bluuebunny/crossref_metadata_2025_split huggingface dataset:
494 Comparison of Disc Height Restoration and Subsidence Rates Between Static Versus Expandable Titanium Cages for Lateral Lumbar Interbody Fusion
Authors: Ashayeri Kimberly , Neifert Sean N. , Frempong-Boadu Anthony , Protopsaltis Themistocles , Lau Darryl 
Published: March 2023

INTRODUCTION:
It has been shown that expandable cages for transforaminal lumbar interbody fusion (TLIF) are associated with increased rates of subsidence. However, as lateral lumbar interbody fusion (LLIF) cages offer substantially larger footprints, this may offset the risks.

METHODS:
A retrospective review was performed of a consecutive adult patients undergoing LLIF with either static or expandable cages from 2013-2021. Demographics and surgical details were collected. Posterior disc height (PDH), subsidence, and fusions status were compared between patients with static and expandable cages. Follow-up were reported at minimum 6-months and 1-year.

RESULTS:
A total of 120 patients had 173 cages implanted: 96 patients with 143 static cages vs. 24 patients with 30 expandable cages. Mean age was 63.4 and 62.4% were male. There were no significant differences in age, gender, BMI, smoking, or osteoporosis. Overall, PDH was significantly increased following LLIF (4.1 v 7.4 mm, p < 0.001). Static and expandable cage types had similar magnitude (3.7 v 3.3 mm, p = 0.311) and percentage (89.0% v 121.5%, p = 0.127) change in PDH, respectively. Overall incidence of cage subsidence at 6-months and 1-year was 6.9% and 10.4% respectively. There was no significant difference in subsidence rates between cage types at 6 months (7.0% v 6.7%, p = 0.949) and 1-year (11.2 v 6.7%, p = 0.461). Radiographic evidence of fusion was present in 92.7% of cases at 1-year, and both cage types achieved similar fusion rates as well (92.2% v 95.6%, p = 0.555).

CONCLUSIONS:
LLIF static and expandable cages offer similar PDH restoration depending on surgical goals. Expandable cages seem to be less prone to subsidence than smaller TLIF cage counterparts and offer similar fusion rates to static cages. Larger cohort studies are warranted to further validate these findings which are ongoing.
500 Non-Verbal Memory Decline is Greater Following Anterior Temporal Lobectomy Than Mesial Temporal Laser Ablation in Non-Dominant Temporal Lobe Epilepsy
Authors: Hulse Kyle , Grannan Benjamin , Kang Jin , Kim Michelle , Tsai Jeff , Hakimian Shahin , Hauptman Jason Scott , Ojemann Jeffrey G. , Ko Andrew Lin 
Published: March 2023

INTRODUCTION:
Although it has been shown for dominant temporal lobe epilepsy that stereotactic laser amygdalohippocampectomy (SLAH) results in less verbal memory decline than anterior temporal lobectomy (ATL), the relative cognitive effects of these surgeries in non-dominant temporal lobe epilepsy have not been directly studied.

METHODS:
A retrospective review of SLAH or ATL surgeries at the University of Washington from 2014 to 2020 was conducted. Hemisphere dominance was determined using WADA testing or functional MRI. Patients that received non-dominant SLAH or ATL and pre- and post-operative neuropsychological testing were analyzed. A composite non-verbal visuospatial memory variable was created using Z-score normalization of the Visual Reproduction (VR) and Rey Complex Figure Test (RCFT) tasks. The Rey Auditory Verbal Learning Test (RAVLT) was used for verbal memory analysis. Paired t-test analysis was used to compare cognitive score distributions. Two-way ANOVA was used to assess the effects of seizure freedom (Engel score 1) and surgical intervention factors on cognitive improvement.

RESULTS:
Pre- and post-operative neuropsychological testing was available for 26 patients (14 SLAH, 12 ATL). Non-verbal visuospatial memory significantly decreased after ATL (mean -0.18 to -0.82, p = 0.025, n = 11) but not after SLAH (mean -0.55 to -0.57, p = 0.96, n = 14). There were no observed changes in verbal memory after ATL (mean -0.41 to -0.07, p = 0.22, n = 11) or SLAH (mean -0.13 to 0.-42, p = 0.26, n = 13). Seizure freedom was a significant factor in explaining non-verbal memory improvement, even when modeled with surgical intervention interaction term (ANOVA, p = 0.04).

