bluuebunny/crossref_metadata_2025_split huggingface dataset:
330 Interactions of Brain, Blood, and CSF: A Novel Mathematical Model of Cerebral Edema
Authors: Doron Omer , Zadka Yulyia , Barnea Ofer , Rosenthal Guy 
Published: March 2023

INTRODUCTION:
Previous models of intracranial pressure (ICP) dynamics have not included flow of cerebral interstitial fluid (ISF) and changes in resistance to its flow when brain swelling occurs.

METHODS:
We developed a lumped parameter model which includes a representation of cerebral ISF flow within brain tissue and its interactions with CSF flow and CBF. The model is based on an electrical analog circuit with four intracranial compartments: the (1) subarachnoid space, (2) brain, (3) ventricles and (4) cerebral vasculature. We determined changes in pressure and volume within cerebral compartments at steady-state and simulated perturbations: Rapid injection into the intracranial space, hyper-and hypoventilation. We simulated changes in resistance to flow or absorption of CSF and cerebral ISF to model hydrocephalus and cerebral edema.

RESULTS:
The model accurately replicates features of intracranial physiology including the pressure–volume curve, increased ICP pulse pressure with rising ICP, hydrocephalus from increased resistance to CSF outflow, and changes associated with ventilation. Importantly, modeling edema with increased resistance to ISF flow mimics key features of brain swelling including elevated ICP, increased brain volume, effaced ventricles, and a contracted subarachnoid space. Similarly, decreased resistance to flow of fluid across the BBB leads to an exponential-like rise in ICP and ventricular collapse.

CONCLUSIONS:
The model accurately depicts the complex interactions that occur between pressure, volume, and resistances to flow in the different intracranial compartments under specific pathophysiological conditions. In modelling resistance to bulk flow of cerebral ISF, it may serve as a platform for improved modelling of cerebral edema and blood–brain barrier disruption that occur following brain injury.
331 A Randomized Controlled Clinical Trial using α-Tocopherol and Ascorbic Acid in the Treatment of Moderate Traumatic Brain Injury
Authors: Philip Jerry , Jung Josephine , Kyesmen Nanpan , Olomo Surajudeen , Nwibo Onyemaechi , Jeneral Dumura , Bot Gyang Markus , Shilong Danan , Tolias Christos , Binitie Peter 
Published: March 2023

INTRODUCTION:
Traumatic Brain Injury (TBI) is a major public health concern and a leading cause of disability worldwide. It accounts for 40% of all deaths from acute injuries worldwide. Oxidative brain damage is one of the most validated pathophysiologic hallmark of secondary traumatic brain injury.

METHODS:
120 patients admitted to Jos University Teaching Hospital with moderate TBI were included in this study. Patients were randomized into 4 equally sized groups: control, enteral α-Tocopherol, intravenous ascorbic acid, or a combination of the latter treatments. Patients were administered the designated drugs for a period of one week in addition to the standard management of head injuries. The control group received neither of these drugs but just the standard management of head injury. Outcome data were collected prospectively including demographics, head injury characteristics, mortality, length of stay (LoS) and Glasgow outcome score (GOS).

RESULTS:
92.5% (n = 111) of patients were male. The most common cause for TBI was road traffic accidents (n = 102). GOS was significantly higher in all treatment groups when compared to the control group at discharge (ascorbic acid p < 0.01, α-Tocopherol p < 0.001, combination p < 0.001), and at 1 and 3 months follow up. Overall mortality was significantly lower in patients treated with either α-Tocopherol (n = 1, 3.3%), ascorbic acid (n = 1, 3.3%) or a combination (n = 0, 0%) compared to the placebo group (n = 8, 26.7%, p < 0.05). The lenght of hospital stay was significantly reduced in the α-Tocopherol (p < 0.05) and the combination groups (p < 0.001)

CONCLUSIONS:
The use of ascorbic acid and/or α-Tocopherol improved survival in this cohort. A combination of both drugs had a potentially synergistic effect in these patients.
334 In-hospital Resource Utilization among Traumatic Brain Injury Patients Presenting With Alcohol and Drug Use: A TRACK-TBI Study
Authors: Sherrod Brandon , Baker Cordell , Young Jacob , Barber Jason , DiGiorgio Anthony Michael , Temkin Nancy , Grandhi Ramesh 
Published: March 2023

INTRODUCTION:
Premorbid alcohol and drug use is frequently seen in traumatic brain injury (TBI), yet in-hospital resource utilization in this population has not been thoroughly studied.

