 vs. N-SNH: $54,569 ± 36,781, p = 0.550), non-routine discharge disposition (SNH: 48.2% vs. N-SNH: 48.4%, p = 0.715) and mortality rate (SNH: 3.1% vs. N-SNH: 2.7%, p = 0.629) were similar. On multivariate analysis, SNH status independently predicted extended LOS [OR: 1.41, p = 0.009], but not non-routine discharge [OR: 0.97, p = 0.773] or increased cost [OR: 0.93, p = 0.655].

CONCLUSIONS:
Our study suggests that the quality of care provided by SNH is largely similar to that provided by non-SNH for patients undergoing surgical intervention of metastatic spinal column tumors
646 Publication Speed Across Neurosurgical Journals: A Bibliometric Analysis
Authors: Hanna Jubran Jubran , Scherschinski Lea , Park Marian , Rhodenhiser Emmajane , Benner Dimitri , Ibrahim Sufyan , Karahalios Katherine , Singh Rohin , Maher Hulou M. , Graffeo Christopher S. , Lawton Michael T. 
Published: March 2023

INTRODUCTION:
Many factors influence an author’s choice for journal submission, including the journal impact factor and publication speed. These bibliometric data points, amongst others, have not yet been assessed in neurosurgical research.

METHODS:
Eight neurosurgical journals were analyzed for original articles, collected via randomized sampling per issue per year from 2016-2020. Publication speed data was gathered from published articles. Journal Impact Factors were gathered using Clarivate Journal Citation Reports. Spearman’s correlation analysis was used to analyze the findings.

RESULTS:
A total of 1617 original articles and systematic reviews across 8 neurosurgical journals were reviewed. The mean (standard deviation; SD, range) time from submission to print publication (SP) in neurosurgery journals is 344 (190) days, while the submission to acceptance (SA) time is 130 (104) days, acceptance to online print (AO) time is 76 (61) days, and the online publication to print publication (OP) is 137 (114) days. Most articles were from authors from the United States (n = 833; 52%), with the second and third highest contributions coming from China (n = 100; 6%) and Japan (n = 83, 5%) respectively. The top three neurosurgical topics published were spine (n = 417; 26%), vascular (n = 316; 20%) and oncology (n = 275; 17%). There were significant correlations across all determinants of publication speed and journal Impact Factors (SP: r = 0.457, SA: r = 0.204, AO: 0.481, OP: 0.317, p < 0.001).

CONCLUSIONS:
Neurosurgical journal publication speeds vary between journals and are significantly correlated with the journal’s impact factor. The majority of neurosurgical research in the past five years has been focused in spine, vascular, and oncology fields and has originated from the United States. The information on individual journals could serve as a guide for publishing neurosurgeons to determine the appropriate journal for submission.