CONCLUSIONS:
Patients undergoing non-dominant ATL experience a greater reduction in visuospatial memory metrics compared to patients undergoing SLAH. Independent of surgery type, seizure freedom is associated with improved non-verbal memory outcome.
504 Safety and Efficacy of Brain-Responsive Neurostimulation Treatment With Depth Leads Placed in the Neocortex
Authors: Purger David Arnold , Parker Jonathon J. , Sadeghzadeh Sina , Mirro Emily , Karakis Ioannis , Gross Robert E. , Wu Chengyuan , Drees Cornelia , Raslan Ahmed M.T. , Ernst Lia , Nerison Caleb , Sather Michael D. , Jobst Barbara , Aronson Joshua P. , Halpern Casey H. 
Published: March 2023

INTRODUCTION:
Responsive neurostimulation (RNS) is efficacious in treating medically refractory epilepsy arising from neocortical foci. During clinical trials, most patients with neocortical seizure foci received cortical strip leads, perhaps due to intracranial monitoring with subdural grids/strips. Stereo-electroencephalography (sEEG) has become more widely utilized since the trials, resulting in increased placement of neocortical RNS depth leads. This is also an appealing approach when dural adhesions make strip lead implantation difficult.

METHODS:
We conducted retrospective chart review of adult patients with refractory epilepsy at seven institutions who underwent placement and connection of at least one RNS depth lead in the neocortex.

RESULTS:
61 neocortical depth leads were connected to the RNS neurostimulator in 53 patients. 33 patients had additional depth leads in a non-neocortical focus, and 12 had an additional neocortical strip lead. Median follow-up was 2.2 years (range: 0.4 – 5.2 years). Median clinical seizure reduction in seizures was 63% at 1 y and 75% at last follow-up. 12 patients (23%) were seizure-free at last follow-up; a majority of these (83%) were seizure-free for >6 mo, with five patients seizure-free for >1 y. There were two (3.8%) scalp infections. One patient (1.9%) had each of the following: chemical meningitis, epidural hematoma, post-surgical status epilepticus (resolved with stimulation), new-onset non-epileptic seizures, and stimulation-related nausea (resolved with programming).

CONCLUSIONS:
Our multicenter series of 53 patients with neocortical-onset epilepsy treated with neocortical RNS depth leads demonstrated 75% median seizure reduction at 2 y of follow-up with a similar safety profile to placement of deep brain electrodes for movement disorders. Neocortical depth leads may be preferred with the RNS system following sEEG evaluation and/or if strip placement poses increased surgical risk.
511 Regional Patterns of Decreased Grey-Matter Volume are Associated with Non-Response to Temporary CSF Drainage in iNPH
Authors: Lang Stefan T. , Dimond Dennis , Isaacs Albert M. , Dronyk Jarred , Hamilton Mark G. 
Published: March 2023

INTRODUCTION:
Temporary drainage of cerebrospinal fluid (CSF) by lumbar puncture or lumbar drain has a high predictive value for identifying patients with idiopathic normal pressure hydrocephalus (iNPH) who will benefit from shunt insertion. However, it is unclear what differentiates responders from non-responders. One hypothesis is that there are patterns of reduced grey-matter volume (GMV) that predispose patients to a poor response.

METHODS:
Subjects included 132 patients with iNPH who underwent testing with temporary CSF drainage and who had undergone structural MRI between 2013 and 2021. Subjects were classified as responders or non-responders to temporary CSF drainage based on clinical examination and standardized measures of cognition (MoCA) and gait velocity. Demographic and clinical variables were examined between groups. Group differences in GMV were assessed using VBM while adjusting for age, sex, and total intracranial volume.

RESULTS:
There were 87 responders and 45 non-responders. There were no differences in age, sex, baseline gait velocity, CSF volume, or white-matter T2 hyperintensity volume. Non-responders had higher baseline MoCA scores and were more likely to have received lumbar puncture vs extended lumbar drainage. Responders had greater increases in MoCA and gait velocity scores. Non-responders demonstrated decreased GMV in the right supplementary motor area and in the right posterior parietal cortex as compared to responders.

CONCLUSIONS:
Decreased GMV in the supplementary motor area and posterior parietal cortex may identify patients with suspected iNPH likely to experience a negative response following temporary CSF drainage. These patients may have limited capacity for recovery due to atrophy in these regions known to be important for motor and cognitive integration.
560 Mechanical Thrombectomy Versus Best Medical Therapy for Medium Vessel Occlusions: A Cost-Effective Analysis Using Local Get with the Guidelines Registry Data
Authors: Lim Jaims , Monteiro Andre , Siddiqi Manhal , Kuo Cathleen , Baig Ammad , Khawar Wasiq , Davies Jason , Levy Elad I. , Siddiqui Adnan Hussain 
Published: March 2023

INTRODUCTION:
Equipoise exists in regards to whether mechanical thrombectomy (MT) is superior to best medical management (BMM) in patients with acute ischemic stroke due to medium vessel occlusion (MeVO). While clinical outcome differences may not be statistically significant in prior series, MT for MeVO may still be cost-effective (CE).

