bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-volume facilities are not always low risk: comparing risk-standardized mortality rates versus facility volume as quality measures in surgical neuro-oncology
Authors: Chalif Eric J. , Young Jacob S. , Villa Genaro R. , Aghi Manish K. , Lenzi Jacopo , Berger Mitchel S. 
Published: July 2023

OBJECTIVE
Risk-standardized mortality rates (RSMRs) have recently been shown to outperform facility case volume as a proxy for surgical quality in lung and gastrointestinal cancer. The aim of this study was to investigate RSMR as a surgical quality metric in primary CNS cancer.

METHODS
This retrospective observational cohort study used data from the National Cancer Database, a population-based oncology outcomes database sourced from more than 1500 institutions in the United States, and included adult patients 18 years of age and older who were diagnosed with glioblastoma, pituitary adenoma, or meningioma and were treated with surgery. For each group, RSMR quintiles and annual volume were calculated in a training set (2009–2013) and these thresholds were applied to the validation set (2014–2018). In this paper, the authors compared the effectiveness and efficiency of facility volume–based versus RSMR-based hospital centralization models and evaluated the overlap between the two systems. A patterns-of-care analysis was also performed to explore socioeconomic predictors of being treated at better-performing treating facilities.

RESULTS
A total of 37,838 meningioma, 21,189 pituitary adenoma, and 30,788 glioblastoma patients were surgically treated from 2014 to 2018. There were substantial differences between RSMR and facility volume classification schemes among all tumor types. In an RSMR-based centralization model, an average of 36 patients undergoing glioblastoma surgery would need to relocate to a low-mortality hospital to prevent one 30-day mortality following surgery, whereas 46 would need to relocate to a high-volume hospital. For pituitary adenoma and meningioma, both metrics were inefficient in centralizing care to reduce surgical mortality. Additionally, overall survival for glioblastoma patients was better modeled in an RSMR classification scheme. Analyses to investigate the impact of care disparities found that Black and Hispanic patients, patients earning less than $38,000, and uninsured patients were more likely to be treated at high-mortality hospitals.

CONCLUSIONS
RSMR is more effective and efficient than a traditional volume-based approach for preventing early postoperative death in glioblastoma surgery. These data have important implications for future quality-related studies in neurosurgical oncology and may be relevant for healthcare/insurance payments, hospital evaluation assessments, healthcare disparities, and the standardization of care across hospitals.
Clinical decision-making based on 11C-methionine PET in recurrent Cushing’s disease with equivocal MRI findings
Authors: Ishida Atsushi , Kaneko Koichiro , Minamimoto Ryogo , Hotta Masatoshi , Inoshita Naoko , Takano Koji , Yamada Shozo 
Published: July 2023

OBJECTIVE
Diagnosis and accurate localization of recurrent tumors in Cushing’s disease (CD) are challenging, especially after multiple transsphenoidal surgeries (TSSs) or radiosurgery. Even experts face difficulties in detecting these recurrent tumors, and a favorable surgical outcome is not guaranteed. In this report, the authors aimed to determine the usefulness of 11C-methionine positron emission tomography (MET-PET) for evaluating patients with recurrent CD with inconclusive magnetic resonance imaging (MRI) lesions and to develop a treatment protocol for these cases.

METHODS
In this retrospective study of patients with recurrent CD in the period between April 2018 and December 2022, the authors assessed the usefulness of MET-PET in determining whether equivocal MRI findings were recurrent tumors or postsurgical cavities and deciding further treatment options. All patients had undergone at least one TSS, and most had undergone multiple TSSs and had pathologically confirmed corticotroph tumors with hypercortisolemia.

RESULTS
Overall, 15 patients with recurrent CD (10 females and 5 males) were included, all of whom had undergone MET-PET. All patients had been subjected to multiple treatments, including TSSs or radiosurgeries. Their MRI scans demonstrated less-enhanced lesions that were not confirmed as recurrences even with cutting-edge MRI because they could not be distinguished from postsurgical changes with confidence. MET uptake was positive in 8 patients (9 examinations) and negative in 7. Following MET-PET, repeat TSS was performed in 5 patients. Corticotroph tumors were identified in all 5 patients, even though one of them had negative MET uptake. The MET uptake precisely identified a tumor location on the opposite side of the MRI-suspected lesion in 2 patients. Meanwhile, patients with negative uptake and mild hypercortisolism were only observed. Nonsurgical options were also used in other patients: temozolomide (TMZ) was administered in 2 patients owing to a prior history of multiple TSSs and radiosurgery and the drug-resistant nature of the disease. TMZ was highly effective in these patients; their Cushing’s symptoms ameliorated, and their adrenocorticotropic hormone and cortisol levels continued to decline. Interestingly, MET uptake disappeared following TMZ treatment.

