bluuebunny/crossref_metadata_2025_split huggingface dataset:
306 Post-Hemorrhagic Stroke Scar Components in the Rat Intracerebral Hemorrhage Model
Authors: Koduri Sravanthi , Okauchi Masanobu , Keep Richard , Pandey Aditya S. , Xi Guohua 
Published: March 2023

INTRODUCTION:
Intracerebral hemorrhage (ICH) has long been known to be a cause of significant morbidity and mortality with few medical or surgical treatment options. Though various studies have investigated hematoma evacuation and iron chelation in acute ICH management, there has been minimal study regarding the components of the scar cavity following ICH.

METHODS:
To investigate this further, our group injected 100 µL of autologous blood into the right basal ganglia of 18-month-old male Fisher 344 rats and euthanized the rats for histological brain analysis at 2 months following injection.

RESULTS:
Study of these brains revealed that the post-hemorrhagic scar cavity had increased fluorescence with GFAP, a marker of astrogliosis following injury, with a reduction in DARPP-32, a protein enriched in dopamine-innervated areas and involved with neurotransmission, which indicates neuronal loss. It was also noted that there was a statistically significant increase in Olig2+ oligodendrocyte cells within the scar cavity compared to similar regions in the contralateral hemisphere or in control animals. Interestingly, when stained with CC1, a marker of mature oligodendrocytes, the scar cavity contained a mix of both mature and precursor oligodendrocytes, indicating that this increase is likely proliferative in nature rather than due to a migration phenomenon.

CONCLUSIONS:
The role of these Olig2+ cells, how they are affected by deferoxamine administration and whether they are functional and contributing to the recovery of this injured region is currently under investigation. As oligodendrocytes provide support and insulation to the axons of the central nervous system, this proliferation within the scar cavity may indicate a form of healing and be the first understanding of the delayed recovery that takes placed after ICH.
320 Deep-Learning Cortical Thickness Analysis as Predictor for Shunt Surgery Effectiveness in Possible iNPH Patients
Authors: Piccolo Daniele , Fabbro Sara , Bagatto Daniele , De Colle Maria Cristina , Belgrado Enrico , Skrap Miran , Tuniz Francesco 
Published: March 2023

INTRODUCTION:
While optimal treatment for iNPH is quite known, diagnosis remains a topic of debate, with different procedures suggested as potential predictors for shunt surgery effectiveness. Various tests, biomarkers, and neuroimaging techniques can be used; however, the diagnostic accuracy is below optimal when performed with neuroimaging techniques alone and not always cost-effective when achieved with CSF biomarkers. Quantitative computational methods for cortical thickness analysis have become available in the last decade, and they only require regularly available T1-weighted brain MR images.

METHODS:
We analyzed 294 total patients referred to our clinic from January 2015 until December 2021. After exclusion criteria, the final sample consisted of 98 possible iNPH patients: 64 were diagnosed as probable iNPH and underwent VPS surgery, while 34 did not receive a surgical indication after diagnostic procedures. We investigated differences in cortical thickness for all possible iNPH patients using a public deep-learning based neuroimaging pipeline composed by an advanced semantic segmentation neural network architecture and automated surface-based cortical thickness analysis.

RESULTS:
In 38 total patients with a negative CSFTT or not responsive to shunt surgery, a significant localized cortical thinning was seen in the lateral surface of the frontal and parietal lobes (bilateral superior and middle frontal gyrus, bilateral pars opercularis, bilateral superior parietal gyrus, bilateral supramarginal gyrus, left inferior parietal gyrus, bilateral precuneus).

CONCLUSIONS:
Preoperative cortical thickness is a feasible analysis that might be useful in defining the optimal therapeutic plan for possible iNPH patients. A large multicentric study is encouraged to elucidate specific patterns and ratios of cortical thickness that might be used as potential predictors for shunt surgery effectiveness.
321 Automated Development of a Spine Registry (Autoregistry) using an Interpretable Surgeon-Written Regular Expression Classifier
Authors: Cheung Alexander , Laufer Ilya , Pacione Donato R. , Lau Darryl , Frempong-Boadu Anthony , Kondziolka Douglas S. , Golfinos John G. , Oermann Eric 
Published: March 2023

INTRODUCTION:
Clinical registries are critical for modern surgery and underpin outcomes research, reimbursement negotiations, device monitoring, and trial development. Existing approaches to registry construction are labor intensive, costly, and prone to user error. Natural language processing (NLP) techniques combined with broad electronic health record (EHR) datasets can theoretically automate the building and maintenance of registries.

