bluuebunny/crossref_metadata_2025_split huggingface dataset:
648 Machine Learning Predicts Cavernous Sinus Invasion of Pituitary Adenomas
Authors: Nernekli Kerem , Asmaro Karam Paul , Zamarud Aroosa , Sozer Batuhan , Moon Ju Hyung , Fernandez-Miranda Juan Carlos , Yeom Kristen , Vigo Vera 
Published: March 2023

INTRODUCTION:
Cavernous sinus invasion (CSI) of pituitary adenoma can lead to incomplete resection, failure of endocrinological remission, and a higher tumor recurrence rate. Therefore, precise approaches toward CSI may help guide treatment strategies and patient counseling.

METHODS:
135 patients (median age = 50.14±15.56; 1.05:1 male to female ratio) with pathologically confirmed pituitary adenoma were retrospectively identified. High-resolution, coronal T1-contrast enhanced pituitary MR images were used. The study cohort was separated into training (n=101) and testing (n = 34) sets. Bounding box applied over the pituitary gland-cavernous sinus complex served to generate input image data. A 2D ResNet50V2 convolutional neural network was used as the base architecture for model development. Intraoperative inspection of the cavernous sinus and histopathologic analysis of the cavernous sinus medial wall served as ground truths for CSI.

RESULTS:
'The receiving operating characteristic (ROC) and precision-recall (PR) curves were used to assess model performance. The model's average area under (AU) ROC was 78.6% compared to Knosp AU ROC %64.7. The model AU PR curve was 82.7% compared to Knosp AU PR curve of 76.7%. The sensitivity and F1 score of the model were 71% and 0.73, respectively, compared to Knosp sensitivity and F1 scores of %35 and 0.50.

CONCLUSIONS:
Inherent challenges exist regarding the pre-operative evaluation of CSI of pituitary adenoma on MRI by human visual inspection alone. Our study demonstrates the potential for MRI-based machine learning analysis of CSI of pituitary adenomas. A future multi-site study that explores model generalizability could further examine the utility of AI integration in the clinical workflow.
669 Is Outpatient Spine Surgery at an Ambulatory Surgical Center Better Than at a Hospital? A MSSIC Study
Authors: Hamilton Travis Matthew , Mansour Tarek R. , Hadi Moustafa , Deshpande Nachiket , Shultz Lonni , Springer Kylie , Hu Jianhui , Nerenz David , Zakko Philip , Khalil Jad , Park Daniel , Easton Richard , Perez-Cruet Mick J. , Taliaferro Kevin , Abdulhak Muwaffak , Schwalb Jason M. , Park Paul , Chang Victor W. 
Published: March 2023

INTRODUCTION:
The number of outpatient surgeries have quadrupled over the past several decades. Although studies have shown increased efficacy and cost-effectiveness of surgery done in an outpatient setting, few studies have compared outpatient surgeries performed at a hospital versus an ambulatory surgery facility (ASF)

METHODS:
The Michigan Spine Surgery Improvement Collaborative was queried for patients undergoing cervical and/or lumbar spine surgery between 1/1/2021 to 12/31/2021 performed at an ASF or hospital with same day discharge. A 4-to-1 propensity score matching using BMI, location (lumbar, cervical), ASA > 2, fusion procedure and number of levels as the matching variables for lumbar and cervical surgeries. Primary outcomes included: achieving MCID for PROMIS physical function, EQ-5D, Return-to-Work and NASS patient satisfaction. Complications were a secondary outcome and included: Surgical site Infection (SSI), urinary retention, hospital readmission/ED visit, return-to-OR, Axial pain, new radicular findings, weakness, Ileus (lumbar only), and Dysphagia (cervical only).

RESULTS:
A total of 2,763 patients were identified prior to matching. Of the 1,665 patients that were matched, 1,332 had surgery at a hospital and 333 in an ASF. There were no statistically significant differences for patient satisfaction, PROMIS-PF MCID, or Return-to-Work at 90-days. Patients who had surgery at an ASF had higher rates of axial pain (10% vs 5%, p = 0.002) and new radicular findings(19% vs 12%, p < .001) compared to surgery at a hospital. Dysphagia was also higher in the ASF group (5% vs 0%, p = .006). There were no differences in SSI, readmission, urinary retention, return-to-OR or ED visits between sites

