bluuebunny/crossref_metadata_2025_split huggingface dataset:
665 A Nationwide Study Characterizing the Risk and Outcome Profiles of Multilevel Fusion Procedures in Neuromuscular Scoliosis Patients With Neurofibromatosis Type 1
Authors: Price Gabrielle , Martini Michael Louis , Caridi John M. , Lau Darryl , Oermann Eric Karl , Neifert Sean N. 
Published: March 2023

INTRODUCTION:
Spine abnormalities are a common manifestation of Neurofibromatosis Type 1 (NF1); however, the outcomes of surgical treatment for NF1-associated spinal deformity are not well explored.

METHODS:
The National Inpatient Sample was queried for NF1 and non-NF1 patient populations with neuromuscular scoliosis who underwent multilevel fusion surgery involving eight or more vertebral levels between 2004 and 2017. Multivariate regression modeling was used to explore the relationship between perioperative variables and pertinent outcomes.

RESULTS:
Of the 55,485 patients with scoliosis, 533 patients (0.96%) had NF1. Patients with NF1 were more likely to have comorbid solid tumors (p < 0.0001), clinical depression (p < 0.0001), peripheral vascular disease (p < 0.0001), and hypertension (p<0.001). Following surgery, NF1 patients had a higher incidence of hydrocephalus (0.6% vs. 1.9% p=0.002), seizures (4.9% vs. 5.7% p = 0.006), and accidental vessel laceration (0.3% vs. 1.9% p = 0.011). Although there were no differences in overall complication rates or in-hospital mortality, multivariate regression revealed NF1 patients had an increased probability of pulmonary (OR 0.5, 95% CI 0.3-0.8, p = 0.004) and neurological (OR 1.8, 95%CI 1.0-3.3, p = 0.053) complications. There were no significant differences in utilization, including non-home discharge or extended hospitalization; however, patients with NF1 had higher total hospital charges (OR -$18739, SE 3384, p < 0.0001).

CONCLUSIONS:
These findings indicate that NF1 is associated with certain complications following multilevel fusion surgery but does not appear to be associated with differences in quality or cost outcomes. These results provide some guidance to surgeons and other healthcare professionals in their perioperative decision making by raising awareness about risk factors for NF1 patients undergoing multilevel fusion surgery. We intend for this study to set the national baseline for complications after multilevel fusion in the NF1 population.
666 Comparison of Minimally Invasive and Open Surgical Approaches for Intradural-Extramedullary Spine Tumors: A Systematic Review and Meta-Analysis
Authors: Urooj Faiza , Baig Ahmer Nasir , Bajwa Mohammad Hamza , Shamim Shahzad M. 
Published: March 2023

INTRODUCTION:
Traditionally spinal intradural-extramedullary (ID-EM) tumors have been accessed via open surgery. Removal of these tumors involves significant tissue damage, prolonged recovery, and risk of infection. More recent minimally invasive surgery (MIS) techniques aim to reduce these risks and complications while achieving similar goals of surgery as traditional approaches.

METHODS:
A systematic literature search was employed (PROSPERO#CRD42022302574) with searches through PubMed (MEDLINE), EBSCO, and Wiley Cochrane Library databases from conception till 9th January 2022. Cohort and case series studies with comparisons of minimally-invasive and open surgery for ID-EM spinal tumors were included; pooled sampled data were included in the random-effects (Mantel-Haenszel method) model for meta-analysis.

RESULTS:
Our search strategy yielded 403 total articles across these databases – after systematic review and exclusion, 13 studies were included for qualitative and quantitative analysis. On meta-analysis, minimally-invasive approaches were non-inferior to open surgery for achieving gross total resection (RR = 1.01, 95% CI 0.94 – 1.09, p = 0.78, I2 = 0%). Intraoperative blood loss (MD = -119.18, 95% CI -157.83 - -80.52, p < 0.0001, I2 = 89%), operative time (MD = -25.94, 95% CI -50.28 – -1.60, p = 0.04, I2 = 91%), and length of stay (MD=-2.50, 95% CI -3.89 – -1.10, p = 0.0004, I2 = 95%) were significantly lower within cohorts undergoing MIS surgery for ID-EM spinal tumor.

