bluuebunny/crossref_metadata_2025_split huggingface dataset:
506 Fingerprinting the Epileptogenic Zone in RAVE
Authors: Nikitenko O'Leary Sean Mikhail , Musa Ibrahim , Zhou Oliver , Husain Adam , Price Anthony , Magnotti John F. , Wang Zhengjia , Beauchamp Michael S. , Gadot Ron , Sheth Sameer A. , Rodriguez Liliana Camarillo , Karas Patrick J. 
Published: March 2023

INTRODUCTION:
The treatment of drug-resistant epilepsy remains a significant challenge. Surgical resection of the epileptogenic zone (EZ) often offers the highest chance of seizure freedom. Grinenko et al. [Brain. 2018; 141(1):117–131] demonstrated that intracranial EEG (iEEG) data analysis can be used to identify a time-frequency pattern or “fingerprint” to help identify the EZ. Complex algorithmic techniques, lack of standardization, and inaccessibility pose a hurdle to surgical programs that may consider fingerprinting as a tool to aid resection. R Analysis and Visualization of Intracranial EEG (RAVE) is a powerful, free, open-source, NIH-funded software designed to analyze iEEG data through a web browser on an internet-connected device. Here we present an accessible implementation of a fingerprinting algorithm with RAVE.

METHODS:
Our fingerprint module consists of three steps, following closely the work of Grinenko et al. First, iEEG seizure data is pre-processed with Morlet wavelet transform and bipolar normalization. Second, each electrode's time-frequency map is run through an image processing algorithm to extract the EZ fingerprint biomarkers: (1) pre-ictal spikes, (2) multiband fast activity, and (3) low-frequency suppression. Each electrode is ranked by biomarker and combined “fingerprint” score based on work by Woolfe et al. [J Neurosci Methods. 2019; 325:108347]. Data is then displayed via time-frequency plot for each electrode and the fingerprint score is projected across the brain with a 3D brain map viewer,

RESULTS:
Our fingerprint module in RAVE significantly streamlines EZ isolation. Time-consuming calculations are built-in, allowing users with no coding, image processing, or statistical experience to explore and share EZ fingerprinting data.

CONCLUSIONS:
We incorporated an algorithm to detect the epileptogenic zone fingerprint into RAVE, allowing free distribution and use of this research algorithm to surgical epilepsy programs.
510 Prospective, Multicenter, International Outcomes Study of Deep Brain Stimulation for Essential Tremor
Authors: Deuschl Günther , Loret Griet , Kovacs Norbert , Estrada Marta Blázquez , Clement Frederik , Lee Jung Il , Schuurman P.R. , Chen Lilly , Jain Roshini 
Published: March 2023

INTRODUCTION:
Essential Tremor (ET) treatment is focused on medical management of motor symptoms and includes pharmacotherapy and ventral intermediate nucleus (VIM) thalamotomy, which is being largely replaced by thalamic Deep Brain Stimulation (DBS) as the surgical treatment of choice. DBS of the VIM thalamus is recommended as a therapeutic option for appropriate subjects with ET (Elble RJ., et al. Expert Rev Neurother. 2018).

METHODS:
This is a prospective, on-label, multi-center, international DBS outcomes study conducted at up to 50 implanting centers. All participants are implanted with a multiple-source, constant-current directional DBS system (Vercise, Boston Scientific). Subjects are followed for up to 3-years post implantation where their overall improvement in quality of life and ET symptoms are evaluated. Clinical endpoints evaluated at baseline and follow-up timepoints include: The Essential Tremor Rating Assessment Scale (TETRAS), Quality of Life in Essential Tremor Questionnaire (QUEST), Fahn-Tolosa-Marin Rating Scale (TRS), and Global Impression of Change. Adverse events also collected.