METHODS:
The local Get with the Guidelines (GTWG) registry data was queued. Patients with MeVO documented on CTA presenting with NIHSS >5 and treated with MT or BMM within 12 hours from symptom onset were included. Rates of each mRS outcomes was collected. Stroke cost data was derived from previous stroke literature including costs associated with imaging done at admission (non-contrast CT, CT Angiography, and CT perfusion), MRI 24 hours post-stroke, perfusion maps software, intravenous alteplase, physician and personnel costs, and thrombectomy. Costs associated with each mRS from presentation to 90-days and post-90 day care were collected. Utilizing the clinical data from GTWG registry and costs from the literature, TreeAge Pro was used to generate cost-effectiveness ratios (CE-ratio).

RESULTS:
Both the MT and BMM groups were similar in age, comorbidities, NIHSS and time to presentation. MT was found to be more cost-effective (CE-ratio 93,500) compared to BMM (CE-ratio 101,496. MT was more costly (total cumulative cost $59,840) than BMM (total cumulative cost $51,763). MT and BMM respectively had an effectiveness score of 0.64 and 0.51.

CONCLUSIONS:
This is one of the first CE studies comparing MT and BMM in acute ischemic strokes due to MeVO. We demonstrate based on GTWG data and costs in the literature that MT is more CE than BMM.
625 The Impact of the Mexico-San Diego Border Wall Extension on Spinal Injuries
Authors: Tenorio Alexander , Brandel Michael G. , Produturi Gautam , McCann Carson , Costantini Todd , Doucet Jay , Ciacci Joseph D. 
Published: March 2023

INTRODUCTION:
San Diego, California has one of the busiest international land borders in the world, and its unauthorized crossing is a contentious issue. The recent border height extension along the San Diego-Mexico border has led to a new set of physical risks to unauthorized individuals traversing the wall.

METHODS:
In this retrospective cohort study, patients who presented to the UC San Diego Trauma Center between 2016 and 2021 were considered. Two different cohorts were compared: pre-height extension (Jan 2016-May 2018), and post-height extension (January 2020-December 2021). Demographics, clinical data (fracture morphology, operative intervention, concurrent injuries, length of stay), and hospital costs were collected. Spinal injuries were normalized using Customs and Border Protection (CBP) apprehensions to adjust for changing migration rates. Statistical analysis was completed with Stata MP Version 14.1 (Stata Corp LP).

RESULTS:
A total of 114 patients met inclusion criteria: 12 in the pre-height extension period, and 102 in the post-height extension period. The increase in spine injuries per month (0.8 to 4.25) and operative spine injuries per month (0.3 to 1.7) were statistically significant (P < 0.001). Concurrent extremity injuries were also significantly increased (8.3 vs. 43.1%, p = 0.02). The severity of injuries and economic costs were reflected in median length of stay (6 vs. 9 days; p = 0.006) and median total hospital charges ($150,914 to $293,798; p < 0.001).

CONCLUSIONS:
The data support that the San Diego-Mexico border wall extension is correlated with more frequent, severe, and costly spinal injuries. These findings advocate for reevaluating our current border wall infrastructure as this represents a humanitarian and public health crisis.
660 Intraoperative O-C2 and O-EA Angular Measurements for Achieving Optimal Alignment During Posterior Fossa Decompression and Occipitocervical Fusion for Complex Chiari Malformation
Authors: Han Rachael , Chae John Kyungjun , Garton Andrew L.A. , Medary Branden , Navarro-Ramirez Rodrigo , Hussain Ibrahim , Hartl Roger , Greenfield Jeffrey P. 
Published: March 2023

INTRODUCTION:
Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications such as dysphagia and neck pain. Achieving neutral craniocervical alignment intraoperatively can be challenging in patients with Chiari malformation (CM) with craniocervical instability (CCI) undergoing posterior fossa decompression (PFD) and OCF because the head must be flexed for optimal PFD and subsequently extended to neutral for OCF.

METHODS:
We retrospectively reviewed patients with CM 1 and 1.5 who underwent PFD and OCF. Patient demographics, preoperative presentation, XR morphometrics, operative details, postoperative complications, and clinical outcomes were analyzed.

