bluuebunny/crossref_metadata_2025_split huggingface dataset:
417 An Athlete-Oriented Holistic Coaching Program Targeting Performance and Wellbeing in Neurosurgery Residents
Authors: Schupper Alexander J. , Carr Matthew , Philbrick Brandon , Chennareddy Susmita , Kalagara Roshini , Turner Dan , Kellner Christopher P. 
Published: March 2023

INTRODUCTION:
Neurosurgery residency is a demanding environment, requiring high levels of performance endured over long periods of time. As a result, neurosurgery residency has been associated with significant rates of fatigue, depression, and physician burnout. To address this, the authors instituted a program within the residency, entitled the “Performance Protection Program,” consisting of a personalized program based on principles used with world-class extreme sports athletes designed for residents to achieve sustainably high levels of performance.

METHODS:
A 12-month coaching program was instituted by a performance coach within a single neurosurgery residency program. Residents attended individual and team-based monthly meetings, engaged in offsite team outings, and completed interactive reflective questions. The program focused on several pillars of performance excellence including mental, emotional, social, physical and physiological domains.

RESULTS:
Residents engaged in a total of 19 team sessions, 3 team outings, and over 87 individual sessions by mobile device or in-person during which they strategized with the coach on topics including: productivity, communication, regulating emotions under pressure, in-hospital nutrition, meal preparation, efficiency, accountability, posture and strength, job interviewing, confidence, visualization skills, and team leadership dynamics. By demand, a bi-weekly posture and mobility session was incorporated into the program. Early feedback demonstrated a need for adaptive strategies personalized to the resident’s stage of training and life. Most residents expressed need for improvement in nutrition, physical wellness, and communication under fatigue.

CONCLUSIONS:
Neurosurgery residency is stress-provoking and arduous for trainees. To optimize resident performance while minimizing burnout, a curriculum based on principles in extreme sports was successfully enacted over a 12-month period. Other training programs may utilize similar interventions to promote resident well-being and improve mental and physiological states.
424 Evaluating the Impact of Effective Neurosurgical Educators on Resident Operative Progression Using the Surgical Autonomy Program
Authors: Suarez Alexander , Venkatraman Vishal , Kirsch Elayna P. , McDaniel Kate , Dharmapurikar Rajeev , Lad Nandan P. , Haglund Michael M. 
Published: March 2023

INTRODUCTION:
Surgical education remains a core goal of all neurosurgical programs, however limited research exists on the impact of highly effective educators vs. less effective educators on trainee progression1.

METHODS:
The SAP breaks a surgical case into four zones of proximal development (ZPD). For each ZPD, residents are evaluated on a 4-tier autonomy scale (“stages) (TAGS scale: T: Teach/Demonstrate, A: Advise/Scaffold, G: Guide/Monitor, S: Solo/Observe) in a surgical case. All neurosurgery residents at Duke University Hospital from July 2017-July 2021 participated in this study. Trainee autonomy was rated by both attendings and residents, and resident progression was defined as the difference in a resident’s autonomy for a case compared to the resident’s prior comparable case. Relative Value Units (RVUs) were utilized to correct for difficulty of an index case. Faculty were divided into performance quartiles (top – “strong educators”, bottom – “poor educators”).

RESULTS:
There were a total of 3993 cases logged by 28 different residents and 27 attendings. Resident progression was significantly higher with strong educators compared to poor educators, both when evaluated by the attending (+1 stage vs. -1 stage, p = .002) and by the resident (+1 vs. -0.5 stage, p = .001). Resident regression was noted in the poor educator cohort. Differences in resident progression remained when accounting for difficulty of cases (resident self-evaluation, p < .0001; attending evaluation, p = .002).

CONCLUSIONS:
Differences exist in the quality of neurosurgical educators. Strong educators compared to poor educators make a demonstrable difference in resident surgical progression. Poor educators are associated with resident autonomy regression. Moving forward, the SAP will be used to provide faculty feedback on the quality of their surgical instruction.
433 Trajectory-based Classification of Recovery Potential in Mild Degenerative Cervical Myelopathy: Analysis of a Prospective Multicentre Dataset of 1047 Patients
Authors: Moghaddamjou Ali , Bak Alex , Badhiwala Jetan H. , Wilson Jefferson R. , Fehlings Michael G. 
Published: March 2023

INTRODUCTION:
Degenerative Cervical Myelopathy (DCM) is the leading cause of disability secondary to a spinal pathology in adults. There exists clinical equipoise between surgery and conservative management with monitoring for patients with mild DCM.