CONCLUSIONS:
Data within the reviewed studies suggest similar rates of gross total resection within MIS and open surgery cohorts for ID-EM spinal tumors. Moreover, MIS affords shorter hospital stays, decreased blood loss, and operative time for patients. For certain patient groups, MIS spinal tumor resection can be preferred over standard surgical approaches, with preservation of function and decreasing overall surgical complications.
668 Intraoperative Ultrasound Elastography is a Promising Technology to Quantify Reduced Spinal Cord Tension During Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome
Authors: Judy Brendan F. , Kerensky Max , Hersh Andrew , Weber-Levine; Amanda Sacino Carly , Liu Ann , Jin Yike , Jiang Kelly , Young Lisa , Routkevitch Denis , Perdomo-Pantoja Alexander , Davidar Daniel , Manbachi Amir , Theodore Nicholas 
Published: March 2023

INTRODUCTION:
Tethered cord syndrome (TCS) has been traditionally treated with detethering surgery.1,2 Posterior vertebral column subtraction osteotomy (PVCSO) is a novel surgery that can treat TCS while avoiding complications of detethering surgery, such as retethering or cerebrospinal fluid leaks.2-6 The pathophysiology of PVCSO is not completely understood. However, the hypothesis is that shortening the vertebral column decreases the spinal cord (SC) tension thereby improving neurological function. Intraoperative ultrasound elastography (USE) is well suited to elucidate the changes that can occur in SC parenchyma secondary to PVCSO.7,8 Through different modalities, such as superb microvascular imaging (SMI) and elastography (USE), US can analyze changes in blood flow and tissue tension.9

METHODS:
Three patients with recurrent TCS underwent PVCSO and intraoperative USE to analyze the tension of the SC at 3 timepoints: pre-, mid- and post-shortening.

RESULTS:
All three patients (two female, one male) had undergone multiple detethering surgeries. Prior to shortening, the median SC elasticity of all patients was 9.8 kPa (IQR 9.7-12.4 kPa). After complete compression of the rods, the SC elasticity decreased by 17.4% to 7.7 kPa (6.5-9.7 kPa). All patients had significant improvement in sensation and reduction in pain at their 2 month follow up appointment.

CONCLUSIONS:
Here we report the first use of USE to demonstrate decreased SC tension after PVCSO for TCS. All patients reported improved symptoms and USE demonstrated decreased SC tension after shortening. USE is a promising tool for evaluating tissue elasticity and blood flow in spinal pathologies, including TCS. This technology serves as an intraoperative confirmation that SC tension decreases after PVCSO. Patients and neurosurgeons both benefit from an intraoperative objective tool to demonstrate reduced SC tension.
675 Chemoprophylactic Anticoagulation Causes a Marked Decrease in Thromboembolic Events Following Lumbar Fusion: Causal Inferences from a Propensity-Matched Analysis of 1302 patients
Authors: Cloney Michael , Koski Tyler R. , Dahdaleh Nader S. 
Published: March 2023

INTRODUCTION:
Chemoprophylactic anticoagulation is commonly used to prevent venous thromboembolic events (VTE) after lumbar fusion. However, the magnitude of the associated risk reduction is not well described, and conventional retrospective statistical methods preclude causal inferences from this association.

METHODS:
1302 consecutive lumbar fusions performed at our institution over a six-year period were identified, and relevant clinical and demographic data were collected. VTE events within 30 days postoperatively were identified. Patients who were given chemoprophylaxis and controls were matched according to age, body mass index, sex, Charlson Comorbidity Index, history of VTE, estimated blood loss, length of surgery, transfusion, whether surgery was staged, and whether surgery used an anterior approach. K-nearest neighbor propensity score matching was performed, and covariate adjustments were made to draw causal inferences regarding VTE rate.

RESULTS:
Unadjusted, there was no difference in the rate of VTE between patients who did (3.8%) and did notreceive chemoprophylaxis (4.4%, OR = 0.86 [0.47, 1.58], p = 0.667). On multivariable regression, and chemoprophylaxis was negatively associated with VTEs (OR = 0.38 [0.15, 0.95], p = 0.039). 589 lumbar fusion patients with and without chemoprophylaxis were successfully matched. After matching, median bias was 1.9%, and overall known bias was reduced by a median of 91.4%. After matching, covariates were well balanced (Rubin's B = 21.8). A covariate adjusted logistic regression model confirmed that chemoprophylaxis was associated with reduced odds of VTE (OR = 0.40 [0.16, 0.98], p = 0.044). The average treatment effect of chemoprophylaxis was a reduction in VTE of 3.7%. The only instance of epidural hematoma occurred in the control group.

