bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of Life After Poor-Grade Aneurysmal Subarachnoid Hemorrhage
Authors: Goldberg Johannes , Z'Graggen Werner J. , Hlavica Martin , Branca Mattia , Marbacher Serge , D'Alonzo Donato , Fandino Javier , Stienen Martin N. , Neidert Marian C. , Burkhardt Jan-Karl , Regli Luca , Seule Martin , Roethlisberger Michel , Guzman Raphael , Zumofen Daniel Walter , Maduri Rodolfo , Daniel Roy Thomas , El Rahal Amir , Corniola Marco V. , Bijlenga Philippe , Schaller Karl , Rölz Roland , Scheiwe Christian , Shah Mukesch , Heiland Dieter Henrik , Schnell Oliver , Beck Jürgen , Raabe Andreas , Fung Christian 
Published: January 2023

BACKGROUND:
Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and poor disability outcome. Data on quality of life (QoL) among survivors are scarce because patients with poor-grade aSAH are underrepresented in clinical studies reporting on QoL after aSAH.

OBJECTIVE:
To provide prospective QoL data on survivors of poor-grade aSAH to aid clinical decision making and counseling of relatives.

METHODS:
The herniation World Federation of Neurosurgical Societies scale study was a prospective observational multicenter study in patients with poor-grade (World Federation of Neurosurgical Societies grades 4 & 5) aSAH. We collected data during a structured telephone interview 6 and 12 months after ictus. QoL was measured using the EuroQoL - 5 Dimensions - 3 Levels (EQ-5D-3L) questionnaire, with 0 representing a health state equivalent to death and 1 to perfect health. Disability outcome for favorable and unfavorable outcomes was measured with the modified Rankin Scale.

RESULTS:
Two hundred-fifty patients were enrolled, of whom 237 were included in the analysis after 6 months and 223 after 12 months. After 6 months, 118 (49.8%) patients were alive, and after 12 months, 104 (46.6%) patients were alive. Of those, 95 (80.5%) and 89 (85.6%) reached a favorable outcome with mean EQ-5D-3L index values of 0.85 (±0.18) and 0.86 (±0.18). After 6 and 12 months, 23 (19.5%) and 15 (14.4%) of those alive had an unfavorable outcome with mean EQ-5D-3L index values of 0.27 (±0.25) and 0.19 (±0.14).

CONCLUSION:
Despite high initial mortality, the proportion of poor-grade aSAH survivors with good QoL is reasonably large. Only a minority of survivors reports poor QoL and requires permanent care.
Thirty-Day Outcomes of Resolute Onyx Stent for Symptomatic Intracranial Stenosis: A Multicenter Propensity Score–Matched Comparison With Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial
Authors: Siddiq Farhan , Nunna Ravi S. , Beall Jonathan M. , Khan Inamullah , Khan Musharaf , Tekle Wondwossen G. , Ezzeldin Mohamad , Tanweer Omar , Burkhardt Jan-Karl , Jabbour Pascal M. , Tjoumakaris Stavropoula I. , Herial Nabeel A. , Siddiqui Adnan H. , Grandhi Ramesh , Martin Renee L. , Qureshi Adnan I. , Hassan Ameer E. 
Published: January 2023

BACKGROUND:
Symptomatic intracranial atherosclerotic disease (sICAD) is estimated to cause 10% of strokes annually in the United States. However, treatment remains a challenge with several different stenting options studied in the past with unfavorable results.

OBJECTIVE:
To report the 30-day stroke and/or death rate associated with intracranial stent placement for sICAD using Resolute Onyx Zotarolimus-Eluting Stent (RO-ZES) and provide a comparison with the results of Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial.

METHODS:
Prospectively maintained databases across 8 stroke centers were used to identify adult patients treated with RO-ZES for sICAD between January 2019 and December 2021. Primary end point was composite of 30-day stroke, intracerebral hemorrhage, and/or death. Propensity score matching was performed using age, hypertension, lipid disorder, cigarette smoking, and symptomatic target vessel to create a matched group for comparison between RO-ZES and the SAMMPRIS medical management and treatment groups (SAMMPRIS percutaneous angioplasty and stenting [S-PTAS]).