RESULTS:
To date, 18-implanted subjects with a mean disease duration of 15.1 ± 14.6-years and a baseline QUEST Summary Index score of 35.0 ± 12.4. At 6-months post-DBS, a clinically significant improvement in quality of life (∆ = 19.5-point change in QUEST SI score) was reported. In addition, a mean 9-hours of tremor reduction was noted (14-hours at Baseline, 6.9-hours at 6-months) in a typical day at 6-months. All subjects (100%) reported mild disability, and no subject reported moderate or marked disability (89% at baseline) as reported by TRS at 6 months.

CONCLUSIONS:
This work represents the first comprehensive, large scale collection of real-world outcomes and evaluation of safety and effectiveness of a multiple-source, constant-current DBS system capable of providing directionality for use in treatment of Essential Tremor.
524 Cytodifferentiation of Pituitary Tumors Influences Pathogenesis and Cavernous Sinus Invasion
Authors: Asmaro Karam Paul , Zhang Michael , Rodrigues Adrian , Mohyeldin Ahmed , Vigo Vera , Vogel Hannes , Born Donald , Katznelson Laurence , Fernandez-Miranda Juan Carlos 
Published: March 2023

INTRODUCTION:
Pituitary neuroendocrine tumors (PitNET) continue to offer unique challenges given their proximity to the cavernous sinus, whereby invasive behavior can dictate extent of resection and surgical outcome, especially in neuroendocrine-active tumors. Recent advances in surgical techniques have resulted in the development of transcavernous endonasal surgery for invasive tumors.

METHODS:
169 consecutive primary PitNET were analyzed, of which 45% were neuroendocrine-active. There were 64 PIT-1, 62 SF-1, 38 TPIT, and 5 none-staining PitNets. The gold standard for cavernous sinus invasion was based on histopathological examination of the cavernous sinus medial wall and intraoperative exploration of cavernous sinus compartments.

RESULTS:
Cavernous sinus disease was present in 33% of patients. PIT-1 tumors had a significantly higher predilection for cavernous sinus invasion, 53% versus 24% and 18% for TPIT and SF-1 tumors, respectively (OR 6.13, 95% CI 1.08-2.58; p<0.001). For Knosp 0-2 tumors, 44% of PIT-1 tumors had cavernous sinus invasion compared to 7% and 13% for TPIT and SF-1 tumors, respectively (p < 0.01). Utilizing the transcavernous approach, surgical biochemical remission rates for patients with acromegaly, hyperprolactinemia, and Cushing’s disease were 88%, 87%, and 94%, respectively. Granulation pattern of PIT-1 tumors, corticotroph functional status, and Crooke’s cell corticotroph morphology did not influence cavernous sinus invasion.

CONCLUSIONS:
Likelihood of cavernous sinus invasion differed by transcription factor expression; PIT-1 expressing somatotroph and lactotroph tumors had a higher predilection for invading the cavernous sinus compared to other tumor subtypes. This elucidates a unique cavernoinvasive behavior absent in cells from other lineages. Innovative surgical techniques, however, can mitigate tumor behavior and achieve robust, reproducible biochemical remission and gross total resection rates. These findings can have considerable implications on the surgical management and study of PitNET biology and behavior.
525 Diffuse Microglia Inflammation is Associated with Anti-Tumor Efficacy in Polio Virotherapy for Glioblastoma
Authors: Yang Yuanfan , Brown Michael , Zhang Gao , Stevenson Kevin , Mohme Malte , Kornahrens Reb , Bigner Darrell , Lopez Giselle , Gromeier Matthias 
Published: March 2023

INTRODUCTION:
Glioblastomas (GBM) harbor abundant inflammatory infiltrates with glioma-associated macrophages and microglia (GAMM) actively promoting tumor progression. Intratumor virotherapy with the highly attenuated rhino:poliovirus chimera, PVSRIPO, causes sublethal infection and activation of GAMM via the constitutively expressed human poliovirus receptor, CD155.