METHODS:
A harmonized dataset was developed from the AOSpine North America, AOSpine International datasets as well as the CSM-Protect trial (N:1047). DCM patients (mJOA ≥15) were selected from the harmonized dataset. Latent class trajectory modeling was applied to classify patients into distinct trajectories. The optimal number of trajectories were chosen based on i) least Bayesian Information Criterion; ii) posterior probability >0.70; iii) odds of correct classification >5; and concordance between the estimated and actual proportion of patients assigned to a class. Predictors of recovery trajectories were identified using descriptive statistics and logistic regression on baseline variables.

RESULTS:
Two distinct recovery trajectories were revealed from our analysis. Good recovery trajectory had patients that improved to near-maximal mJOA scores within 12 months. Functional decline trajectory was characterized by a decline in more than two mJOA points over 12 months. There were 33 patients (15.6%) that followed functional decline and 179 that showed good recovery (84.4%). Demographic factors associated with following a functional decline trajectory included older age, hypertension, and higher baseline Nurick score. Posterior laminectomy and fusion was associated with functional decline compared to anterior fixation.

CONCLUSIONS:
Mild DCM can be classified into one of two distinct subpopulations with different recovery trajectories. This study lends support to the heterogeneity of mild DCM and classifying the clinical course of mild DCM based on defined clinical phenotypes rather than baseline severity of myelopathy alone. We also discovered that anterior surgery is associated with better neurological recovery in the context of mild DCM patients.
435 Non-smokers and Smokers Undergoing Decompression for Lumbar Spinal Stenosis and Lumbar Disc Herniation Experience Similar Clinical Improvement at 12 Months
Authors: Owens Kirk , Carreon Leah , Gum Jeffrey Lynn , Randy Bisson Erica Fay , Djurasovic Mladen , Bydon Mohamad , Glassman Steven D. 
Published: March 2023

INTRODUCTION:
Smoking has been shown to be detrimental on patient reported outcomes (PROs) and fusion with lumbar arthrodesis. Evidence is unclear whether smoking affects PROs in patients undergoing decompression only.

METHODS:
Patients who underwent 1 or 2-level decompression only for LDH or LSS enrolled in QOD were identified. Demographics, surgical variables, smoking status and PROs at baseline and 12 months postoperatively were collected.

RESULTS:
3038 Smokers and 14,233 Nonsmokers met inclusion criteria. Smokers were younger (50.3 vs 56.7, p<0.000), had worse ASA grades (2.3 vs 2.2, p<0.000) and had more males (1663, 55% vs 7130, 50%, p<0.000) compared to Nonsmokers. Number of surgical levels was similar between groups (1.7, p = 0.169). For all PROs, both Smokers and Nonsmokers improved following surgery. Preoperative PROs in Smokers were worse (p<0.000) for BP (7.0 vs 6.1), LP (7.4 vs 6.9), ODI (52.2 vs 45.9) and EQ-5D (0.5 vs 0.6). PRO improvement in Smokers was less than in Nonsmokers at 12-months (p<0.001), but may be clinically irrelevant: BP (3.2 vs 3.3), LP (4.3 vs 4.6), ODI (25.0 vs 26.8) and EQ-5D (0.24 vs 0.26). Only 60 LSS and 38 LDH cases could be propensity matched, with no significant differences in improvements in PROs in the LSS group (ΔBP:3.2 vs 3.5, p = 0.577; ΔLP:3.3 vs 4.5, p = 0.097; ΔODI:18.1 vs 23.5, p = 0.155; ΔEQ5D: 0.2 vs 0.2, p = 0.948) or in the LDH group (ΔBP:3.1 vs 3.7, p = 0.530; ΔLP:3.7 vs 5.3, p = 0.050; ΔODI:24.6 vs 28.6, p = 0.463; ΔEQ5D: 0.2 vs 0.3, p = 0.301).

CONCLUSIONS:
Although Nonsmokers demonstrated greater improvement in all PROs, these differences were small and less evident in a propensity-matched sub-analysis. Compared to fusion surgery, both smokers and non-smokers treated with decompression only for LDH or LSS exhibit significant clinical improvement in PROs.
445 Evaluation of Low Dose Intrathecal Morphine Delivery in the Treatment of Chronic Pain
Authors: Jalal Muhammad Ibrahim , Jalal Muhammad , Jalaluddin Muhammad 
Published: March 2023

INTRODUCTION:
The use of low-dose intrathecal morphine via a morphine drug delivery system is an alternative to oral analgesics in the treatment of chronic pain.