CONCLUSIONS:
Among patients undergoing lumbar fusions, chemoprophylactic anticoagulation causes a marked decrease in VTE.
745 Medical Student Specialty Decision Making by Gender: Perceptions of Neurosurgery
Authors: Pugazenthi Sangami , Johnson Gabbie , Lee Hedwig , Strahle Jennifer 
Published: March 2023

INTRODUCTION:
Although 50% of medical school graduates are female, less than 30% of neurosurgery residency applicants are female and less than 10% of neurosurgeons are female. More information is needed to understand the disproportionately low interest in neurosurgery for female medical students.

METHODS:
A Qualtrics survey was administered at Washington University School of Medicine to survey all MD/MD-PhD students to assess factors influencing medical student specialty decision making and perceptions of neurosurgery. Likert scale responses converted to numerical values on a 5-point scale were analyzed by Mann Whitney-U tests. Chi Squared analyses were performed on binary responses.

RESULTS:
Of the 131 respondents (31% response rate), 62.6% were female. When making specialty decisions, female students considered maternity/paternity leave more (P = 0.028) and salary less than their male counterparts (P = 0.072). There was no significant difference between genders in consideration of perceived happiness of people in the field, intellectual interest, perceived fit in the field, work/life integration, length of training, or having a mentor in the field, or research opportunities. Female students were more hesitant toward neurosurgery due to maternity/paternity needs (P = 0.031), and technical skill required (P = 0.020). Across both genders, the majority of medical students were hesitant towards neurosurgery due to opportunities for work/life integration (93%), length of training (88%), malignancy of the field (76%), and perceived happiness of people in the field (76%).

CONCLUSIONS:
Compared to male students, female medical students value maternity/paternity needs more in the specialty decision making process and are hesitant toward pursuing neurosurgery due to maternity/paternity needs.
746 PGY-6 Versus PGY-7 Neurosurgical Chief Year: A Survey of Residents and Program Directors
Authors: Mooney James Henry , Salehani Arsalaan , Shannon Chevis , Rozzelle Curtis 
Published: March 2023

INTRODUCTION:
Recently, more neurosurgical residency programs have transitioned from a post-graduate year (PGY)-7 to a PGY-6 chief year. There has not been a national analysis of resident and program director perceptions regarding the timing of chief year conductance and its influence on overall program satisfaction.

METHODS:
An online survey was distributed via individual institution program coordinators to all North American PGY 4-7 residents and program directors. Data regarding program size, protected research timing, chief year timing (PGY-6 vs PGY-7) and resident and program director perceptions of the influence of neurosurgical chief year timing on program satisfaction and ability of residents to practice were recorded. Survey results were summarized descriptively.

RESULTS:
A total of 134 respondents completed the survey. Thirty-five percent of respondents reported a recent program transition from a PGY-7 to PGY-6 chief year while 44% of respondents at programs conducting a PGY-7 chief year reported they were interested in transitioning to a PGY-6 chief year. The large majority of residents (76%) and program directors (80%) at PGY-6 chief year programs stated they were overall satisfied with this. A greater percentage of residents (54%) reported a positive impact of PGY-6 chief year on patient care and preparation to practice when compared to program directors (8%). A large percentage (>80%) of all respondents reported that a PGY-6 chief year provided increased opportunity for subspecialty focus, enfolded fellowships and career planning.

CONCLUSIONS:
Program directors and residents at PGY-6 chief year program s report a high level of satisfaction with many of those at PGY-7 programs desiring to make this transition. A PGY-6 chief year may allows for greater sub-specialty focus and career planning during the PGY-7 year and its impact on programs should be investigated further.
748 Utility of a Neurosurgery Sub-Internship Boot Camp in Preparing Medical Students for Neurosurgical Residency
Authors: Ng Patrick , Yearley Alexander , Gupta Saksham , Rees "Rees" Cosgrove G. , Mooney Michael Anthony 
Published: March 2023

INTRODUCTION:
The neurosurgical sub-internship is a crucial step for prospective neurosurgeons. However, the expectations for sub-interns, particularly the technical skills required by residents and attendings, are often unclear. Neurosurgical skills-based workshops have been recently applied to medical students.

METHODS:
A one-day craniotomy lab using cadaveric cranial specimens was conducted for medical students. Surveys querying important competencies for sub-internships were answered by residents and attendings at affiliated hospitals. Pre- and post-lab surveys querying interest in and perceptions of neurosurgery, self-assessment of skills, and important competencies for sub-internship preparation were answered by attendees.