METHODS:
We optimized immune-competent CT2A murine glioblastoma models for blinded neuropathological analysis of therapy responses. Samples (n = 55) were collected in a time series after PVSRIPO or mock intratumor infusion for systemic review of histological features related to therapy. Immune cells were defined both by morphology and immunohistochemical (IHC) staining patterns. Multiplex IHC and RNA sequencing were performed to study the immune infiltrate and PD1/PD-L1 immune checkpoint expression. The role of the PD1:PD-L1 axis in restricting the antitumor efficacy of PVSRIPO was tested using survival studies.

RESULTS:
PVSRIPO treatment caused substantial, but transient tumor regression with intense engagement of the GAMM infiltrate. This was accompanied by diffuse microglia activation and inflammtion in the CNS surrounding the tumor, extending to the ipsilateral and even the contralateral hemispheres. PVSRIPO-instigated pervasive microglia activation occurred against a backdrop of sustained innate antiviral inflammation, associated with induction of the PD-L1 immune checkpoint on GAMM. Combining PVSRIPO with PD1/PD-L1 blockade led to more durable remissions in CT2A model.

CONCLUSIONS:
Our work implicates GAMM as active drivers of PVSRIPO induced antitumor inflammation and reveals profound and widespread neuroinflammatory activation of the CNS-resident myeloid compartment by PVSRIPO, which is closely associated with tumor regression.
551 Middle Meningeal Artery Embolization Embolic Agents – A Systematic Review & Meta-Analysis
Authors: Ellens Nathaniel R. , Schartz Derrek , Kohli Gurkirat S. , Rahmani Redi , Medha Akkipeddi Sajal , Mattingly Thomas , Bhalla Tarun , Bender Matthew T. 
Published: March 2023

INTRODUCTION:
Middle meningeal artery (MMA) embolization is increasing in popularity and is thought to lower the rate of subdural hematoma recurrence and need for surgical rescue. Multiple embolic agents have been utilized, but the most effective agent has not been identified.

METHODS:
Clinical outcomes of embolization using polyvinyl alcohol (PVA) with or without (+/-) coils, N-butyl cyanoacrylate (n-BCA) +/- coils, and Onyx alone were separately evaluated. Outcome measures were the need for surgical rescue and in hospital periprocedural complications.

RESULTS:
30 studies were identified with a total of 646 patients, with 449 receiving PVA +/- coils, 134 receiving n-BCA +/- coils, and 60 patients receiving onyx alone. Composite rates for need for surgical rescue following embolization were 4.6% (95% Confidence Interval: 2.5% to 6.7%) for PVA +/- coils, 3.7% (CI: 0.6% to 6.8%) for n-BCA +/- coils, and 9.0% (CI: 1.9% to 5.4%) for Onyx alone. However, meta-regression revealed no significant difference between n-BCA and PVA based embolization (P = 0.728), between n-BCA and Onyx alone (P = 0.177), nor between PVA based and Onyx (P = 0.323) concerning need for surgical rescue. In regard to periprocedural complication rates, there was a pooled composite rate of 1.5% (CI: 0.3% to 2.7%) for PVA +/- coils, 3.1% (CI: 0.2% to 6.1%) for n-BCA +/- coils, and 2.7% (CI: 0% to 6.7%) for Onyx embolization. Similarly, meta-regression indicated no significant difference between PVA and n-BCA based therapy (P = 0.318), between n-BCA and Onyx embolization (P = 0.869), nor between PVA based and Onyx (P = 0.574).

CONCLUSIONS:
Rates of periprocedural complications and need for surgical rescue following MMA embolization are not influenced by the type of embolic agent utilized.
557 Results of Microsurgical Clipping of Unruptured Anterior Communicating Artery Aneurysms (ACOMa) Using the Pretemporal Minimal Durotomy Approach
Authors: Adepoju Adedamola , Krisht Ali F. 
Published: March 2023

INTRODUCTION:
Recent reports suggest the superiority of microsurgical clipping of ACOMa compared to endovascular treatments. We present our experience with the pretemporal minimal durotomy (minimal brain exposure) approach in 168 patients.