METHODS:
The multicenter TRACK-TBI database was queried for patients with blood alcohol content (BAC, positive ≥0.08), cannabinoid (THC), and hard drug (cocaine, amphetamines, PCP, MDMA) screening at presentation. Patient demographics, presenting GCS, ICU admission, ventilator time, number of head CTs, ICP monitor placement, and length of stay (LOS) were analyzed after stratifying by substance use.

RESULTS:
Of 2032 TRACK-TBI subjects, 1448 (71.3%) had BAC screening, 891 (43.8%) had THC screening, and 891 (43.8%) had hard drug screening. BAC+ patients (n = 370 [25.6%]) had lower presenting GCS (11.5 ± 4.7 v. 12.7 ± 3.9, p<0.001) as did THC+ patients (n = 136 [15.3%], 10.9 ± 4.7 v. 12.6 ± 4.0, p < 0.001), although hard drug+ patients (n = 82 [9.2%]) did not (p = 0.119). BAC+ and hard drug+ patients had higher positive head CT rates (p < 0.001 and p = 0.034, respectively), although THC+ patients did not (p = 0.248). All substance use groups were more likely to be admitted to ICU but did not have more ICU days on average. Hard drug+ patients were more likely to require ICP monitor placement (27% v. 14%, p = 0.003) despite having similar presenting GCS. BAC+ patients had significantly more CTs performed (p = 0.007). Only hard drug+ patients required more ventilator days (p = 0.04). LOS was significantly longer for THC+ and hard drug+ patients (mean 10.8 v. 8.1 d, p = 0.035 and 11.5 v. 8.2 d, p = 0.017, respectively) but not BAC+ patients. On multivariate analysis, THC+ (aHR = 1.21, 95% CI 1.04-1.40, p = 0.012) and moderate GCS BAC+ patients (aHR = 1.67, 95% CI 1.20-2.31, p = 0.002) had higher number of head CTs performed.

CONCLUSIONS:
Substance use associated with TBI is correlated with greater ICU admission rates and imaging resource utilization.
337 Quantitative Analysis of Admission Electroencephalography Predicts Post-Traumatic Epilepsy After Severe Traumatic Brain Injury
Authors: Pease Matthew , Elmer Jonathan , Mallela Arka , Rodriguez Juan Francisco Ruiz , Sexton Daniel , Barot Niravkumar , González-Martínez Jorge Alvaro , Castellano James , Okonkwo David O. 
Published: March 2023

INTRODUCTION:
Up to one-third of severe traumatic brain injury (TBI) patients develop post-traumatic epilepsy (PTE), often years after their injury. Currently, there is no validated predictive model to identify patients at high risk for PTE.

METHODS:
We retrospectively analyzed a prospective database of severe TBI patients treated at a single level one trauma center from 2012 through 2018. Outcomes were recorded with the Expanded Glasgow Outcomes Scale (GOSE) at 6- and 12-months post-injury. We identified a cohort of patients who survived to two years and did not have an early post-traumatic seizure, defined as a seizure within 7 days of initial injury. From this cohort, we matched patients with PTE to those without using age and Glasgow coma scale score at admission. All patients underwent continuous EEG for 3-5 days upon admission, and a board-certified epileptologist identified 5-minute artifact-free segment for analysis. We extracted qEEG features, described them with qualitative statistics, and developed a logistic regression model using backwards selection.

RESULTS:
We identified 27 patients with PTE and 23 without who survived two years post-injury. The median time to onset of PTE was 7.2 months post-trauma and GOSE was similar when stratified by PTE at 6- and 12-months (p > 0.73). On qEEG analysis, patients with PTE had higher spectral power in the delta frequencies (p = 0.003), more variance in the delta and theta frequencies (p < 0.04), a higher mean amplitude (p = 0.01), and peak envelope (p = 0.01). On multivariate modeling, delta power (Odds Ratio [OR] 1.8), theta power (OR 0.2), and rhythmic spectrum (1.7) all increased risk of PTE and had an AUC of 0.85 for predicting PTE.