CONCLUSIONS
MET-PET is extremely useful for confirming equivocal lesions on MRI in patients with recurrent CD and for deciding further treatment options. The authors propose a novel protocol based on MET-PET results for treating patients with relapsing CD in whom the recurrent tumors cannot be confirmed with MRI.
Brain plasticity and age after restoring elbow flexion with distal nerve transfers in neonatal brachial plexus palsy and nonneonatal traumatic brachial plexus injury using the plasticity grading scale
Authors: Socolovsky Mariano , Lovaglio Ana , Bonilla Gonzalo , Masi Gilda Di , Barillaro Karina , Malessy Martijn 
Published: July 2023

OBJECTIVE
Ulnar and/or median nerve fascicle to musculocutaneous nerve (MCN) transfers are used to restore elbow flexion following severe neonatal and nonneonatal brachial plexus injuries (BPIs). Restoring volitional control requires plastic changes in the brain. To date, whether the potential for plasticity is influenced by a patient’s age remains unknown.

METHODS
Patients who had presented with a traumatic upper (C5–6 or C5–7) BPI were divided into two groups: neonatal brachial plexus palsies (NBPPs) and nonneonatal traumatic BPIs (NNBPIs). Both groups underwent ulnar or median nerve transfers to the MCN for elbow flexion restoration between January 2002 and July 2020. Only those who attained a British Medical Research Council strength rating of 4 were reviewed. The primary comparison between the two groups was the plasticity grading scale (PGS) score to determine the level of independence of elbow flexion (target) from forearm motor muscle movement (donors). The authors also assessed patient compliance with rehabilitation using a 4-point Rehabilitation Quality Scale. Bivariable and multivariable analyses were used to identify intergroup differences.

RESULTS
In total, 66 patients were analyzed: 22 with NBPP (mean age at surgery 10 months) and 44 with NNBPI (age range at surgery 3–67 years, mean 30.2 years; mean time to surgery 7 months, p < 0.001). All NBPP patients obtained a PGS grade of 4 at the final follow-up versus just 47.7% of NNBPI patients (mean 3.27, p < 0.001). On ordinal regression analysis, after nature of the injury was excluded because of excessive collinearity with age, age was the only significant predictor of plasticity (β = −0.063, p = 0.003). Median rehabilitation compliance scores were not statistically different between the two groups.

CONCLUSIONS
The extent of plastic changes that occur for patients to regain volitional control over elbow flexion after upper arm distal nerve transfers following BPI is influenced by patient age, with complete plastic rewiring more likely in younger patients and virtually ubiquitous in infants. Older patients should be informed that elbow flexion after an ulnar or median nerve fascicle transfer to the MCN might require simultaneous wrist flexion.
Treatment of symptomatic sacral arachnoid cysts in the pediatric population
Authors: Özen Ali , Özek M. Memet 
Published: July 2023

OBJECTIVE
Symptomatic sacral arachnoid cysts are extremely rare in pediatric patients, resulting in a lack of consensus regarding optimal treatment measures. The current study evaluated the clinical symptoms and surgical indications, techniques, and outcomes of pediatric patients who underwent treatment for sacral arachnoid cysts with the aim of developing recommendations for follow-up and treatment.

METHODS
This retrospective study included pediatric patients who underwent surgical treatment for sacral arachnoid cysts between January 2000 and December 2020 at the Department of Pediatric Neurosurgery, Acıbadem University Faculty of Medicine.