METHODS:
Data of 168 patients were prospectively collected and retrospectively reviewed. The pretemporal approach with the removal of the posterior roof of the orbit and the anterior clinoid process with a minimized subfrontal durotomy allowed broad exposure to the ACOMa complex and minimal exposure to the surrounding brain. The technique allowed early proximal control and 360-degree visualization of the aneurysm and its surroundings.

RESULTS:
The average aneurysm size was 6.4 mm. Total clip occlusion was achieved in 100%, confirmed by intraoperative indocyanine green videography and post-operative computer tomography angiography/cerebral angiography. At discharge, 93.5% were modified Rankin Scale (mRS) 0-2, and 99.0% were mRS 0-2 at 1 year follow up. There was zero mortality, and one patient with a giant aneurysm had a stable residual on follow-up.

CONCLUSIONS:
Microsurgical clipping of ACOM aneurysms using the pretemporal minimal durotomy approach results in more durable outcomes than endovascular technique with excellent functional outcomes and should be strongly considered as a first treatment option, especially in aneurysms that have anatomic endovascular disadvantages that have a high likelihood of recurrence.
565 Delayed Rupture Risk of Persistently Filling Saccular ICA Aneurysms Following Flow Diversion with the Pipeline Embolization Device
Authors: Lee Ryan P. , Bhimreddy Meghana , Kim Jennifer E. , Wicks Robert Thomas , Xu Risheng , Bender Matthew T. , Jackson Christopher Mitchell , Gonzalez L. Fernando , Tamargo Rafael Jesus , Caplan Justin M. 
Published: March 2023

INTRODUCTION:
Flow diversion of intracranial aneurysms results in high occlusion rates. However, 10-20% of aneurysms remain persistently filling on one year angiography. Often, these are retreated, but risks and benefits of retreatment are not well established. Calculating benefit requires a better understanding of rupture risk of persistently filling flow diverted aneurysms, which is not sufficiently established.

METHODS:
Our single institution database of 1000 flow diversion cases was queried for persistently filling saccular aneurysms of the clinoidal, ophthalmic, and communicating segments of the internal carotid artery treated with Pipeline Embolization Device or Pipeline Flex. Persistent filling was defined as continued contrast flow into the aneurysm on catheter angiogram one year after treatment. The clinical record was queried for occurrences of retreatment and delayed subarachnoid hemorrhage. Only cases with at least two years of follow up were included.

RESULTS:
Ninety-four persistent aneurysms were identified. The average size was 6 mm. The branch vessel originated separately from the aneurysm in 55% of cases, from the body of the aneurysm in 10.6% of cases, and from the neck in 34% of cases. Eighteen percent of aneurysms demonstrated >95% filling at one year and 61% were filling 5-95% of their original size. Average follow up time was 4.9 years, including 23 cases with >5 years follow up. No retreatment was undertaken in 91.5% of aneurysms. There were no cases of delayed subarachnoid hemorrhage.

CONCLUSIONS:
In our cohort of saccular ICA aneurysms treated with Pipeline flow diversion that demonstrated persistent aneurysm filling at one year, there were no instances of delayed rupture during the study period. This data suggests that observation may be appropriate for continued aneurysm filling at least in the first several years following Pipeline placement.
569 Functional Recovery from Thalamic Intracerebral Hemorrhage Following Minimally Invasive Evacuation
Authors: Odland Ian , Ali Muhammad , Schuldt Braxton Riley , Downes Margaret , Vasan Vikram , Iruvanti Sushruta , Rossitto Christina P. , Kalagara Roshini , Chennareddy Susmita , Smith Colton James , Shigematsu Tomoyoshi , Mocco J. D. , Kellner Christopher Paul 
Published: March 2023

INTRODUCTION:
Intracerebral hemorrhage (ICH) carries a high risk of disability and death, with thalamic hemorrhages associated with the worst outcomes. A minimally invasive (MIS) approach is a promising option to reduce time-to-treatment and prevent further injury during ICH evacuation. The functional outcomes of thalamic ICH evacuation should be accounted for when considering patient eligibility for MIS Hemorrhage Evacuation.