METHODS:
We utilized a Hadoop datalake consisting of the EHR, billing systems, imaging systems, and other data representing all information generated by an AMC. Using this database and SQL queries, we retrieved every operative note written in the department of neurosurgery over the last decade. Operative notes were parsed using regular expressions constructed by the operative surgeons themselves. A random subset of 100 notes was selected for manual review and analysis.

RESULTS:
31,139 operative cases were identified and downloaded. An operative note processor was written by the operating surgeons and required three days of development time with approximately two weeks of validation. In 100 random cases, the regex classifier was on average 98.6% accurate at identifying whether a particular procedure was performed and correctly identified the entire list of defined surgical procedures in 88% of patients. Most errors (64.2%) occurred during the identification of the involved vertebral levels. Operative notes from ancillary specialties for assistive approaches or closures also led to false-positive results.

CONCLUSIONS:
This study demonstrates the feasibility of automatically generating a spine surgery registry (“autoregistry”) using a Hadoop EHR datalake combined with an interpretable and customizable surgeon-written natural language processing algorithm, which may reduce labor costs and other pitfalls associated with manual registry development.
322 Distributed Vector Representations of Neurosurgical Admission Notes Predict Discharge Disposition
Authors: Khanna Arjun , Coumans Jean-Valery 
Published: March 2023

INTRODUCTION:
Natural language processing (NLP) aims to extract information from unstructured language input for use in machine learning, without the need for laborious manual review of text to retrieve data of potential interest. An NLP-based model utilizing term frequency-inverse document frequency (TF-IDF) vectoral representations of pre-operative clinical notes has previously been shown to predict discharge disposition following meningioma resection. The TF-IDF vectorization scheme is based on word counts across documents but does not account for word order or semantic information. An alternative algorithm, paragraph vectorization, utilizes an unsupervised neural network to learn document vector representations.

METHODS:
We analyzed 7,122 admission notes. We trained a neural network to derive paragraph vector representations of notes and trained a classifier to predict home vs non-home discharge disposition based on these representations. Out-of-sample performance was assessed on a held-out testing set. We repeated the analysis using TF-IDF document representations to compare the two approaches. Performance was quantified using area under the receiver operating characteristic curve (ROC-AUC).

RESULTS:
Model performance increased with vector dimensionality. A 200-dimensional distributed document vectorization was highly predictive of nonhome discharge with an ROC-AUC of 0.82 ± 0.01 (mean ± standard error over 5-fold nested cross-validation). When the dimensionality of the embedding vector space was relatively low (e.g. <100), learned paragraph vectors predicted discharge disposition better than TF-IDF vectors.

CONCLUSIONS:
Natural language processing of admission notes via neural network-learned distributed vectoral representations is a viable strategy of information extraction from neurosurgical clinical documentation. This embedding scheme overcomes some of the limitations of TF-IDF and encodes more information in lower-dimensional embedding vector spaces. It holds promise as a method of using free text to train machine learning algorithms for prediction of clinically relevant outcomes.
329 Acute Cognitive Symptom Cluster Predicts Return-to-Learn Duration Following a Sport-Related Concussion
Authors: Tang Alan Ruigang , Davis Philip , Neitz Kristen , Grusky Alan , Hajdu Katherine , Hou Brian , Yengo-Kahn Aaron Michael , Zuckerman Scott L. , Terry Douglas 
Published: March 2023

INTRODUCTION:
Adolescents sustaining sport-related concussion (SRC) often experience difficulties with the return-to-learn (RTL) process. While initial symptom burden has predicted prolonged RTL, no studies have established a relationship between acute cognitive symptoms and RTL duration.

METHODS:
A retrospective single-institution cohort study of adolescent athletes 12-23-years-old evaluated within 5 days of a diagnosed SRC from 11/2017-10/2020 was conducted. Athletes missing cognitive symptom ratings and RTL data were excluded. The primary exposure variable was cognitive symptom score, consisting of 4 symptoms for a total possible score of 24. Primary and secondary outcomes were time-to-RTL and total length-of-care, respectively. Multivariable Cox proportional hazards modeling was used to assess the effect of Cognitive Symptom Ratio (CSR), defined as cognitive symptom score divided by Post-Concussion Symptom Scale (PCSS) score, on RTL duration.