RESULTS
Thirteen patients were included in the study, 9 of whom were girls and 4 were boys. Five patients presented with urinary incontinence, 2 of whom also exhibited constipation. Other chief complaints included recurrent urinary tract infections (UTIs) and low-back pain (n = 4 patients each). Urological evaluation was performed in all patients, followed by urodynamic examination in those with urinary symptoms. Spinal MRI showed extra- and intradural sacral cysts in 12 patients and 1 patient, respectively. The latter patient exhibited recurrence during follow-up and underwent reintervention. Samples from the excised cyst walls were sent for pathological examination. Five patients with urinary incontinence, 2 with constipation, 4 with recurrent UTIs, and 3 with low-back pain exhibited resolution of symptoms after treatment. However, 1 patient with low-back pain did not show any improvement in symptoms. No postoperative complications were observed in the current study. The patients were followed-up regularly after surgery, and the mean follow-up duration was 4 years.

CONCLUSIONS
Sacral arachnoid cysts in pediatric patients may be associated with urinary system dysfunction and low-back pain. Surgery is the treatment of choice for symptomatic patients and those with enlarged cysts with radiological evidence of compression, and the morbidity and mortality rates associated with surgery are low.
Survival and prognostic factors in pediatric patients with medulloblastoma treated at a national pediatric hospital in Peru: a retrospective cohort
Authors: Flores-Sanchez Jose D. , Perez-Chadid Daniela A. , Diaz-Coronado Rosdali Y. , Hernandez-Broncano Eddy , Ugas-Charcape Carlos F. , Ramirez Alberto , Racchumí-Vela Augusto E. , Boop Frederick A. , Preguntegui Ivethe 
Published: July 2023

OBJECTIVE
The objectives of this study were to determine the overall survival (OS) and event-free survival (EFS) rates of patients with medulloblastoma treated in a national pediatric hospital in Peru, as well as to identify demographic, clinical, imaging, postoperative, and histopathological characteristics and prognostic factors associated with OS and EFS.

METHODS
The authors conducted a retrospective study analyzing information from the medical records of children with a diagnosis of medulloblastoma who underwent surgical treatment at the Instituto Nacional de Salud del Niño—San Borja, a public hospital in Lima, Peru, from 2015 to 2020. Clinical-epidemiological variables, degree of disease extension, risk stratification, extent of resection, postoperative complications, status of oncological treatment received, histological subtype, and neurological sequelae were taken into account. The Kaplan-Meier method and Cox regression analysis were used to estimate OS, EFS, and prognostic factors.

RESULTS
Of the 57 children evaluated with complete medical records, only 22 children (38.6%) underwent complete oncological treatment. OS was 37% (95% CI 0.25–0.55) at 48 months. EFS was 44% (95% CI 0.31–0.61) at 23 months. High-risk stratification—meaning patients with ≥ 1.5 cm2 of residual postoperative tumor, those younger than 3 years, those with disseminated disease (HR 9.69, 95% CI 1.40–67.0, p = 0.02), and those who underwent subtotal resection (HR 3.78, 95% CI 1.09–13.2, p = 0.04)—was negatively associated with OS. Failure to receive complete oncological treatment was negatively associated with OS (HR 20.0, 95% CI 4.84–82.6, p < 0.001) and EFS (HR 7.82, 95% CI 2.47–24.7, p < 0.001).

CONCLUSIONS
OS and EFS of patients with medulloblastoma in the author’s milieu are below those reported in developed countries. Incomplete treatment and treatment abandonment in the authors’ cohort were also high compared with high-income country statistics. Failure to complete oncological treatment was the most important factor associated with poor prognosis, both in terms of OS and EFS. High-risk patients and subtotal resection were negatively associated with OS. Interventions are needed to promote the completion of adjuvant oncological therapy for medulloblastoma in the disadvantaged Peruvian population.
Supraorbital minicraniotomy for open Ommaya reservoir placement in pediatric craniopharyngiomas: a case series and technical report
Authors: Greuter Ladina , Richards Oliver L. , Malik Noor , Breitbart Sara , Riesel Johanna N. , Bartels Ute , Ibrahim George M. , Kulkarni Abhaya V. 
Published: July 2023

OBJECTIVE
Craniopharyngiomas with a predominant cystic component are often seen in children and can be treated with an Ommaya reservoir for aspiration and/or intracystic therapy. In some cases, cannulation of the cyst can be challenging via a stereotactic or transventricular endoscopic approach due to its size and proximity to critical structures. In such cases, a novel placement technique for Ommaya reservoirs via a lateral supraorbital incision and supraorbital minicraniotomy has been used.