RESULTS:
Out of 39 patients (mean age 24.6 years, range 3-51, 76.9% female), 37 patients did not require revision surgery after PFD and OCF. In this non-revision cohort, O-C2a (13.5 ± 10.4° vs. 17.5 ± 10.1°, P = .047) and nPAS (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = .007) increased significantly after surgery. In 2 patients who required revision due to postoperative dysphagia, these measurements acutely decreased after initial surgery (mean difference -16.6° in O-C2a and -12.8° in O-EAa), and revision surgery restored the morphometrics back to baseline. Applying these observations, we now intraoperatively measure these fluoroscopic morphometrics and ensure neutral craniocervical alignment using the Mayfield head clamp locking mechanism prior to hardware placement.

CONCLUSIONS:
Utilizing fluoroscopic morphometrics pre- and intra-operatively can guide surgeons in appropriate positioning during combined PFD and OCF. With neutral rotatory fixation, single-axis flexion/extension of the head during each stage of the surgery with the Mayfield head clamp locking mechanism facilitates positioning in conjunction with these fluoroscopic-based measurements.
677 Do Flare-Ups in Systemic Disease Activity Correlate to Cervical Deformity in Patients With Rheumatoid Arthritis?
Authors: Lebouille-Veldman Anna , Spenkelink Dylan , Vleggeert-Lankamp C.L.A. 
Published: March 2023

INTRODUCTION:
Following the introduction of biological DMARDs in Rheumatoid Arthritis (RA) treatment, cervical spine deformity seems to be less prevalent in those patients. It seems that this vast decline in patients with Atlanto-axial Subluxation (AAS), Subaxial Subluxation (SAS) or Vertical Subluxation (VS) is correlated to better control of systemic disease activity (DAS). The aim of the current study is to correlate the frequency of flare-ups in DAS to cervical spine deformity.

METHODS:
272 RA patients were included and cervical deformity (AAS and/or SAS) was observed in 108 patients. 84 (31%) patients were in remission at 10 years FU and 206 (75%) of patients reached remission at least once during 10 years FU. Patients with cervical spine deformity at 10 years had less flare-ups (1.26) in DAS than patients without cervical spine deformity (1.58; 95% CI: 0.013-0.627).

RESULTS:
So, even though the BeSt Trial was designed to optimize treatment, 40% of the patients still developed RA-associated cervical spine deformity. However, remarkably, patients with more flares had less cervical deformity. This may be explained by the treatment regimen that anti-inflammatory medication is augmented upon measuring a systemic flare-up.

CONCLUSIONS:
This raises the hypothesis that RA medication treatment regimes should not be solely aimed at DAS values, as they are currently defined, in order to avoid cervical deformity in RA in the long term.
765 Outcome of Chronic Subdural Hematoma Management in Patients on Long Term Antiplatelet Therapy—A Propensity Score Matched Analysis
Authors: Salih Mira , Salem Mohamed M. , Ravina Kristine , Stippler Martina , Papavassiliou Efstathios , Alterman Ron L. , Thomas Ajith , Moore Justin M. , Ogilvy Christopher S. 
Published: March 2023

INTRODUCTION:
Chronic subdural hematomas (cSDH) are particularly common in frail older adults given their increased risk of falls, and the fact that they often have conditions that require antithrombotic agents, such as antiplatelets.

METHODS:
Patients who underwent surgical management for subdural hematoma (SDH) at our institution between January 2006 and June 2021 were identified. Propensity score matched analysis was used to make a balance in patients on antiplatelets before procedure vs those who were not on antiplatelets and patients on antiplatelets post-procedure vs those who were not. Length of hospitalization, peri-procedural complications, reintervention rate during the same admission, rebleeding risk and reintervention rates after discharge were compared.

RESULTS:
In total, 180 patients were on long-term antiplatelets before procedure, while 286 were not. After matching, 57 pairs were included in analysis. Post-procedure, 76 patients were started on long-term antiplatelets, the rest were not. Then 44 patients in each group were included in the analysis after matching. Comparing the pre-procedure antiplatelet group with non-antiplatelet group, no significant differences were found in length of hospitalization (7.9 ± 5.5 vs 9.2 ± 7.7, p = 0.28), procedural complications (3.5% vs 5.3%, p = 0.65), or reintervention during the same admission (10.5% vs 3.5%, p=0.14). In the comparison of post-procedure antiplatelet group and non-antiplatelet group, no significant differences were seen in recurrence rate (9.1% vs 13.6%, p = 0.5) or reintervention rate after discharge (4.5% vs 4.5%, p = 1).