METHODS:
This was a retrospective chart-review. Patients were enrolled from June 2016 to April 2019. An out-patient intrathecal morphine trial was performed by injecting a single dose of 0.1-0.2 mg of preservative-free morphine in the lumbar intrathecal space. Following at least 60% reduction in pain, patients were weaned off oral analgesics completely over several weeks, and a permanent intrathecal catheter and morphine pump was implanted. Follow-up data was included at 3 and 6 months and 1 and 3 years.

RESULTS:
20 patients were enrolled (median age 59, 60% female). 10 patients were diagnosed with CPS and 10 were diagnosed with PLS. Pain was significantly controlled and reduced at each time point post-implantation compared to baseline. (p < 0.05). Intrathecal dosing did increase over the 3-year period on average, but the increase in dose was moderate. (p < 0.01) (median increase: 0.09 mg/day over 3 years).All patients were on oral medication for their pain prior to implantation as summarized: Remarkably, no patients previously taking oral opiates/analgesics restarted oral opiate/analgesic therapy following implantation up to and including the 3 years follow-up. There were no infections or complications present in the study.

CONCLUSIONS:
Low dose intrathecal drug delivery was shown to significantly reduce pain following treatment at each follow-up time point. This study further characterizes the efficacy of the use of low-dose intrathecal drug delivery in the treatment of chronic pain. A future multi-center study is desired.
448 Analysis of Bipolar Re-Referencing on Spectral Composition and Spike Detection in Human Electrocorticography
Authors: Caldwell David , Krish Devon , Chang Edward , Kleen Jonathan 
Published: March 2023

INTRODUCTION:
Electrocorticography (ECoG) enables the localization of epileptic seizure foci prior to surgical resection. Improving the signal-to-noise ratio is paramount, and can be accomplished with bipolar re-referencing.

METHODS:
Intracranial recordings for drug-resistant epilepsy were performed at UCSF using high-density ECoG grid (4 mm inter-electrode pitch), strip (10 mm), and penetrating depth (5 mm) electrodes. Raw voltages for each participant (n = 11) were systematically re-referenced (bipolar subtraction) at increasing scales (4 mm-50 mm) and a multi-taper power spectrum (2-200 Hz) was generated around spike-free baseline windows. Cluster based permutation tests (p < 0.05) were used to compare spectral composition features after z-scoring log power features by frequency and binning by bipolar distance. High-density and low-density (4mm vs 8mm) re-referencing schemes were used for spike localization by applying a line length transform to highlight epileptiform features in peri-spike windows and comparing to baseline windows using cluster-based permutation tests.

RESULTS:
Bipolar pair distances <10 mm decreased low-frequency (<30 Hz) power, whereas both low and high frequency (30-200 Hz) power increased by longer bipolar distances. These findings were consistent across different components (grids, strips, depths). The detection of high gamma (50-200 Hz) neural activity in the STG related to an audio stimulus was enhanced at bipolar distances of <45 mm but attenuated at higher distances. Similar spike detection (duration and number of channels involved) was seen between high- vs. low-density bipolar re-referencing.

CONCLUSIONS:
Re-referencing at <10 mm bipolar distance preferentially attenuated low-frequency signal while standard clinical and larger distances systematically augmented broadband (2-200 Hz) signals. Shorter distances, especially high-density, augmented spatial delineation of neural activity when compared to more widely spaced arrays, however, standard clinical arrays capture the general spatio-temporal extent of spike waveforms.
452 Booting Up the Brain: Intracranial Electroencephalography Reveals Cognitive Network Dynamics During Anesthesia Emergence
Authors: Purger David Arnold , Eagleman Sarah , Arikan Lara , Reid Brandon , Kaboodvand Neda , Halpern Casey H. , Drover David , Razavi Babak , Meador Kimford , Buch Vivek 
Published: March 2023

INTRODUCTION:
The dynamic interplay between several large-scale brain networks is thought to underlie human consciousness. The default mode network (DMN) governs internal thought during rest, the central executive network (CEN) drives goal-directed problem solving, and the salience network (SN) detects and integrates new stimuli during the transition between resting and cognitively active states. While scalp electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) have elucidated much about these networks in steady states, intracranial EEG (iEEG) dynamics during state transitions remain largely unclear.

METHODS:
Seven patients with medically refractory epilepsy underwent robot-assisted stereotactic placement of depth electrodes for epileptic focus localization. Recordings from 422 total iEEG contacts representing 49 distinct cognitive network nodes were obtained during anesthesia emergence. Local-field dynamics and Observer’s Assessment of Alertness/Sedation (OAAS) scale state were analyzed in 20s clips for complexity, functional connectivity (FC), and graph communicability metrics.