RESULTS:
Medical students, residents, and attendings agreed that burr hole placement, bone replating, and galea and skin closure were of high importance for sub-interns. There was significant disagreement on the importance of dural opening, dural closure, establishing a craniotomy, and neuronavigation for sub-interns. Additional competencies expected of sub-interns include minor procedures, neuroimaging, neuroanatomy, and proactive patient care. The workshop altered perceptions of neurosurgery with significant changes in recognizing the value of peer mentorship. Students also expressed increased confidence in technical skills with significant improvements in an understanding of high-speed drill use in neurosurgery (p < 0.001).

CONCLUSIONS:
Though the expectations for sub-interns may be heterogeneous, there is general agreement that proficiency in the initial and final steps of craniotomies, as well as minor procedures, is recommended. Cadaveric labs can improve student engagement in neurosurgery and enhance technical skills.
766 Use of Ventriculostomy for Severe Traumatic Brain Injury Significantly Reduces Mortality Compared to Intraparenchymal Monitor Use
Authors: Mouchtouris Nikolaos , Luck Trevor , Yudkoff Clifford , Locke Katherine , Andrews Carrie Elizabeth , Harrop James S. , Shah Syed O. , Jallo Jack 
Published: March 2023

INTRODUCTION:
There is a lack of data on whether intracranial pressure (ICP)-guided therapy with an intraparenchymal fiberoptic monitor (IPM) or an external ventricular drain (EVD) leads to superior outcomes. Given the lack of consensus on whether an EVD or an IPM monitor should be preferentially used if both are feasible options, there is a pressing need to determine which modality leads to more effective ICP-guided therapy while also minimizing the procedure-related complications.

METHODS:
Retrospective analysis of severe TBI that required IPM or EVD placement for ICP-guided therapy from 1/1/2010-12/31/2020. The data was obtained from the Pennsylvania Trauma Systems Foundation (PTSF) registry.

RESULTS:
A total of 2,305 patients met the inclusion criteria with 1,048 (45.5%) IPM and 1,257 (54.5%) EVD placed. A craniectomy was performed in 47.0% of the patients in the IPM cohort and 66.0% of the EVD cohort (p < 0.001). Multivariable logistic regression analysis showed that older age (OR 1.03, p < 0.001), decreasing GCS score (OR 1.16, p < 0.001), requiring craniectomy (OR 1.22, p = 0.049), and an IPM (OR 1.40, p = 0.001) were significant predictors of mortality. Among those treated medically only, inpatient mortality occurred in 171 (30.8%) of those with an IPM and in 100 (23.4%) of those with an EVD (p = 0.010); the EVD conferred significant mortality benefit (30% decrease, p = 0.005) when controlling for age and admission GCS.

CONCLUSIONS:
The lack of consensus on whether IPM monitor or EVD is more effective leads to ambiguity in the treatment of patients with severe TBI. Our study demonstrates a significant improvement in mortality was associated with the use of EVD in comparison to IPM. This mortality benefit was seen in patients who underwent decompressive hemicraniectomy as well as those who did not.
768 The Device for Intraventricular Entry (DIVE) Guide: A Novel Solution to a Perpetual Problem
Authors: Blue Rachel , Jabarkheel Rashad , Ajmera Sonia , Tomlinson Samuel , Miranda Stephen , Schuster James M. , Spadola Michael 
Published: March 2023

INTRODUCTION:
Safe and reliable access to the ventricular system is a necessary skill in the neurosurgical armamentarium. The freehand technique for catheter placement remains an accepted method, yet the inaccuracy rate can be as high as 40%, with as many as 3 passes per procedure, and complication rates between 10-40%. A number of devices have been developed to assist with catheter placement, however, these devices inhibit ergonomics or require larger incisions and expensive navigation technology.

METHODS:
A novel device for ventricular entry, the DIVE guide, was designed by the first and senior author. 50 patients undergoing extra ventricular drain (EVD) or shunt placement were prospectively enrolled for DIVE assisted catheter placement under an IRB approved study with a non-significant risk (NSR) device designation. The primary outcome is catheter location on CT. Secondary outcomes include number of catheter passes, clinically significant hemorrhages and procedure-related infections.

RESULTS:
50 patients were enrolled at a single academic center for ventricular access with DIVE assistance. Indications included subarachnoid or intraventricular hemorrhage, TBI, hydrocephalus, pseudotumor and post-surgical wound drainage. 76% (38/50) underwent right sided placement and 24% (12/20) underwent left. 100% (50/50) had successful cannulation in an average of 1.06 passes. Post procedure head CT confirmed ipsilateral frontal horn or 3rd ventricle placement (Kakarla Grade 1) in 92% (46/50) and 8% (4/50) in the contralateral lateral ventricle (Grade 2). There were no significant tract hemorrhages or procedural infections.