CONCLUSIONS:
Outpatient spine surgery at an ASF demonstrated no significantly increased surgical morbidity compared to hospitals. Although ASFs had a higher rate of new radicular findings and axial pain, there were no differences in patient satisfaction and PROs after surgery.
671 Examining Degenerative Disease Adjacent to Lumbosacral Transitional Vertebrae: A Retrospective Cohort Study
Authors: Desai Ansh , McGrath Kyle , Schmidt Eric , Lee Jonathan , Statsevych Volodymyr , Steinmetz Michael P. 
Published: March 2023

INTRODUCTION:
Bertolotti syndrome is a clinical diagnosis given to patients with lower back pain arising from a lumbosacral transitional vertebra (LSTV). LSTVs cause altered biomechanics at the lumbosacral junction and adjacent segments, predisposing these patients to degenerative disease. Signs of degenerative disease can manifest on magnetic resonance imaging (MRI) as signal changes in the intervertebral discs and facet joints, as well as spinal stenosis and spondylolisthesis, all of which may contribute to a patient’s symptoms.

METHODS:
This is a retrospective analysis of patients with Bertolotti syndrome and anatomically normal controls who received care at a single institution between 2010 and 2020. The control group consisted of patients presenting with lower back pain without an LSTV. Patients with a history of prior trauma, laminectomy, or fusion were excluded. Degree of spinal stenosis and spondylolisthesis, as well as signs of degenerative changes in the intervertebral disc and facet joints, were assessed using sagittal and axial magnetic resonance grading criteria established in prior literature.

RESULTS:
A total of 173 patients were included in the study, 104 with Bertolotti syndrome and 69 controls. On two-tailed t-test, mean L4-L5 spinal stenosis grade was shown to be significantly different between patients with Bertolotti syndrome (1.00) and control patients (1.47) (p = .002). The difference in mean L4-L5 facet grade (p = .32), mean L4-L5 spondylolisthesis grade (p = .13), and mean L4-L5 disk grade (p=.33) were not significantly different on two-tailed t-test (p = .32).

CONCLUSIONS:
Patients with Bertolotti Syndrome may be more likely to develop spinal stenosis above the lumbosacral junction than patients without an LSTV. More research needs to be done to determine whether Bertolotti Syndrome patients are at an increased risk to develop clinically-significant lumbar spondylosis.
680 Lower Preoperative Hounsfield Units Predict Distal Junctional Kyphosis After Posterior Cervical Decompression and Fusion
Authors: Caruso James , Adenwalla Ammar , Sundarrajan Chandrasekhar , Van Hal Michael , Morrill Kevin C. , Tamimi Mazin Al , Bagley Carlos Antonio , Aoun Salah Ghassan 
Published: March 2023

INTRODUCTION:
Low bone mineral density (BMD) may predispose patients to structural and adjacent segment complications after spine surgery. While dual energy X-ray absorptiometry (DEXA) remains the gold standard for BMD quantification, it is rarely performed on a routine basis prior to cervical fusion. Alternatively, vertebral body Hounsfield Units (HU) may provide useful and convenient estimates on BMD. However, minimal evidence exists to evaluate the value of HU in predicting postoperative complications after cervical fusion.

METHODS:
A retrospective, single-institution analysis was conducted, focusing on patients who underwent PCDF without a history of cervical spine surgery. Preoperative vertebral body HU were measured at each level of the cervical spine, and demographic, clinical, and postoperative complication data were recorded.

RESULTS:
166 patients were eligible for inclusion (mean age 66 ± 12 years), with an average follow-up time of 13.5 months. In a multivariate logistic regression analysis, controlling for age, gender, and construct length, lower HU at the superior instrumented level were associated with increased rates of distal junctional kyphosis (p = 0.042, AUC = 0.86). Additionally, lower HU at the superior adjacent level were associated with increased rates of revision surgery (p = 0.016, AUC > 0.99).

CONCLUSIONS:
Preoperative cervical HU offer valuable insight in anticipating structural complications after PCDF, and HU may be useful for identifying patients who require preoperative BMD optimization.
802 The Predictive Role of Initial Brain Imaging on Seizure Development in Pediatric Traumatic Brain Injury
Authors: Sciscent Bao Y. , Bailey David , Chand Daggubati Lekhaj , Hallan David , King Steven , Trifoi Mara , Rizk Elias Boulos 
Published: March 2023

INTRODUCTION:
Pediatric traumatic brain injury (TBI) poses risk for early post-traumatic seizures (EPTS). Antiepileptic drugs are often prescribed prophylactically, though limited evidence exists regarding their effectiveness in pediatric TBI. Neuroimaging has been predictive of EPTS in adult TBI, but this is not well studied in children. Given the heterogeneous nature of TBIs, injury type and location may serve as predictors of seizure development.