CONCLUSIONS:
In a cohort of severe TBI patients, quantitative qEEG features in the acute phase after injury identified future risk of PTE.
338 Ultra-Early Cranioplasty Versus Conventional Cranioplasty: A Retrospective Review at an Academic Level 1 Trauma Center
Authors: Chee Keanu , Sethi Akal , Kaakani Alia , Beauchamp Kathryn M. , Kang Jennifer S. 
Published: March 2023

INTRODUCTION:
Decompressive craniectomy (DC) is a common neurosurgical procedure for management of intracranial hypertension following traumatic brain injury. Traditionally, cranioplasty has been delayed for as long as three-to-six months following initial DC. Few studies have assessed the effect of 'ultra-early' cranioplasty on rates of postoperative complications following DC.

METHODS:
A retrospective review of cranioplasties performed at our institution between January 2016 and July 2020 was performed. Craniectomies performed at other institutions were excluded. Seventy-seven cranioplasties met inclusion criteria.Ultra-early cranioplasty was defined as cranioplasty performed within 30 days of craniectomy whereas conventional cranioplasty occurred after 30 days. Postoperative wound infection rates, rate of return to the operating room with or without bone flap removal, operative length, and rate of post-cranioplasty hydrocephalus were compared between the two groups.

RESULTS:
39 and 38 patients were included in the ultra-early and conventional cranioplasty groups, respectively. The average number of days to cranioplasty in the ultra-early group was 17.7 ± 7.75 days compared to 95.7 ± 65.60 days in the conventional group. The mean GCS upon arrival to the ER was 7.28 ± 3.90 and 6.92 ± 4.14 for the ultra-early and conventional groups, respectively. The operative time was shorter in the ultra-early cohort that in the conventional cohort (ultra-early, 2.4 ± 0.71 hours; conventional, 3.0 ± 1.63 hours; p = 0.0336). The incidence of post-cranioplasty hydrocephalus was also lower in the ultra-early cohort (ultra-early, 10.3%; Conventional, 31.6%; p = 0.026). No statistically significant differences were observed regarding postoperative infection, return to the operating room, or bone flap removal.

CONCLUSIONS:
Our study shows that ultra-early cranioplasty can significantly reduce the rate of post-cranioplasty hydrocephalus, as well as operative time in comparison to conventional cranioplasty. However, the timing of cranioplasty following DC should remain a patient-centered consideration.
340 Predicting Progression and Recurrence of Pediatric Low Grade Gliomas Using miRNA Composition in Plasma and CSF
Authors: Coyle Anne , Rathi Komal , Koptyra Mateusz , Foster Jessica , Hollawell Madison , Beck Christopher , Choudhari Namrata , Storm Phillip B. , Resnick Adam C. , Tucker Alexander M. , Madsen Peter J. 
Published: March 2023

INTRODUCTION:
Liquid biopsy is a non-invasive method of diagnosing and monitoring brain tumor patients. miRNA profiling from cerebrospinal fluid (CSF) and plasma has become an increasingly attractive biomarker, however targets have yet to be established in CNS tumors. Low grade glioma (LGG) patients often have excellent outcomes, but some have progressive disease or unresectable lesions. There has been limited work in establishing a clinically approved liquid biopsy assay for such patients.

METHODS:
miRNA profiling of 17 plasma and 12 CSF samples from 10 pediatric LGG and 7 DMG patients was performed using the HTG EdgeSeq platform. Clinical information was obtained through chart review. miRNA expression was evaluated with unsupervised consensus clustering and differential analysis.

RESULTS:
At time of data analysis, 5 LGG had progression or recurrence. The remaining LGG (5) had stable or no evidence of disease. Mean follow-up was 23 months. miRNA consensus clustering revealed that LGG with a recurrence, progression, or malignant transformation clustered with DMG rather than with tumors of similar histology or WHO classification. Pilocytic astrocytoma could be identified by miRNA composition in CSF. In plasma, 103 unique miRNAs were identified with significant differential expression between the progression/recurrence LGG cohort versus those with stable or no evidence of disease (logFC > 1, FDR < 0.05). miR-16-5p, a miRNA correlated with tumor growth and invasion in non-CNS tumors, had higher expression in the more aggressive cohort (p = 0.0022). Over 100 miRNAs correlated with histology, survival, disease state, and presence of leptomeningeal disease (p < 0.05).