RESULTS:
A total of 132 patients met the inclusion criteria for analysis (mean age: 64.2 years). Mean severity of stenosis was 81.4% (±11.4%). A total of 4 (3.03%) stroke and/or deaths were reported within 30 days of treatment in the RO-ZES group compared with 6.6% in the SAMMPRIS medical management group (OR [odds ratio] 2.26, 95% CI 0.7-9.56, P = .22) and 15.6% in the S-PTAS group (OR 5.9, 95% CI 2.04-23.4, P < .001). Propensity score match analysis of 115 patients in each group demonstrated 30-day stroke and/or death rate of 2.6% in the RO-ZES group and 15.6% in the S-PTAS group (OR 6.88, 95% CI 1.92-37.54, P < .001).

CONCLUSION:
Patients treated with RO-ZES had a relatively low 30-day stroke and/or death rate compared with the S-PTAS group. Further large-scale prospective studies are warranted to evaluate the safety and efficacy of RO-ZES for the treatment of sICAD.
Surgical Strategy and Application of Robotic-Assisted Benign Sacral Neurogenic Tumor Resection
Authors: Wu Hui , Fu Yi-wei , Gao Zhen-hua , Zhong Zhi-hai , Shen Jing-nan , Yin Jun-qiang 
Published: January 2023

BACKGROUND:
Robotic surgery may be advantageous in neurogenic sacral tumor resection but only a few studies reported robotic-assisted neurogenic sacral tumor resection.

OBJECTIVE:
To propose a new surgical strategy for robotic-assisted benign sacral neurogenic tumor resection and introduce the ultrasonic osteotomy surgical system in robotic surgery.

METHODS:
Twelve patients who had robotic-assisted primary benign sacral neurogenic tumor resection between May 2015 and March 2021 were included. Our surgical strategy divides tumors into 4 types. Type I: Presacral tumors with diameter <10 cm. Type II: Narrow-base tumors involving the sacrum with diameter <10 cm. Type III: Broad-base tumors involving the sacrum with diameter <10 cm. Type IV: Tumors involving sacral nerve roots ≥2 levels and/or with diameter ≥10 cm.

RESULTS:
Five type I, 5 type II, and 1 type III patients underwent tumor resection via an anterior approach, and 1 type IV patient via a combined approach. The median operation time, blood loss, and postoperative hospital stay of type I and II were much less than those of type IV. The ultrasonic osteotomy surgical system facilitated osteotomy in 2 type II and 1 type III patients. Eleven patients had total resections, and 1 type III patient had a partial resection. During the follow-up period of 7.9 to 70.9 months (median: 28.5 months), no local recurrences or deaths were noted.

CONCLUSION:
With the largest single-center series to our knowledge, this surgical strategy helped to guide robotic-assisted benign sacral neurogenic tumor resection. The ultrasonic osteotomy surgical system was effective for type II and III.
Interhemispheric Transcingulate Sulcus Approach to Deep-Seated Medial Frontal and Parietal Lesions—Fiber Dissection Study With Illustrative Cases
Authors: Gungor Abuzer , Gurses Muhammet Enes , Dogan Eray , Varol Eyup , Gökalp Elif , Etli Mustafa Umut , Ozoner Baris 
Published: January 2023

BACKGROUND:
Surgery for lesions located in the medial frontal and parietal lobes can be quite challenging for neurosurgeons because of morbidities that may arise from damage to critical midline structures or intact neural tissue that need to be crossed to reach the lesion. In our anatomic studies, the cingulate sulcus was observed as an alternative access route for lesions located in medial frontal and parietal lobes.

OBJECTIVE:
To explain the microsurgical anatomy of the medial hemisphere and cingulate sulcus and to demonstrate the interhemispheric transcingulate sulcus approach (ITCSA) with 3 clinical cases.

METHODS:
Five formalin-fixed brain specimens, which were frozen at −18 °C for at least 2 weeks and then thawed under tap water, were gradually dissected from medial to lateral. Diffusion fiber tracking performed using DSI Studio software in data was provided by the Human Connectome Project. Clinical data of 3 patients who underwent ITCSA were reviewed.

RESULTS:
Cingulate sulcus is an effortlessly identifiable continuous sulcus on the medial surface of the brain. Our anatomic dissection study revealed that the lesions located in the deep medial frontal and parietal lobes can be reached through the cingulate sulcus with minor injury only to the cingulum and callosal fibers. Three patients were treated with ITCSA without any neurological morbidity.