METHODS:
This is a single-center retrospective analysis of 348 pediatric patients with TBI from January 2011 to June 2021 treated with levetiracetam. Factors analyzed include age, sex, GCS, dosage and date of levetiracetam administration, presence of seizures, medical and surgical management, and findings on CT imaging. The primary outcome was the prevalence of seizures within 7 days of injury.

RESULTS:
On multivariate analysis, the risk of having seizures any time within 7 days of injury was decreased in children with contusions (OR .425 [.205-.880], p = 0.021), simple skull fractures (OR .226 [.079-.648], p = 0.006), and complex skull fractures (OR .370 [.175-.784], p = 0.009). Findings of SDH, traumatic SAH, and pneumocephalus did not significantly increase the risk of EPTS. On univariate analysis of patients who developed seizures after levetiracetam, the only significant imaging factor for EPTS was SDH (OR 4.398 [1.447-13.370], p = 0.009). On multivariate analysis, no imaging characteristics were predictive of EPTS, but older children had a decreased risk of EPTS (1-2 yo OR .095 [.016-.560], p = 0.009; 3-18 yo; OR .006 [0-.132], p = 0.001) despite levetiracetam prophylaxis.

CONCLUSIONS:
This study demonstrates that regardless of initial neuroimaging, younger age is associated with an increased risk of seizures despite prophylaxis. Further studies are needed to determine the predictive value of imaging characteristics in developing EPTS in pediatric TBI patients.
804 The Association Between Hyperoxia after TBI and Degree of Disability in Pediatric Patients
Authors: Tang Si Jie , Mor Sirjan , Fine Jeffrey , Shahlaie Kiarash 
Published: March 2023

INTRODUCTION:
Traumatic brain injury (TBI) is a leading cause of death and disability in children worldwide. Hyperoxia has been suggested as a mechanism of secondary injury following adult TBI, but its effect on pediatric patients has not been well-described.

METHODS:
We conducted a review of all pediatric (≤18yo) TBI patients in a prospective institutional registry from October 2008 to January 2021. PaO2 was extracted from the arterial blood gas report for the first 24 hours after admission to the ICU. The first PaO2, highest PaO2 and the AUC calculation of PaO2 were collected and calculated for each patient. Outcomes 6 months after injury were measured using the modified Rankin Scale (mRS) and dichotomized as favorable (1-2) or unfavorable (3-6). A multivariable logistic regression model was used to determine if minimum PaO2, maximum PaO2, or AUC PaO2, predicted an unfavorable outcome.

RESULTS:
We identified 122 pediatric patients with severe TBI (GCS 3 – 8) during the study period. The incidence of hyperoxia (PaO2 >300 mmHg) was 25%. Elevated PaO2 values, determined by both maximum and AUC PaO2 within the first 24 hours of hospitalization, was an independent predictor of worse neurological outcome at 6 months.

CONCLUSIONS:
Using an institutional database, hyperoxia was an independent predictor of poor neurological outcome in pediatric patients. Further studies are needed to determine if efforts to prevent and/or correct hyperoxia are associated with improved outcomes.
836 Factors Associated With Non-Routine Discharge Following Spinal Cord Stimulator Insertion Surgery
Authors: Nathani Karim , Bhandarkar Archis R. , Jarrah Ryan , Bydon Mohamad 
Published: March 2023

INTRODUCTION:
Neuropathic pain can lead to functional impairment and psychological stress in the patients. Spinal cord stimulation offers pain alleviation that can lead to improvement in quality of life and functionality.

METHODS:
The national inpatient sample (NIS) 2016-2019 was used to identify patients undergoing surgery for spinal cord stimulator (SCS) insertion. The patients were divided based on their discharge disposition to either routine or non-routine discharge groups.

RESULTS:
A total of 1786 patients, with a mean age of 60.0 (14.0) years and 1031 (57.7%) females, were enrolled in the study. The non-routine discharge group comprised 462 (25.9%) patients that were not discharged to home or self-care. The univariate analysis observed a higher risk for nonroutine discharge following SCS insertion to be associated with higher age (64.3 vs. 58.5 years, p < 0.01), female sex (64.3% vs. 55.4%, p<0.01), insurance type (p<0.01), and postoperative complications (2.6% vs. 0.7, p < 0.01). On the multivariate regression model, a significant association of nonroutine discharge was observed for age (OR: 1.02 (1.01 – 1.03), p < 0.01), female sex (OR: 1.44 (1.14 - 1.81), p < 0.01), Hispanic race (OR: 1.85 (1.27 - 2.69), p < 0.01), Medicare insurance (OR: 1.71 (1.26 - 2.32), p < 0.01), and postoperative complication (OR: 3.50 (1.43 - 8.53), p < 0.01).