RESULTS:
Signal complexity as represented by mean multiscale sample entropy (MSE) of SN and DMN nodes increases significantly during emergence from anesthesia (P < 0.05), driven by a shift from low- to mid-frequency power in key nodes. Intermediate consciousness states demonstrated higher mean MSE and participation coefficient, representing early integrative network behavior, before reaching an optimal balance of segregation and integration at wakefulness. During emergence, between-network FC increased most strongly between SN and CEN nodes. Communicability of SN nodes increased during emergence, driven predominately by increasing communicability of right anterior insula.

CONCLUSIONS:
Intracranial electroencephalographic recording of brain activity during anesthesia emergence demonstrates a complex but quantifiable interplay of default mode, central executive, and salience network hubs. There may be a greater than previously understood role of right anterior insula in gating transitions in consciousness states.
454 Effects of Human Brain Organoid Age on Post-Transplant Growth in the Rat Motor Cortex
Authors: Blue Rachel , Fu Marissa , Harary Paul , Jgamadze Dennis , Rahaman Imon , Singh Shikha , Ming Guo-Li , Song Hongjun , Chen H. Isaac 
Published: March 2023

INTRODUCTION:
Human brain organoids have potential to be used as a substrate for brain repair following injury, however the factors affecting survival and integration of transplanted organoids are unknown. We hypothesized that organoids transplanted at an earlier time point would result in improved survival and integration into the motor cortex because of their greater growth potential.

METHODS:
Human forebrain organoids at two timepoints (d20-25, d55-60) were transplanted into the motor cortex of adult rats following an aspiration injury. The first cohort was survived for 1 month post transplantation (MPT, n = 6); the second cohort was survived for 2 MPT (n = 16). Quantification of organoid volume and immunohistochemistry were performed.

RESULTS:
Survival of organoids post-transplantation was >90%. Pre-transplantation organoid size at d20-25 was significantly smaller than d55-60 (p < 0.0001). Average organoid volume 2 MPT was 1.04E + 10 µm3, significantly increased from 1435.4 µm3 pre-transplant (p = 0.0156). 2 MPT was correlated with more growth than 1MPT, though not statistically significant (p = 0.2672). Younger organoids trended toward a larger end-volume with the mean d20-25 volume being 3.1x larger than d55-60 at 1MPT (p = 0.3211) and 1.74x larger at 2MPT (p = 0.5090). Axon projections were seen in the adjacent host cortex at both timepoints. Both organoid age groups contained neural progenitors (PAX6, Sox2) with d20-25 retaining areas reminiscent of neural progenitor zones at 1MPT.

CONCLUSIONS:
Survival of transplanted organoids following injury was successful with a vast majority of organoids experiencing rapid growth within the injury cavity. Both age cohorts demonstrated adjacent axon projection and the presence of neural progenitors. Though further investigation is needed to clarify the influence of organoid maturity on integration, the survival rate and degree of post-transplant growth is a promising first step.
470 Robotic Transcranial Doppler With Artificial Intelligence for Real-Time Intraoperative Neuromonitoring During Endovascular Carotid Revascularization – A Novel and Autonomous Neuromonitoring Tool
Authors: Baig Ammad , Cappuzzo Justin Mark , Monteiro Andre , Khawar Wasiq , Waqas Muhammad , Donnelly Brianna , Davies Jason , Levy Elad I. , Siddiqui Adnan Hussain 
Published: March 2023

INTRODUCTION:
Real-time intraoperative neuromonitoring is crucial to account for cerebral blood flow and embolic protection offered by proximal and distal cerebral protection devices during carotid revascularization procedures.

METHODS:
All patients diagnosed with high-grade carotid stenosis were prospectively enrolled between October 2021 thru February 2022. The TCD Robot head-brace system was used to secure the patients head, and the robot calibrated to automatically identify ipsilateral MCA or the terminal ICA. Patient demographics and procedural characteristics relevant to the robotic system such as signal strength, time to find signal, intracranial depth of the relevant vessel, cerebral waveform, and emboli count were recorded for the 4 critical phases: i- Access to crossing the lesion, ii- Filter and balloon deployment, iii- Stent placement and implantation, and iv- Removal of delivery system.