METHODS
The authors conducted a retrospective chart review of all children undergoing supraorbital Ommaya reservoir insertion from January 1, 2000, to December 31, 2022, at the Hospital for Sick Children, Toronto. The technique involves a lateral supraorbital incision and a 3 × 4–cm supraorbital craniotomy, with identification and fenestration of the cyst under the microscope and insertion of the catheter. The authors assessed baseline characteristics and clinical parameters of surgical treatment and outcome. Descriptive statistics were conducted. A review of the literature was performed to identify other studies describing a similar placement technique.

RESULTS
A total of 5 patients with cystic craniopharyngioma were included (3 male, 60%) with a mean age of 10.20 ± 5.72 years. The mean preoperative cyst size was 11.6 ± 3.7 cm3, and none of the patients suffered from hydrocephalus. All patients suffered from temporary postoperative diabetes insipidus, but no new permanent endocrine deficits were caused by the surgery. Cosmetic results were satisfactory.

CONCLUSIONS
This is the first report of lateral supraorbital minicraniotomy for Ommaya reservoir placement. This is an effective and safe approach in patients with cystic craniopharyngiomas, which cause local mass effect but are not amenable to traditional Ommaya reservoir placement stereotactically or endoscopically.
Evaluation of patients referred to the spine clinic via telemedicine and the impact on diagnosis and surgical decision-making
Authors: Melnick Kaitlyn , Porche Ken , Sriram Sai , Goutnik Michael , Cuneo Micaela , Murad Gregory , Chalouhi Nohra , Polifka Adam , Hoh Daniel J. , Decker Matthew 
Published: July 2023

OBJECTIVE
Telemedicine encounters are expanding in utility for outpatient care and evaluation, partially as a necessity during the COVID-19 pandemic. It is unclear if telemedicine evaluation is comparable to in-person assessment of patients with spinal pathology undergoing surgical consultation. The objective of this study was to determine if treatment plans change for spine patients evaluated in person following an initial telemedicine consultation.

METHODS
Patients referred to the authors’ comprehensive spine center were evaluated first via telemedicine and then in clinic. Telemedicine evaluations were conducted via video evaluation with an attending surgeon. Demographic data including age, gender, and distance traveled from the clinic were retrospectively recorded. A chart review retrieved symptoms, radiographic details, and past medical history. The primary outcome was if the treatment plan changed (plan change [PC]) after seeing the patient in the clinic. Chi-square tests and binary logistical regression produced uni- and multivariate analyses.

RESULTS
There were 152 new patients seen via telemedicine and in person. Pathology was present in the cervical (28.3%), thoracic (9.9%), and lumbar (61.8%) spine. The most common symptom was pain (72.4%), followed by radiculopathy (66.4%), weakness (26.3%), myelopathy (15.1%), and claudication (12.5%). There were 37 patients (24.3%) for whom there was a PC after clinic evaluation, and of those, only 5 (3.3%) were due to physical examination (PCPE) findings. On univariate analysis, a longer duration between telemedicine and clinic visit (odds ratio [OR] 1.094 per 7 days, p = 0.003), having pathology in the thoracic spine (OR 3.963, p = 0.018) and lack of sufficient imaging (OR 25.455, p < 0.0001) were predictive of a PC. Having pathology in the cervical spine (OR 9.538, p = 0.047) and adjacent-segment disease (OR 11.471, p = 0.010) were predictive of a PCPE.

CONCLUSIONS
This study demonstrates that telemedicine may be an effective modality for the initial evaluation of spine surgical patients, without compromising decision-making in the absence of an in-person physical examination.
Surgical outcomes and risk factors for recurrence of myxopapillary ependymoma: a single-center experience
Authors: Dougherty Mark C. , Sandhu Mani Ratnesh S. , Teferi Nahom , Noeller Jennifer L. , Rosinski Clayton L. , Park Brian J. , Menezes Arnold H. , Nourski Kirill V. , Hitchon Patrick W. 
Published: July 2023

OBJECTIVE
Myxopapillary ependymomas (MPEs) are low-grade, well-circumscribed tumors that often involve the conus medullaris, cauda equina, or filum terminale. They account for up to 5% of all tumors of the spine and 13% of spinal ependymomas, with a peak incidence between 30 and 50 years of age. Because of the rarity of MPEs, their clinical course and optimal management strategy are not well defined, and long-term outcomes remain difficult to predict. The objective of this study was to review long-term clinical outcomes of spinal MPEs and identify factors that may predict tumor resectability and recurrence.