CONCLUSION:
Deep-seated lesions in the medial frontal lobe and parietal lobe medial to the corona radiata can be approached by using microsurgical techniques based on anatomic information. ITCSA offers an alternative route to these lesions besides the known lateral transcortical/transsulcal and interhemispheric transcingulate gyrus approaches.
Quantitative Comparative Analysis of the Endoscope-Assisted Expanded Retrosigmoid Approach and the Far-Lateral Approach to the Inframeatal Area: An Anatomic Study With Surgical Implications
Authors: Revuelta Barbero J. Manuel , Porto Edoardo , Prevedello Daniel M. , Noiphithak Raywat , Yanez-Siller Juan C. , Martinez-Perez Rafael , Pradilla Gustavo 
Published: January 2023

BACKGROUND:
The inframeatal area (IFMA) is a complex anatomic region of the posterior cranial fossa. Given its deep-seated location, tumors involving the IFMA represent a surgical challenge.

OBJECTIVE:
To objectively compare the endoscope-assisted expanded retrosigmoid approach (ERSA) and the far-lateral supracondylar transtubercular approach (FLTA) to address the IFMA.

METHODS:
Anatomic dissections were performed on 5 cadaveric heads (10 sides). The ERSAs were performed before and after the FLTAs. The surgical exposure, surgical freedom, and angles of attack to the IFMA were measured and compared for each approach. In addition, 2 illustrative clinical cases are reported.

RESULTS:
Compared with FLTA, ERSA yielded a nonsignificantly smaller mean area of exposure, whereas FLTA provided a significantly larger mean area of surgical freedom, compared with ERSA (P = .002). The mean horizontal and vertical angles of attack were significantly different between the approaches. In the vertical plane, FLTA yielded the broadest angle of attack at the root entry zone of the lower cranial nerves (CN; P < .004), whereas ERSA did so at the dural entry zone of CN VII/VIII (P = .006). In the horizontal plane, FLTA achieved its broadest angle of attack at the root entry zone of the lower CNs (P = 1.83) while ERSA at the dural entry zone of CN VII/VIII (P = .37).

CONCLUSION:
ERSA and FLTA granted a comparable exposure with the IFMA. Although FLTA may afford a larger area of surgical freedom, ERSA may be a suitable alternative to approach the IFMA, particularly to reach the most medial and superior aspects of this region. Conversely, FLTA may facilitate access to more caudally targets.
Minimally Invasive Preganglionic C2 Root Section for Occipital Neuralgia: 2 Case Reports and Operative Video
Authors: Shahin Maryam N. , Ross Donald A. 
Published: January 2023

BACKGROUND:Occipital neuralgia is a painful condition that is believed to occur from processes that affect the greater, lesser, or third occipital nerves. Diagnosis is often made with a combination of classical symptoms, tenderness over the occipital region, and response to occipital nerve blocks. Cervical computed tomography or MRI may be obtained in multiple positions to detect any impingement. Diagnosis can be made with MRI tractography. Nonsurgical treatments include local anesthetic and steroid injections, anticonvulsant medications, botulinum toxin injections, physical therapy, acupuncture, transcutaneous electrical stimulation, cryoneurolysis, and radiofrequency ablation. Surgical treatments include greater occipital nerve decompression, C2 root section, intradural dorsal root rhizotomy, C1-2 fusion, and occipital nerve stimulation. Although stimulation has been favored in the past decade, complications and maintenance of the devices have led us to return to C2 ganglionectomy.OBJECTIVE:To report on the use of a minimally invasive technique for C2 ganglionectomy to treat occipital neuralgia.METHODS:Review demographic, surgery, and outcome data of a minimally invasive C2 root ganglionectomy used to treat to 2 patients with occipital neuralgia.RESULTS:We report on 2 patients with clinically stereotypical unilateral occipital neuralgia confirmed by greater occipital nerve block, but with no imaging correlate. Both were successfully managed by C2 ganglionectomy through an 18-mm tubular retractor and outpatient surgery. Accompanying text, still photographs, and video describe the technique in detail.CONCLUSION:Minimally invasive C2 ganglionectomy can be used to successfully treat occipital neuralgia.
Clip Ligation and Disconnection of a Ruptured Ventral Subaxial Cervical Isolated Spinal Aneurysm Using Tailored Access Osteotomies: An Operative Technique
Authors: Scullen Tyler , Ng Christina , Mathkour Mansour , Tubbs R. Shane , Bui Cuong , Kalyvas James 
Published: January 2023

BACKGROUND:
Isolated spinal aneurysms (iSAs) are lesions of the spinal vasculature with no associated vascular malformation with difficult management paradigms limited by safe access.