CONCLUSIONS:
Being on long-term antiplatelets before cSDH procedures does not affect length of hospitalization, peri-procedural complications or reintervention during the same admission. Similarly, long-term antiplatelets after cSDH procedure does not increase rebleeding risk or reintervention rate. Our data suggest that similar management protocols can be applied to both groups of patients, and it is safe to restart antiplatelet agents in the setting of a chronic subdural hematoma (cSDH).
840 Dorsolateral Prefrontal Cortex Beta Power Dynamics Underlying Verbal Working Memory Encoding in Parkinson’s Disease
Authors: Paulo Danika Lea , Qian Helen , Subramanian Deeptha , Johnson Graham Walter , Bick Sarah KB 
Published: March 2023

INTRODUCTION:
Cognitive impairment (CI) is the most frequent nonmotor symptom in Parkinson’s Disease (PD) and is associated with deficits in executive functions such as working memory (Kehagia et al, 2010). Previous studies have demonstrated that caudate and DLPFC beta power underlie learning and working memory (Bick et al, 2019). Decreased dopamine in motor cortico-striato-thalamo-cortical (CSTC) circuits results in increased beta power and PD motor symptoms (Lapidus et al, 2014). Analogous changes in cognitive CSTC circuits, including the dorsolateral prefrontal cortex (DLPFC), may contribute to PD CI and be a target for neuromodulation. Better understanding of anatomic structures and neurophysiologic changes associated with working memory deficits is needed to develop potential neuromodulatory treatment strategies for PD CI.

METHODS:
Thirteen PD and ten ET patients who underwent deep brain stimulation in 2021 at Vanderbilt University Medical Center were consented and included in this analysis. Intraoperative local field potential recordings were obtained from the DLPFC during a 2-back verbal memory task with performance feedback (Owen et al, 2005). Signals were sampled at 1000Hz, Butterworth band pass filtered, de-meaned and averaged across patients. Average beta power differences 500-1000 msec following image onset were analyzed for correct and incorrect trials for PD and ET patients.

RESULTS:
PD patients exhibited significantly lower mean beta power compared to ET patients for correct trials (p = 0.0305, Wilcoxon rank-sum test).

CONCLUSIONS:
Neurophysiologic patterns underlying working memory encoding deficits in PD patients may reflect underlying dopaminergic dysfunction in cognitive CSTC circuits that result in CI. Structures within this circuit may be implicated in PD memory impairment and may serve as potential secondary targets for neuromodulation to improve working memory in patients with comorbid CI.
875 The Role of Frailty in Geriatric Cranial Neurosurgery for Primary Central Nervous System Neoplasms
Authors: Shahrestani Shane , Brown Nolan James , Ransom Seth C. , Ballatori Alexander , Ton Andy , Chen Xiao , Singh Rohin , Gendreau Julian , Sahyouni Ronald 
Published: March 2023

INTRODUCTION:
Frailty is a clinical state of increased vulnerability due to age-associated decline and has been well established as a perioperative risk factor. Yet, literature describing the effects of frailty on short- and long-term complications in geriatric patients is limited.

METHODS:
The authors conducted a retrospective cohort study between 2010 and 2017 by using the Nationwide Readmission Database. Demographics and frailty were queried at primary admission, and readmissions were analyzed at 30-, 90-, and 180-day intervals. Nearest-neighbor propensity score matching for demographics was implemented to identify nonfrail control patients with similar diagnoses and procedures. The analysis used Welch two-sample t-tests for continuous variables and chi-square test with odds ratios.

RESULTS:
A total of 6713 frail patients and 6629 nonfrail patients were identified at primary admission. At primary admission, frail geriatric patients undergoing cranial neurosurgery had increased odds of developing acute posthemorrhagic anemia (OR 1.56, 95% CI 1.23-1.98; p = 0.00020); acute infection (OR 3.16, 95% CI 1.70-6.36; p = 0.00022); acute kidney injury (OR 1.32, 95% CI 1.07-1.62; p = 0.0088); urinary tract infection prior to discharge (OR 1.97, 95% CI 1.71-2.29; p < 0.0001); acute postoperative cerebral infarction (OR 1.57, 95% CI 1.17-2.11; p = 0.0026); and mortality (OR 1.64, 95% CI 1.22-2.24; p = 0.0012) compared to nonfrail geriatric patients receiving the same procedure. In addition, frail patients had a significantly increased inpatient length of stay (p < 0.0001) and all-payer hospital cost (p < 0.0001) compared to nonfrail patients at primary admission.

CONCLUSIONS:
Frailty may significantly increase the risks of short-term acute complications in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. Long-term analysis revealed no significant difference in complications between frail and nonfrail patients.