RESULTS:
Of 653 athletes evaluated within 5 days of their concussion, 343 patients were included in the final cohort. Athletes reported a median initial PCSS score of 21 (IQR 6-37) and a median cognitive symptom score of 4 (IQR 0-9). Most patients endorsed some degree of “difficulty concentrating” (n = 212, 61.3%). Median CSR was 0.18 (IQR 0.00-0.27). On multivariable regression analysis, higher CSR was associated with prolonged RTL duration (HR 0.30, 95% CI 0.13-0.69, p = .004). When initial PCSS was added to the model, the previously significant association between CSR and RTL was no longer significant (HR 0.67, 95% CI 0.29-1.59, p = .367). When dichotomized based on frequency distribution, a higher proportion of low CSR patients achieved RTL by 7 days post-injury (82.2% vs. 69.9%, p = .007), a difference not seen at 14 days (92.2% vs. 87.3%, p = .133).

CONCLUSIONS:
Acute cognitive symptom scores can predict who may be at increased risk for prolonged RTL and which patients with normal PCSS scores may experience difficulties once resuming school activities.
332 Estimation of Intracranial Pressure Using Non-Invasive Monitor and Machine Learning
Authors: Habboub Ghaith , Hassett Catherine , Kondylis Efstathios , Gomes Joao 
Published: March 2023

INTRODUCTION:
Several non-invasive technologies have attempted to utilize surrogate markers of cerebral hemodynamics to infer intracranial pressure (ICP). Successful clinical application of these methods have been limited by hesitancy to rely upon surrogate data and inferences about ICP, in lieu of directly measured ICP. One newer method utilizes a mechanical extensometer to detect subtle, dynamic skull deformations can yield a non-invasive ICP waveform. This data has been validated to provide important information about intracranial dynamics, including inferences on the cerebral compliance. This method does not provide an absolute intracranial pressure and thus questions about clinical application remain.

METHODS:
High frequency (326 Hz) arterial blood pressure, non-invasive and invasive ICP measurements were collected from 5 patients. Samples were collected over 30 minutes. The first 15 minutes were used for training and last 15 minutes were used for testing. Facebook Prophet was used to perform signal analysis and forecasting. Switch-point analysis tools were also used to identify shifts in ICP measurements.

RESULTS:
Model per patient was generated from the 5 patients. Trend and seasonality analysis were then performed using Facebook Prophet modeling. Arterial blood pressure and non-invasive measurement were used as regressor to invasive intracranial pressure measurement. Mean absolute error of the testing samples of all models ranged from 0.8–2.4 mmHg.

CONCLUSIONS:
More closely and reliably estimating invasive intracranial pressure measurement from non-invasive measurements and arterial blood pressure is feasible using sequence analysis and machine learning. This will aid the clinical applicability of non-invasive monitoring and perhaps provide the pathway to replacing invasive measurement altogether. Further study of the applications of this clinical tool is warranted with the goal of intervening early to improve neurologic outcomes following acute brain injuries.
352 Prevalence and Charactersitics of Moyamoya Syndrome in Patients With Down Syndrome
Authors: Ritz Caitlin , Malik Noor , Wilkinson C. Corbett , Graber Sarah 
Published: March 2023

INTRODUCTION:
Moyamoya arteriopathy can be idiopathic (moyamoya disease, MMD) or associated with other diseases, i.e., Down syndrome (moyamoya syndrome, MMS). The prevalence of Down syndrome in patients admitted for moyamoya has been estimated using the National Inpatient Sample to be 3.8%. However, the prevalence of moyamoya in Down Syndrome is not well-quantified.

METHODS:
This retrospective study used the Sie Center for Down Syndrome and Stroke Program databases at Children’s Hospital Colorado to identify moyamoya patients aged 30 days to 18 years at diagnosis. Demographics, clinical presentation, treatment, and outcome were compared among patients with DS, those with idiopathic MMD, and the entire group.