OBJECTIVE:
To describe a case of an irregular fusiform ruptured distal subaxial cervical spine iSA with a complex angioarchitecture intimately associated with the ventral pial plexus (VPP), treated using open clip ligation and disconnection.

METHODS:
A 51-year-old woman presented with complete spinal cord injury with a C8 sensory level and ventral subarachnoid hemorrhage at the C6-T1 vertebral levels. After emergent anterior evacuation and fusion, angiography revealed a small iSA around the VPP. A total laminectomy spanning C5 to T3 was completed, and bilateral C7 pedicle resections were performed. A temporary clip was placed from the left for proximal control, and a permanent clip was placed across the dome of the distal vessel for disconnection. The dura was then closed, and a cervicothoracic fusion completed.

RESULTS:
Postoperative angiography confirmed iSA disconnection and obliteration with anterior spinal artery preservation. The patient had intermittent numbness in the right C8 dermatome. On postoperative day 1, she regained proprioception in the right foot and movement in the lower extremities on command. On postoperative day 3, she regained full sensation and voluntary movement in both lower extremities.

CONCLUSION:
iSA is a rare and morbid condition with nonstandardized guidelines regarding management. We promote the concept of using tailored osteotomies to establish safe corridors for the open treatment of difficult subaxial cervical ventral lesions not amenable to transarterial treatment. Multidisciplinary collaboration is promising, and further investigation is highly warranted.
Intraoperative Predictor of Remission in Cushing Disease
Authors: Zachariah Marcus A. , Cua Santino , Muhlestein Whitney E. , Otto Bradley A. , Carrau Ricardo L. , Kirschner Lawrence S. , Ghalib Luma M. , Lonser Russell R. , Hardesty Douglas A. , Prevedello Daniel M. 
Published: January 2023

BACKGROUND:
Cushing disease represents a challenge for neurosurgeons, with high recurrence rates reported. Characteristics associated with remission are incompletely understood; thus, an intraoperative predictor for outcome would be valuable for assessing resection of adrenocorticotropic hormone (ACTH) secreting tissue.

OBJECTIVE:
To evaluate whether intraoperative ACTH measurement could predict outcome after surgery for Cushing disease.

METHODS:
Retrospective cohort study of 55 consecutive encounters with Cushing disease who had peripheral plasma ACTH levels measured intraoperatively before, during, and after tumor resection. The primary outcome measure was remission, defined by either 2 negative 24-hour urine free cortisol or 2 negative midnight salivary cortisol measurements. A logistic regression machine learning model was generated using recursive feature elimination.

RESULTS:
Fifty-five operative encounters, comprising 49 unique patients, had a mean follow-up of 2.73 years (±2.11 years) and a median follow-up of 2.07 years. Remission was achieved in 69.1% (n = 38) of all operations and in 78.0% (n = 32) of those without cavernous sinus invasion. The final ACTH level measured intraoperatively correctly predicted outcome (area under the curve = 0.766; P value = .002). The odds ratio of remission in patients with the lowest quartile vs highest quartile final intraoperative ACTH was 23.4 (P value = .002). Logistic regression machine learning model resulted in incorporating postoperative day 1 morning cortisol, final intraoperative ACTH that predicted outcome with an average area under the curve of 0.80 (P = .0027).

CONCLUSION:
Intraoperative ACTH may predict outcome after surgery in Cushing disease; furthermore, investigation is warranted.
Prognostic Factors for Surgically Managed Spontaneous Spinal Epidural Hematoma: A Single-Center Case Series of 18 Patients
Authors: Baig Mirza Asfand , Pedro Lavrador Jose , Gebreyohanes Axumawi , Vastani Amisha , China Musa , Kalaitzoglou Dimitrios , Bartram James , Eid Hazem , Bleil Christina , Bell David , Thomas Nicholas , Malik Irfan , Grahovac Gordan 
Published: January 2023

BACKGROUND:
Spontaneous spinal epidural hematoma (SSEH) is a rare pathology, which carries a significant morbidity.

OBJECTIVE:
To review our institutional experience of surgically managed patients with SSEH, seeking to better understand clinical prognostic factors related to postoperative outcomes and thereby improve counseling of patients before treatment.

METHODS:
All patients who underwent surgical management of SSEH between September 2011 and 2021. Baseline and postoperative clinical and radiological characteristics are presented, including the American Spinal Injury Association grade (ASIA). Statistical analyses were performed using Stata 13.1.