RESULTS:
Eight patients were included in our study (6 males [75%]; mean age 71.5 ± 3.9). Six out of 8 patients were symptomatic with a mean diameter stenosis of 83.5 ± 4.1. Average time taken to find a stable signal was 62 seconds (Range: 10-122). Terminal ICA was the vessel identified in all cases with a mean depth of 64mm (Range: 59-71). Flow arrest was demonstrated in all cases with flow reversal demonstrated in 2. Mean duration for the TCD Robotic surveillance was 23.6 ± 0.9 minutes with an average of 117 distal emboli (Range: 45-143) recorded by the device. Linear regression model identified stent placement and implantation as statistically significant (P = 0.0419) contributor to the final emboli count.

CONCLUSIONS:
To our knowledge, this is the first case series of real-time comprehensive neuromonitoring using a Robotic Transcranial Doppler system with Artificial Intelligence demonstrating various cerebral blood flow parameters including flow arrest and distal embolic incidence intra-operatively.
474 Incidence and Risk Factors for Perioperative Stroke Following Resection of Intracranial Tumors: A Nationwide Analysis of 30,951 Cases
Authors: Kassicieh Alex , Varela Samantha , Rumalla Kavelin NA , Kazim Syed Faraz , Bowers Christian Andrew 
Published: March 2023

INTRODUCTION:
Perioperative cerebrovascular accidents (CVA) in neurosurgical patients is a serious complication that may result in permanent neurological deficits. Establishment of associated risk factors allows for mitigation of CVA risk and sequelae.

METHODS:
The National Surgical Quality Improvement Program (NSQIP) database was queried for cranial tumor excision cases (2015-2019, N = 30,951). Univariate and multivariable analysis of demographic data and comorbidities was used to assess predictive strength of these factors on postoperative CVA.

RESULTS:
CVA occurred in 1.7% of cases (N = 532). Patients with CVA, on average, were older, frailer, with increased rates of diabetes mellitus, hypertension, and weight loss. In multivariable analysis, predictors of CVA included advanced age (≥75th percentile in cohort)(OR: 1.9, 95% CI: 1.4-2.5), diabetes mellitus (OR: 1.4, 95% CI: 1.1-1.8), hypertension (OR: 1.4, 95% CI: 1.1-1.7), and weight loss (OR: 1.9, 95% CI: 1.1-3.2). Increased proportions of CVA were found among patients with primary malignant brain tumors (46.1%) and meningiomas (32.9%) when compared to all other benign brain tumors (6.6%) and secondary metastatic brain tumors (14.5%)(all p < .001). Elective surgery status was associated with decreased likelihood of CVA (OR: .74, 95% CI: .60-.91). In multivariable analysis, increasing frailty (as measured by mFI-5 and RAI-revised) was associated with increasing likelihood of CVA.

CONCLUSIONS:
The current study was the largest to identify preoperative risk factors for perioperative stroke after resection of intracranial tumors. Patients with advanced age, multiple comorbidities, and higher frailty scores were significantly more likely to suffer CVA. Frailty (as measured by mFI- and RAI-revised) is a valuable tool for preoperative risk stratification.
491 Durability of Short Segment Instrumentation With Vertebrectomy in the Setting of Metastatic Disease to the Thoracic Spine
Authors: Fahim Daniel K. , Vanood Aimen , Chieng Lee Onn , Ragheb Andrew 
Published: March 2023

INTRODUCTION:
Current treatment of spinal metastases in the thoracic spine requiring vertebrectomy entails pedicle screw fixation at least two levels above and below the level of reconstruction.

METHODS:
We reviewed a series of 30 patients treated for single-level, non-junctional (T2 to T11) thoracic spinal metastasis via single level vertebrectomy with posterior short segment instrumentation. The primary outcome was need for reoperation due to construct failure. Secondary outcomes included local tumor recurrence, pain scores, neurological function, estimated blood loss, operative time, length of hospital stay, and post-operative wound complications.

RESULTS:
The most common primary tumor origin was non-small cell lung carcinoma (n = 9). All patients had a SINS score of at least 10 and Bilsky Grade of 2 or 3. Mean intraoperative blood loss was 605 mL (range 50 – 1200 mL) and mean operative time was 260.73 minutes (range 169 to 442 minutes). Two patients suffered perioperative complications but there was no construct failure or need for revision surgery at any time during the follow-up period. Mean length of follow-up was 24 months (range 1-65 months). An overall improvement in pain was seen postoperatively (7.67 versus 2.77, p < 0.001) and no patient experienced worsening neurological function. Average length of stay was six days. Three patients in this cohort had local tumor recurrence, although two of these patients suffered from a radioresistant tumor pathology.

CONCLUSIONS:
Our results encourage consideration of this less invasive technique in the management of patients suffering from metastatic disease requiring vertebrectomy and reconstruction in the non-junctional thoracic spine.