RESULTS:
Sixty-five patients (30 idiopathic, 14 MMS with DS, 21 MMS without DS). Prevalence of MMS in the DS population was 0.4%. Gender and age at presentation did not differ significantly between populations. 47% of idiopathic moyamoya patients initially presented with transient ischemic attacks (TIAs) versus 14% of DS patients (P < 0.05). This is compared to 34% of the total population that presented with TIAs. DS patients were more likely to present with stroke (57%) compared to idiopathic (37%) and total patient populations (40%) although these results were not significant. 23% of idiopathic patients presented with basal ganglia strokes compared to 7% in the DS population (P < 0.05).

CONCLUSIONS:
In this study, the prevalence of moyamoya in DS was 0.4%. Patients with DS were less likely to present with TIAs and more likely to present with stroke, with different stroke locations, than were other moyamoya populations.
358 Biomechanical Analysis of the Structural Stability of the Lumbar Spine Following the Extent of Endoscopic Lumbar Foraminotomy and Laminotomy: A Finite Element Analysis
Authors: Liu Yanting , Kim Jin-sung , Lee Jeong Hyeon , Lee Sung Jae 
Published: March 2023

INTRODUCTION:
Facetectomy as the standard surgical option performed to relieve the patient's symptoms. Recently, endoscopic lumbar foraminotomy shows an alternative to secure space for the spinal nerve to pass through the foramen. However, the biomechanical research on the postoperative structure stability of the spine after endoscopic surgery remains unknown.

METHODS:
Six types of models were constructed following the graded removal L4 left side of the superior articular process with or without lamina: Type 1: intact model; Type 2: foraminotomy of left-superior dorsal corner of the superior articular process; Type 3: extended foraminotomy of left superior ventral side of the superior articular process; Type 4: left side total facetectomy; Type 5: left side facetectomy and unilateral laminectomy; Type 6: left side facetectomy and laminectomy.

RESULTS:
From the changes of experiment data in our finite element analysis of simulated endoscopic surgery, the extent of facet removal increases, the mobility and stress distribution of the surgical segment increases. In all loading conditions, the increase rate of the range of motion was the highest in Type 6 in L3-L4 compared to the intact model. The measured increase rate of von Mises s tresses was highest in left lateral bending in types 5 and 6. Furthermore, under other modes of movement, there was no peak von Mises stress differences on Type 1 to Type 4.

CONCLUSIONS:
In symptomatic lumbar foraminal stenosis, the impact of endoscopic foraminotomy on the stability may be less than those of total facetectomy. There is no significant difference between the standard and extended endoscopic foraminotomy on stability of the lumbar spine.
359 Sacroiliac Joint Fusion – A Shift Towards Variant Anatomy and Their Clinical Implications
Authors: Wessell Jeffrey Ernest , Saway Brian Fabian , Glaser John , Patel Sunil J. , Kalhorn Stephen P. 
Published: March 2023

INTRODUCTION:
Sacroiliac joint (SIJ) dysfunction is a common cause of low back pain, estimated to account for 14-22%. Currently, a limited amount is known about risk factors predicting surgical outcomes. Few studies have evaluated the prevalence of variant SIJ anatomy, while none have investigated this in the pathologic SIJ. Furthermore, the impact SIJ morphology on outcomes is unknown.

METHODS:
We performed a retrospective review of patients undergoing SIJ fusion at our institution between 2014 and 2021. Inclusion criteria included patients 18 years or older, diagnosed with SIJ dysfunction refractory to conservative management. Clinical and sociodemographic information was collected from chart review. Two separate study team members independently reviewed CT and MRI studies, categorizing anatomic subtypes based on Prassopoulos et. al’s classification system. Disagreement was resolved by consensus for the final data analysis.

RESULTS:
A total of 77 joints were instrumented across 67 patients. Postoperative VAS significantly improved from preoperative VAS of 2 (0-5) and 6.6 (5.5-8) respectively (p < .001). Interestingly, median percent improvement and interquartile range (IQR) for smokers was 77.8 (50-100) compared to 57.1 (14.3-83.3) for non-smokers (p = 0.04). There were significantly fewer normal SIJs than previously reported (p < 0.05). There were differences in outcomes between anatomic subtypes, though this failed to reach statistical significance.