CONCLUSIONS:
miRNA profiling of CSF and plasma in patients with LGG may predict disease course to better inform patient care and treatment monitoring.
341 Post-Operative Outcomes and Rare Complications in Pediatric Stereotactic Electroencephalography: A Retrospective Review from a High Volume Pediatric Epilepsy Center
Authors: Plonsker Jillian Hannah , Stone Lauren , Wali Arvin Raj , Daniel Manjari , Ravindra Vijay , Gonda David D. , Khan Usman , Sattar Shifteh 
Published: March 2023

INTRODUCTION:
Stereotactic electro-encephalography (sEEG) allows for spatial and temporal localization of epileptic foci for definitive treatment guidance. High volume center studies are more likely to detect rare, although potentially significant complications.

METHODS:
A retrospective review of 58 sEEG cases performed by a single surgeon at a single pediatric academic institution was performed. Patients <18 years old were included. Patients without 5 years of follow-up were excluded.

RESULTS:
25 (49%) of the patients undergoing SEEG were non-lesional on pre-operative imaging. 50 patients (98%) received surgical treatment of their epilepsy following sEEG. 19 underwent open surgical resection of EZ, 16 laser interstitial thermal ablation, 13 responsive neurostimulation, and 1 was treated with DBS. We achieved Engle 1, 2, 3, and 4 level outcomes in 22 (55%), 8 (20%), 5(13%), 5 (13%) of patients respectively. Engle outcome scores were comparable for lesional and non-lesional EZ in patients who underwent resection (Engle 1 outcome in 10/12 and 1/2 respectively) and ablation (6/9 and 6/7, respectively). IPH occurred in 3 cases (5.2%), with only one requiring surgical evacuation. 2 of the 3 hemorrhages caused transient neurologic deficits and the third caused a longstanding hemiparesis. Two (3.4%) cases developed asymptomatic pseudo-aneurysms identified on routine delayed vascular imaging. One was treated successfully with endovascular coiling, however the second was too distal and required surgical clipping. There were no complications from either pseudo-aneurysm treatment.

CONCLUSIONS:
sEEG offers favorable morbidity, source localization, and seizure control in surgical lesions. We recommend surveillance imaging with CTA or MRA 3-6 months post operatively to rule out pseudoaneurysm formation given.
344 Drivers of Adverse 30-Day Outcomes for Pediatric Spine Tumor Surgery Patients: A Nationwide Analysis
Authors: Tang Oliver Young , Chen Jia-Shu , Groves Mari L. , Shao Belinda , Ganga Arjun , Svokos Konstantina , Klinge Petra Margarete , Zadnik Sullivan Patricia Leigh 
Published: March 2023

INTRODUCTION:
Spine tumors in children are an uncommon clinical entity. Drivers of reoperation and readmission following surgery for this pathology are poorly characterized.

METHODS:
We conducted a retrospective cohort analysis of all spine tumor surgery cases in the National Surgical Quality Improvement Program-Pediatrics database from 2012-2020, using diagnosis and Current Procedural Terminology codes. The primary outcome was a composite of 30-day mortality, reoperation, readmission, and non-home discharge disposition. Stepwise regression with bidirectional elimination via the Akaike Information Criterion was used to identify predictors of adverse 30-day outcomes. 25 candidate variables were assessed, including tumor characteristics, patient demographics, preoperative comorbidities, operative details, and postoperative complications.

RESULTS:
The analytic cohort included 728 pediatric patients undergoing spine tumor surgery. Patients predominantly had intradural intramedullary tumors (79.3%). Average age was 7.7 years and 54% were male. 86.5% were discharged to home. 30-day mortality rate was 0.4%. 48 patients (6.6%) required reoperation, with the most common reasons being infection (n = 14), repair of cerebrospinal fluid leak (n = 8), shunt placement (n = 8), and tumor recurrence (n = 6). 39 patients (5.4%) underwent readmission within 30 days, primarily for surgical site infection (n = 11), nervous system complication (n = 8), or wound dehiscence (n = 7). Stepwise regression identified predictors of adverse 30-day outcomes including emergent surgery (OR = 2.64, P = 0.014), operative time (OR = 1.03 per +10 minutes, P < 0.001), length of stay (OR = 1.03 per +1 day, P = 0.035), surgical site infection or dehiscence (OR = 5.26, P < 0.001), nervous system complications (OR = 10.31, P = 0.009), and non-surgical site infections (OR = 27.95, P < 0.001). When mortality, reoperation, and readmission were analyzed in aggregate, emergent surgery and postoperative complications remained as significant predictors.