METHODS:
Patients with spontaneous thalamic ICH who presented to a large healthcare system between December 2015 and December 2021 were triaged to a central hospital for MIS endoscopic or surgiscopic evacuation. Criteria for inclusion was age ≥18 years, hematoma volume ≥15 ml, National Institutes of Health Stroke Scale (NIHSS) score ≥6, premorbid mRS score ≤3, and time from ictus ≤72 hours.

RESULTS:
MIS evacuation was performed on 29 patients. 19 patients had hemorrhage confined to the thalamus, whereas 10 patients had hemorrhages extending into surrounding parenchymal structures. 25 patients (86%) had intraventricular hemorrhage. The average preoperative volume was 42.5 mL ± 33.7 mL and postoperative volume was 8.6 ± 11.3 mL indicating an evacuation rate of 78.0 ± 25.0%. One month after hemorrhage, two patients (6.9%) had expired. At 6-month, 6 patients (22.2%) had improved to a favorable outcome (mRS ≤ 3) with 2 patients lacking mRs outcome data.

CONCLUSIONS:
This study suggests that MIS evacuation can be safely performed in patients with thalamic hemorrhage. Moreover, it presents long-term functional outcomes to assist clinicians in determining treatment plans, and dictating randomization schemes or subgroup analyses for future comparison of MIS evacuation to standard hemorrhage evacuation.
623 Improving Access to Extracranial-Intracranial Bypass Surgery in Border Hispanic Communities Utilizing Collaborative Approach Between Plastics and Neurological Surgery
Authors: Wadekar Sonia , De La Garza Mauricio , Fernandez Patricia , Desai Sohum K. 
Published: March 2023

INTRODUCTION:
Hispanic patients such as those with Moyamoya disease are less likely to receive surgical revascularization therapy due to inequities in access (1). Our institution is a located in the Southern Texas-Mexico border region serving a largely Hispanic population. We previously referred patients for EC-IC bypass to other quaternary-care centers in Texas. While referrals were already challenging due to distance, mixed immigration status, and poor socioeconomic background of many patients; COVID-19 further exacerbated this problem with restriction of elective surgical volume.

METHODS:
A consecutive series of EC-IC bypasses performed by authors (SKD and MDLG) were retrospectively reviewed. Baseline clinical, perioperative radiographic, and post-operative outcomes were studied. All patients were offered option of a referral to a quaternary-care centers and also given local option for performing bypass surgery. Further, patients met preoperatively with both the plastic and neurological surgeon. Ultimately, decision was made by patient.

RESULTS:
A total of 6 craniotomies for EC-IC bypass were performed during the study period. The diagnoses included Moyamoya in 5 cases and symptomatic intracranial atherosclerosis in one. All patients were Hispanic, female, and nonsmokers with mean age of 35.6 years. Mean preoperative HBa1c was 7.9, preoperative LDL was 82, and mean preoperative hemoglobin was 11.3. Direct bypass was performed in 40% of cases. Mean OR time was 3 hours and 7 minutes.

CONCLUSIONS:
We have found collaboration between plastic and neurological surgery for surgical revascularization is feasible and improved access to care for Hispanic Moyamoya disease patients residing in a border community.

References

1) Chiu R, Chaker A, McGuire LS, et al. “Socioeconomic Inequities in the Surgical Management of Moyamoya Disease.” World Neurosurg. 2021 Nov; 155: e188-e195.
627 Trends and Patterns of Neurosurgery Influencers on Instagram: Increasing a Neurosurgeon's Social Media Footprint
Authors: Pando Alejandro , Gabriel Phabinly , Patel Aman , Talbot Christopher , Liu James K. 
Published: March 2023

INTRODUCTION:
Neurosurgery is a highly technical field and Instagram provides the dissemination of information to a large audience. Misleading information can potentially be harmful.