CONCLUSIONS:
The study found that non-routine discharge following SCS insertion was independently associated with higher age, female sex, Hispanic race, medicare insurance coverage, and postoperative complications.
839 Beta-Band Power Modulation in the Human Amygdala During a Go/No-Go Reaching Task
Authors: Chung Ryan , Martin del Campo-Vera Roberto , Gilbert Zachary , Tang Austin M. , Cavaleri Jonathan , Leonor Andrea , Shao Arthur , Tabarsi Emiliano , Sundaram Shivani , Kammen Alexandra , Gogia Angad S. , Liu Charles Y. , Kellis Spencer , Lee Brian 
Published: March 2023

INTRODUCTION:
The role of the amygdala in motor control is a developing area of investigation. Although classically known for its involvement in emotional processing, the amygdala has also been associated with modulating motor processing. For example, increases in the gamma frequency band (30-200 Hz) have been observed during volitional movements. However, the underlying neural mechanisms of amygdaloid motor movement and inhibition are not well-understood.

METHODS:
Nine patients with drug resistant epilepsy underwent implantation with stereoelectroencephalographic (SEEG) depth electrodes for seizure monitoring in the amygdala (5 bilaterally, 2 left unilaterally, and 2 right unilaterally). SEEG data were sampled throughout discrete phases of a Go/No-Go task (ITI, Fixation, Go/No-Go response), which required participants to touch a target or inhibit movement based on a colored cue. A Wilcoxon signed-rank hypothesis test was used to assess significant modulations of beta-band power between the response and fixation (baseline) phases of the task.

RESULTS:
In the Go condition, six out of seven patients with electrodes in the right amygdala had a significant decrease in beta-band power (p < 0.0479), and four out of seven in the left amygdala (p < 0.049). During the No-Go condition, seven out of seven patients with electrodes in the right amygdala displayed statistically significant increases of beta-band power when compared to the baseline period (p < 0.0451), and four out of seven in the left amygdala (p < 0.0137).

CONCLUSIONS:
This study reports beta-band power modulation in the human amygdala during voluntary movement in the setting of motor execution versus inhibition. This finding adds to previous studies in other brain areas that have linked beta-band power to motor control. The presence of beta-band power modulation in No-Go conditions suggests that the beta-band potentially plays a role in amygdaloid motor inhibition.
877 EZH2 Inhibition Decreases SMARCB1 and NF2 Mutant Meningioma Cell Viability
Authors: Clark Victoria Elizabeth , Young Richard 
Published: March 2023

INTRODUCTION:
The majority of sporadic and familial forms of meningiomas bear mutations in NF2. A subset of NF2 mutant meningiomas are co-mutant for SMARCB1, which encodes the SWI/SNF complex core subunit BAF47, grow in the midline/parafalcine region, and confer risk for atypia. SMARCB1/NF2 meningiomas and WHO Grade II NF2 meningiomas have demonstrated PRC2/EZH2 hyperactivity by ChIPseq analysis, providing a rationale for EZH2 inhibition for these aggressive tumors.

METHODS:
Pharmacologic growth inhibition experiments were conducted in a SMARCB1/NF2 co-mutant meningioma cell line (BEN-MEN-1), an NF2 mutant/SMARCB1 wildtype meningioma cell line (MN1-LF), and a control wildtype arachnoid cell line (A2). Tazemetostat was administered in triplicate at 9 dosages (ranging from 1.5 uM to 10 mM) over 14 days. Cell viability was calculated via luminescent-based assay and normalized to DMSO-treated cells.

RESULTS:
After 14 days of tazemetostat treatment, SMARCB1/NF2 mutant cells showed a significantly decreased viability compared to control arachnoid cells (26.87% viability for SMARCB1 mutant vs 87.80% viability for arachnoid cells; p = 0.0047). NF2 mutant meningioma cells also had significantly decreased viability (48.84% vs 87.80%, p = 0.0102). The calculated IC50 for tazemetostat is 3.098 mM for SMARCB1/NF2 mutant cells, 6.263 mM for NF2 mutant cells, and was estimated to be 43.98 mM in control arachnoid cells using nonlinear regression.