RESULTS:
Eighteen patients were identified in total (11 male patients and 7 female patients) with a median age of 59.5 (range 3-83) years. The most common spinal region affected was cervicothoracic (33.3%). Limb weakness (94.4%) and urinary dysfunction (83.3%) represented the most common presenting symptoms. Preoperatively, the presence of spinal cord edema on imaging was associated with worse preoperative Medical Research Council (MRC) grade (P = .033), female sex was associated with preserved saddle sensation (P = .04), and patients receiving antiplatelet medication were associated with a higher risk of preoperative axial back pain (P = .005). Higher postoperative MRC grade was associated with higher preoperative ASIA (P = .012) and MRC grade (P = .005), and preservation of saddle sensation (P = .018). Postoperative improvements in axial back pain were associated with higher preoperative ASIA grade (P = .035) and anticoagulation treatment (P = .029).

CONCLUSION:
Neurosurgical intervention for SSEH yields positive outcomes and benefits patients. Patients with higher preoperative ASIA, MRC grade, and those presenting with preserved saddle sensation may experience further improved clinical outcomes after intervention.
Choledochal Cyst in Children, presentation and outcome - 10 years’ experience from a tertiary care center in Pakistan
Authors: Muhammad Arslan Farooq  , Khan Sabeen Abid , Malik Munir Iqbal 
Published: January 2023

Objectives: This study was done to compare the clinical features, laboratory findings and surgical outcomes of pediatric patients with choledochal cysts.
Methods: Retrospective review of the hospital records of all pediatric patients admitted with choledochal cysts from 2011 to 2021 were collected and analyzed. Patients were divided into two groups; infant (less than one year age) and pediatric (1 to 16 years) for statistical comparison of two groups.
Results: The study included 34 children, 9 (26.5%) were infant (<1 year) and 25 (73.5%) were more than one year old. Mean age at diagnosis was 15 months with age ranging from 14 days to 16 years. Females were 19 (55.9%) and males were 15 (44.1%). Type-I choledochal cyst was the most common (73.5%), presentation followed by Type-IVA (26.5%) in our patients. Patients from infant group presented with jaundice in 7 (77.7%), and clay-colored stool in 3 (33.3%) as the most common clinical features, while abdominal pain (88%), vomiting (72%), fever (32%) and pancreatitis (32%) were the frequent presentations among older age group. Post-surgical complications of excision of choledochal cyst were observed in 4 (11.7%) patients.
Conclusion: Choledochal cysts have variable presentations depending upon age of the patients. Complete surgical excision of choledochal cyst is the treatment modality of choice and timely surgical management can prevent complications.
doi: https://doi.org/10.12669/pjms.39.2.6196
How to cite this: Farooq MA, Khan SA, Malik MI. Choledochal Cyst in Children, presentation and outcome - 10 years’ experience from a tertiary care center in Pakistan. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.6196
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Islamic legal perspectives on digital currencies and how they apply to Jordanian legislation
Authors: Albalawee Nasir , Al Fahoum Amjed S. 
Published: January 2023

Background: The industrial transformation requires a speedy shift to financial digitization. One of the needs for financial digitalization in the study of Islamic contracts and Islamic business law is the use of digital platforms with digital currencies. Regarding the merits and downsides of its Sharia restrictions and its halal certification, which is currently under discussion, digital currencies and perks have generated controversy in Jordan and other Islamic countries. Methods: This study intends to analyze the legal foundations of digital currency from Jordanian and Islamic legal perspectives. The descriptive-qualitative research approach was utilized, and data collection processes included documentation and a literature review. All legal possibilities that may be drawn from Islamic law in order to investigate the legality of digital currencies are explored further and used to obtain the conclusions of this study. Results: A review of Sharia reasons and consideration for the wellbeing of the people suggests that digital currencies in their current form are incompatible with it and must adhere to the stipulations of Islamic finance. Therefore, digital currencies are unsuitable as a store of value or wealth due to their erratic swings, lack of purchasing power, and instant responsiveness to any technical problem, technical penetration, or official circumstance. Due to market instability, digital currencies can't be utilized to defer payments, settle debts, or repay loans. Conclusions: Digital currencies are speculative; not real money. Most of those who have this money are speculators seeking a quick payoff. Sharia views digital currency trading as gambling due to its high degree of volatility. Jordan's government should regulate digital currency use to meet demand. Digital currencies must be addressed under e-commerce laws.