CONCLUSIONS:
This a prospective study to investigate the safety and efficacy of DIVE-assisted ventricular access. 100% of procedures had successful ventricular cannulation, with 92% achieving Kakarla Grade 1, in an average of 1.06 passes.
794 Interventional Approaches to Symptomatic Tarlov Cysts: a Five-year Institutional Experience
Authors: Tracz Jovanna , Judy Brendan F. , Khan Majid , Witham Timothy F. 
Published: March 2023

INTRODUCTION:
Tarlov cysts are perineural collections of cerebrospinal fluid most often affecting sacral nerve roots. Up to 4.6% of the general population has one or more Tarlov cysts, with 20% of cysts becoming symptomatic, causing back pain, extremity paresthesias and weakness, bladder/bowel dysfunction, and sexual dysfunction. The most effective treatment of symptomatic Tarlov cysts, with options including nonsurgical management, cyst aspiration and injection of fibrin glue, cyst fenestration, and nerve root imbrication, is debated.

METHODS:
Retrospective chart review was conducted for 50 patients with Tarlov cysts seen at our institution in the last 5 years. Clinical outcome was determined based on improvement in one or more symptoms.

RESULTS:
36 patients with symptomatic Tarlov cysts were identified.The average age of patients with symptomatic Tarlov cysts was 55.67 years (range, 2–77). Common symptoms were back pain/sacrococcygeal (94.4%), radiculopathy (66.7%), and bladder/bowel dysfunction (33.3%). 12% of patients had underlying connective tissue disorders (CTD), 44% of patients had bilateral cysts, and 16% of patients had cysts in multiple regions. 47.2% of patients with symptomatic Tarlov cysts were managed nonsurgically; 50% were managed with CT-guided aspiration of the cyst with or without injection of fibrin glue. Of patients treated interventionally, 47.4% saw lasting clinical improvement, with the most improvement in patients after aspiration with fibrin glue injection, 10.5% saw improvement for ≥ 6 months, and 36.8% saw no improvement or temporary improvement for < 6 months.

CONCLUSIONS:
Patients with symptomatic Tarlov cysts who underwent cyst aspiration with injection of fibrin glue saw the most clinical improvement. As a significant portion of patients with Tarlov cysts have CTD, evaluation by rheumatology may be warranted.
803 Outcome Analysis of Surgical Management of Paediatric Cervical Kyphotic Deformity (CKD): An Institutional Experience
Authors: Kumarasamy Sivaraman , Sawarkar Dattaraja , Kumar Rajinder , Chandra Sarat P. , Kale Shashank S. , Singh Pankaj Kumar 
Published: March 2023

INTRODUCTION:
Paediatric cervical kyphotic deformity (CKD) is extremely rare and occurs due to congenital, traumatic, metabolic or neoplastic processes which mandates surgical correction. Most outcomes analysis following surgery are small retrospective case series and are limited to specific etiology or surgical technique.

METHODS:
Patients (aged ≤ 18 years) operated at a tertiary centre between January 2009 to April 2022 were included. Besides demographic details, the outcome measures assessed were clinical (Nurick grading, mJOA score), radiological (Cobb’s angle) and operative complications.

RESULTS:
A total of twenty-two patients were included, with mean age of 12.90 4.02 years (3 – 18) of which ten were syndromic, three were metabolic, seven were post-traumatic and one post-infective. Thirteen patient had features of myelopathy on presentation. All underwent surgical correction, of which nine patients underwent Antero-posterior approach, eight patients underwent Posterior only approach and four patients underwent Anterior only approach. Clinically, patients improved postoperatively with – Nurick grade (pre vs. post: 3.24 vs. 2.24, p – 0.172), mJOA score (pre vs. post: 10.19 vs. 12.71, p – 0.679). There was significant deformity correction from 37.086° to 13.725° (p – 0.045). Mean blood loss encountered was 680 ± 671.93 cc. Early complications included intraoperative hemodynamic instability (4) and lung collapse (1). Late complications included junctional kyphosis (1). Mean follow-up was 49.38 ± 44.15 months.

CONCLUSIONS:
Pediatric CKD are rare, debilitating condition which can be managed surgically. Antero-posterior approach provides circumferential decompression and better correction compared to Anterior only and posterior only approach. Patients should be screened for syndromic association and regularly followed.