METHODS:
A social media tracking tool (Influencity, Madrid, Spain) was used to compile a list of the top neurosurgeon Instagram profiles based on number of followers, average interaction, and engagement obtained between May 2022 and June 2022. Profiles that were professional groups/societies/academic centers, not in the United States, had less than 1000 followers, and those not belonging to board-certified neurological surgeons were excluded. Individual posts were categorized as (1) clinical or professional, (2) lifestyle, or (3) patient-centered. Data such as number of followers, likes, comments, hashtags, caption words, user engagement, average user activity, interests, posts, and Instagram verification were collected and analyzed.

RESULTS:
A total of 84 neurological surgeon “influencer” Instagram profiles were identified. Of the most recent 30 posts for each influencer, clinical and professional posts made up 61.60%, lifestyle posts made up 29.41%, and patient posts made up 1.77%. The most frequent hashtags were #neurosurgery, #medicine, and #surgery. When comparing the 30 profiles with the most followers to the rest of the field, average interaction (437.13 vs. 136.44; p < 0.001), uploads (569.43 vs 199.65; p = 0.003), likes given in the top posts (791.16 vs 217.78; p < 0.001), and comments given in the top posts (32.67 vs 17.19; p = 0.03) were significantly higher in the top 30. Although the top 30 profiles had an average increased posts per week (2.15 vs. 1.34; p = 0.18) posts per month (8.06 vs. 4.87; p = 0.16), and lifestyle posts (3.9 vs. 2.83), those were not significant.

CONCLUSIONS:
Neurosurgeons may be able to increase their footprint and reach a wider audience by increasing their upload rate. Our analyses found that most neurosurgeons' posts are centered around clinical and professional interests.
647 Pain Prediction Using Digital Phenotyping Speech Data for Neurological Spine Disease Patients
Authors: Duey Akiro , Rana Aakanksha , Siddi Francesca , Hussein Helweh , Onnela J.P. , Smith Timothy R. 
Published: March 2023

INTRODUCTION:
Predicting pain-levels is integral for evaluating spine patients during pre- and post-surgical interventions. However, quantifying pain is challenging due to its complexities and subjective nature.

METHODS:
Patients with spine disease were enrolled from a general neurosurgical clinic. Data were collected both actively and passively, using an application installed into patient’s smartphones (Beiwe). Speech features including Pitch, Jitter, Shimmer, and HNR are extracted using the Parselmouth python library. We sought to predict pain levels using the K-Nearest-Neighbor (KNN) prediction model by correlating actively acquired speech recordings with the daily pain questionnaires (the visual analogue scale (VAS) was employed for rating) obtained through this application.

RESULTS:
A total of 60 patients were enrolled; with a mean age of 58.5 (S.D. 12.7), and 56.7% being females. We reported a mean pain score of 4.6 (S.D 2.7; range 0 to 10). A total of 384 daily observations were used to train and test the model. 80% of the total observations were used for training and 20% was used for testing. Using KNN prediction model, an accuracy of 68% with a mean precision of 0.69 was achieved in classifying pain intensity into low (VAS range 0 to 4) and high (VAS range 5 to 10). The model showed 0.71 and 0.69 precision, and a recall of 0.73 and 0.67 for high and low pain scores respectively. The overall F1-score was 0.68.

CONCLUSIONS:
The speech features obtained from a smartphone-based application showcases a good discriminative capacity for assessing the pain-levels in this cohort. Pain intensity was precisely quantified utilizing smart phone technology and ML, thus, overcoming the issue of objectivity that is considered an inherent flaw in the regularly used self-reporting pain scales.