CONCLUSIONS:
SIJ fusion leads to significant improvement in patients with refractory SIJ pathology. The distribution across anatomic joint subtypes is markedly different in the pathologic SIJ. There appears to be differences in clinical outcomes between these subtypes. Further research is needed to power these results. These changes may further understanding on SIJ dysfunction pathophysiology and prompt additional investigations into differences in clinical outcomes.
362 Transforaminal Versus Interlaminar Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: a Systematic Review and Meta-Analysis
Authors: Jitpakdee Khanathip , Liu Yanting , Kotheeranurak Vit , Kim Jin-sung 
Published: March 2023

INTRODUCTION:
The endoscopic lumbar discectomy can be divided into two main approaches, transforaminal (TELD) and interlaminar endoscopic lumbar discectomy (IELD). However, results of comparative studies between these techniques have been inconsistent, and consensus on the decision making to select which approach has not been reached.

METHODS:
Three electronic databases were searched for reported outcomes following TELD and IELD. Oswestry Disability Index (ODI), visual analog scale of back (VASB) and leg pain (VASL), and MacNab criteria were evaluated. Operative time, hospital stays, radiation exposure, and complications were investigated. Odds ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random and fixed-effect models.

RESULTS:
Total of 1,948 patients from 18 studies were included, consisting of 1,006 patients (51.6%) in TELD group and 942 (48.4%) patients in IELD group. TELD had slightly better improvement of postoperative ODI (MD = 1.26; 95% CI: 0.07–2.16; P = 0.04), postoperative VASB (MD = -0.23; 95% CI: -0.40 to -0.05; P = 0.01) and last follow-up VASB (MD = -0.25; 95% CI: -0.41 to -0.09; P = 0.002), but with longer operative time (MD = 10.1 mins; 95% CI: 1.925–18.77; P < 0.00001) and more fluoroscopic time (SMD = 4.12; 95% CI: 3.22–5.03; P < 0.00001), especially in L5-S1 operation. Postoperative bed rest time was significantly longer in IELD. However, there was no difference in VASL, hospital stays, or complication.

CONCLUSIONS:
We found comparable clinical outcomes in terms of ODI, VAS, patient satisfaction, hospital stays, and complication between both techniques. TELD required more radiation exposure and longer operative time at L5-S1 level than IELD. Our study provided helpful results to consider which approach is suitable for selected patients and informed consent of benefits from each approach.
366 Micro-Endoscopic Posterior Cervical Foraminotomy and Discectomy is Health Economically Dominant to Anterior Cervical Discectomy and Fusion for Unilateral Cervical Radiculopathy
Authors: Hani Ummey , Monk Steve Hubert , Pfortmiller Deborah , Kim Paul Keetae , Bohl Michael , Holland Christopher Michael , Smith Mark D. , Adamson Tim E. , McGirt Matthew J. 
Published: March 2023

INTRODUCTION:
Micro-endoscopic posterior cervical foraminotomy and discectomy (MPCF) has served as a minimally invasive, motion sparing alternative to ACDF for unilateral cervical radiculopathy for decades. While growing data suggests similar effectiveness, the cost effectiveness and potentially superior healthcare value of MPCF vs ACDF remains largely unstudied.

METHODS:
The National Quality Outcomes Database (QOD) was queried for 323 consecutive ASA 1-3 patients (201 ACDF, 122 MPCF) performed at the authors' single institution for unilateral cervical radiculopathy at our ambulatory surgical center (ASC). Propensity-matching yielded 222 patients. Resource utilization, missed workdays, and EQ5D quality adjusted life year (QALY) gains were assessed over a one-year period. Direct cost (resource use x unit costs based on Medicare national allowable payment amounts) and indirect cost (missed workdays x average US daily wage) were recorded and incremental cost-effectiveness ratio (ICER) was calculated.

RESULTS:
Estimated blood loss, and length of surgery were less for MPCF vs. ACDF (p < 0.001). All other safety measures and patient-reported outcomes were similar between cohorts. MPCF vs. ACDF demonstrated reduction in total one-year costs of $6,709 (Medicare) and $13,061 (private payers) (p < 0.001), and comparable QALYs gained. ACDF vs. MPCF had a cost ineffective ICER of $91,773/QALY-gained and $178,668/QALY for Medicare and private payer patients, respectively.

CONCLUSIONS:
MPCF is a health-economically dominant option to ACDF for unilateral cervical radiculopathy given the increased healthcare costs despite comparable safety, outcome, and QALY gains associated with ACDF.