CONCLUSIONS:
30-day adverse events following pediatric spine tumor surgery were predominantly driven by emergent surgery, prolonged operative or hospitalization time, and postoperative complications.
345 Structural Cardiac Defects and Vascular Anomalies in Vein of Galen Malformation Patients: A Multi-Institutional Cohort With Genetic Sequencing
Authors: Piwowarczyk Paulina , Moyer Quentin , Mekbib Kedous Y. , Kappel Ari D. , Zhao Shujuan , Shohfi John , Smith Hannah , Orbach Darren , See Alfred P. , Smith Edward R. , Kahle Kristopher 
Published: March 2023

INTRODUCTION:
Vein of Galen malformations (VOGM) are rare, potentially lethal brain arteriovenous malformations (AVM). The roles of EPHB4, RASA1, and ACVRL1 have been described in VOGM pathogenesis, and previous studies have reported the co-occurrence of VOGM with cardiac and vascular disorders.

METHODS:
We queried our cross-institutional cohort of 129 VOGM patients with detailed genotypic and phenotypic data. Genetic samples from a subset of 114 VOGM probands, including 90 trios, underwent whole exome sequencing.

RESULTS:
We found that 9.3% of our patients had structural cardiac defects, as compared to 0.8-1.2% in the general population. Our cohort’s cardiac defects included 3.9% with patent ductus arteriosus, compared to 0.1% in the general population, and 1.6% with atrial septal defect, a congenital condition previously connected to VOGM. 22.5% of our patients had vascular abnormalities, including 16.3% with cutaneous vascular lesions and 4.7% with recurrent epistaxis. One patient presented with VOGM and moyamoya disease. Our whole exome sequencing found that patients with damaging RASA1 mutations presented with significantly more cutaneous vascular lesions relative to the rest of the VOGM cohort (60% vs 16%, p = 0.007) and patients with damaging ACVRL1 mutations had significantly higher rates of recurrent epistaxis (50% vs 5%, p = 0.002).

CONCLUSIONS:
RASA1 is associated with capillary malformation-arteriovenous malformation syndrome (CM-AVM), and ACVRL1 is associated with hereditary hemorrhagic telangiectasia (HHT); CM-AVM and HHT are neurovascular disorders in which the VOGM phenotype is frequently encountered. Our findings demonstrate the high incidence of cardiac defects and vascular abnormalities in VOGM patients and the value of clinical sequencing of VOGM patients with these co-occurring clinical features.
346 Development of Deuterium Magnetic Resonance Imaging for Cerebrospinal Fluid Studies
Authors: Hunt Rachel Joy , Nagaraja Tavarekere , Knight Robert , Lee Ian Yu , Ewing James , Penning Donald 
Published: March 2023

INTRODUCTION:
Over the past ten years, the role of the glymphatic system has been defined and explored using various cerebrospinal fluid (CSF) tracers to track the movement of CSF through the perivascular spaces and into the brain interstitium. Glymphatic studies most commonly use gadolinium as a CSF tracer, which is not blood-brain-barrier (BBB) soluble. The primary component of CSF is water, however, which is BBB permeable. Cerebrospinal fluid may behave differently than large molecule tracers. Heavy water (D2O) is an isotope of water often used in physiology studies. We hypothesized that D2O would provide a traceable MR signal in the brain, allowing for more physiologically realistic models of CSF flow within the glymphatic system.

METHODS:
Two adult male rats underwent deuterium enhanced MR imaging. Images were obtained using a custom-made RF transmit/receive coil from Rapid MR International that is dual tuned to both proton (1H, 300.3 MHz) and deuterium (2H, 46.1 MHz) resonant frequencies for use in a 7 Tesla Bruker MRI system. After appropriate system calibration for optimization of deuterium MR signal with intravenous D2O infusion, the rats underwent spinal catheter implantation for intrathecal infusion. Images were taken during and after D2O infusion to evaluate uptake and clearance.

RESULTS:
Deuterium produced a imageable MR signal in the brain with intravenous and intrathecal infusion. Complete signal washout was noted within 10 minutes of stopping the intrathecal infusion.

CONCLUSIONS:
Deuterium MRI holds promise as a physiologic CSF tracer. As the technique is refined, it can be used for further CSF physiology studies. The rapid clearance of intrathecal D2O as compared to previous models using gadolinium supports our theory that CSF behaves differently than the large molecule tracers historically used to characterize its flow.