METHODS
Pathologically confirmed cases of MPE at the authors’ institution were identified and medical records were reviewed. Demographics, clinical presentation, imaging characteristics, surgical technique, follow-up, and outcome data were noted. Two groups of patients—those who underwent gross-total resection (GTR) and those who underwent subtotal resection (STR)—were compared using the Mann-Whitney U-test for continuous and ordinal variables and the Fisher exact test for categorical variables. Differences were considered statistically significant at p ≤ 0.05.

RESULTS
Twenty-eight patients were identified, with a median age of 43 years at the index surgery. The median postoperative follow-up duration was 107 months (range 5–372 months). All patients presented with pain. Other common presenting symptoms were weakness (25.0%), sphincter disturbance (21.4%), and numbness (14.3%). GTR was achieved in 19 patients (68%) and STR in 9 (32%). Preoperative weakness and involvement of the sacral spinal canal were more common in the STR group. Tumors were larger and spanned more spinal levels in the STR group compared with the GTR cohort. Postoperative modified McCormick Scale grades were significantly higher in the STR cohort compared with the GTR group (p = 0.00175). Seven of the 9 STR patients (77.8%) underwent reoperation for recurrence at a median of 32 months from the index operation, while no patients required reoperation after GTR, for an overall reoperation rate of 25%.

CONCLUSIONS
Findings of this study emphasize the importance of tumor size and location—particularly involvement of the sacral canal—in determining resectability. Reoperation for recurrence was necessary in 78% of patients with subtotally resected tumors; none of the patients who underwent GTR required reoperation. Most patients had stable neurological status postoperatively.
The Origin of venerable Savvati of Tver
Authors: Беляев С. М. свящ. 
Published: July 2023

В данной статье будут приведены все имеющиеся на данный момент сведения и версии о происхождении преподобного Савватия Тверского. Возможно, это первая попытка наиболее объективно интерпретировать дошедшие до наших дней сведения о его жизни. Некоторые современные исследователи пытаются связать происхождение преподобного Савватия Тверского и его становление как монаха с исихастской традицией Палестинского монашества. Для достижения данной цели они приводят свои аргументы. В данной статье некоторые из них будут представлены и прокомментированы. Также личностью преподобного и ее происхождением интересовались и дореволюционные тверские краеведы. Их версии тоже будут представлены и рассмотрены здесь. Цель настоящей работы заключается в восстановлении, на основании сопоставления разных точек зрения, объективного исторического взгляда на происхождение преподобного Савватия Тверского. На мой взгляд, необходимо более полно представить личность преподобного, историю его происхождения, поскольку она, в связи с малым количеством источников, недостаточно изучена; поэтому создаются разные версии и теории по вопросу его происхождения. Несомненно, эта работа будет ещё одним вкладом в краеведение Тверской земли, в изучение истории того временного периода истории Русской Церкви, в котором жил преподобный Савватий Тверской.
This article will present all the currently available information and versions about the origin of St. Savvati of Tver. Perhaps this is the first attempt to interpret the information about his life that has come down to our days in the most objective way. Some modern researchers are trying to link the origin of St. Savvati of Tver and his formation as a monk with the hesychastic tradition of Palestinian monasticism. To achieve this goal, they give their arguments. In this article, some of them will be presented and commented on. The pre-revolutionary Tver local historians were also interested in the personality of the monk and her origin. Their versions will also be presented and reviewed here. The purpose of the presented work is to restore, on the basis of a comparison of different points of view, an objective historical view of the origin of St. Savvati of Tver. In my opinion, it is necessary to present a more complete picture of the personality of the monk, its origin, since, due to the small number of sources, it is insufficiently studied, therefore, different versions and theories are being created on the question of its origin. Undoubtedly, this work will be another contribution to the local history of the Tver land, to the study of the history of the temporal context of the history of the Russian Church in which the Monk Savvati of Tver lived.