CONCLUSIONS:
Tazemetostat decreases viability for both SMARCB1/NF2 and NF2 mutant meningioma cells. This represents a novel pharmacologic target for the majority of meningiomas, and may obviate the need for repeat surgery for recurrent tumors or serve as a suppressant agent for patients with neurofibromatosis type II.
878 Development of a Near Infrared Somatostatin Receptor Type 2 (SSTR2)-Targeted Probe for Fluorescence-Guided Surgery in Meningiomas
Authors: Fürtjes Gina , Weitzenberg Merle , Rolbieski Hannes , Arús Bernardo , Mawrin Christian , Goldbrunner Roland , Plettenburg Oliver , Bruns Oliver , Neuschmelting Volker 
Published: March 2023

INTRODUCTION:
Meningioma frequently recur at the primary resection site requiring improvement in the intraoperative tumor visualization and surgical technique. To guide the resection, this study aims to develop a highly specific and sensitive optical method for intraoperative meningioma imaging. By suitable cameras fluorescent dyes in the near infrared (NIR, 700-1000nm) can be detected up to few millimeters in depth in real time.

METHODS:
We invented a SSTR2 targeting probe by linking a somatostatin analogue (TATE, Tyr(3)Thr(8)-Octreotid) to a new developed dye (sNIR). In the optical characterization, our probe showed similarities to indocyanine green and stability as well as bleaching kinetic were investigated in vitro. The probe was intravenously injected in native mice and detected by a custom-built camera setup to evaluate pharmacokinetics and biodistribution, focusing on physiologically SSTR2 overexpressing organs that were validated by immunohistochemistry (IHC). As proof-of-principle, fluorescence-guided meningioma resection was performed in an ectopic and orthotopic IOMM-Lee mouse model.

RESULTS:
Our probe is stable in aqueous solution up to 12h with favorable optical properties regarding pharmacokinetics, biodistribution and photostability compared to its IRDye800 analogue. In vivo, we observed a highly specific signal uptake in the gastric epithelium, pancreas and pituitary (all are overexpressing SSTR2) compared to autofluorescence and negative controls. Given the intermediate SSTR2 expression in the meningioma mouse model, we could still detect a mean tumor-to-brain ratio of 6.12 (n = 5; SD 1.8) allowing the fluorescence-guidance to be feasible.

CONCLUSIONS:
Our preclinical results indicate that the new SSTR2-targeted fluorescent probe is stable in various media over time and capable of specifically targeting the SSTR2 in vitro and in vivo potentially enabling sensitive and specific meningioma fluorescent-guided surgery in the future.
884 Frailty and Socioeconomic Status Predict Outcome in Newly Diagnosed Glioblastoma Patients
Authors: Mirpuri Pranav , Singh Maharaj , Rovin Richard A. 
Published: March 2023

INTRODUCTION:
Identification of molecular markers of glioblastoma (GBM) prognosis has not often led to meaningful intervention. Individual patient and socioeconomic factors are underexplored prognostic factors. Frailty, a measure of physiological vulnerability, and area deprivation, a measure of socioeconomic status, are easily obtained during the preoperative evaluation. Moreover, both are amenable to intervention; the medical conditions that contribute to frailty can be optimized prior to surgery, while barriers to health care (physical, financial, and cultural) can be addressed for patients at risk socioeconomically.

METHODS:
This is a retrospective review of patients with newly diagnosed GBM undergoing surgery from 2015 through 2020. Demographic and tumor specific data were recorded. Additionally, the 5-factor modified frailty index (mFI-5) and national area deprivation index (ADI) were determined for each patient.

RESULTS:
There were 244 patients. Compared to patients in the “some or no” frailty category, patients with “significant” frailty had a shorter median survival: 273 days (95% CI 126-339) vs 393 days (95% CI 317-458), p = 0.008. The median survival for patients living in the most disadvantaged neighborhoods, 210 days (95% CI 134-334), is significantly lower than for those living in the least, 384 days (95% CI 239-484), p = 0.17. Twenty-five percent of patients living in the most disadvantaged neighborhoods did not receive postoperative chemoradiation compared to 11% of patients in the least disadvantaged neighborhoods, p=0.046. Similarly, patients of color were less likely to receive standard of care chemoradiation than white patients.

CONCLUSIONS:
Both increasing frailty and neighborhood disadvantage are associated with worse outcome in newly diagnosed GBM patients undergoing surgery. Patients living in the most deprived neighborhoods and patients of color are less likely to receive postoperative chemoradiation. Identification of non-traditional predictors of treatment and outcome will lead to mitigation strategies.