bluuebunny/crossref_metadata_2025_split huggingface dataset:
367 Microendoscopic Posterior Cervical Foraminotomy in the Ambulatory Setting: A Longitudinal Experience
Authors: Monk Steve Hubert , Zeitouni Daniel , Cowan David , Rossi Vincent , Smith Mark D. , Kim Paul Keetae , Adamson Tim E. 
Published: March 2023

INTRODUCTION:
Posterior cervical foraminotomy (PCF) is a motion-sparing surgical option for unilateral cervical radiculopathy caused by foraminal stenosis. The evolution of microendoscopic (MED) techniques makes it an ideal procedure for the outpatient setting. There are few studies to date that report the safety and efficacy of this procedure specifically in the ambulatory setting.

METHODS:
This study was a retrospective case series of all patients who underwent MED-PCF at a single ambulatory surgery center over a 6-year period. Standard demographic and perioperative data were collected. Outcome measures included visual analog scale (VAS) pain scores, postoperative complications, 30-day readmission, and need for reoperation at the index or adjacent levels.

RESULTS:
A total of 825 patients underwent MED-PCF during the 6-year study period. Mean age was 56.5 years. Most patients underwent decompression at C5-6 (260, 31.5%) or C6-7 (426, 51.6%). Eighty-five patients (10.3%) underwent surgery at multiple levels. Mean operative time was 38.0 minutes for single-level cases and 53.1 minutes for multilevel cases. There were no intraoperative or immediate postoperative complications. All patients were discharged home with an approximate length of stay of 3 hours (mean 182.7 ± 44.8 minutes). The vast majority of patients (85.7%) experienced improved VAS pain scores postoperatively and achieved a good or excellent clinical outcome (75.8%) according to the Odom criteria. Almost half (43.5%) had complete resolution of their preoperative pain (ie. postoperative VAS pain score of 0). Very few patients (5, 0.6%) were readmitted within 30 days. Only 46 patients (5.6%) required reoperation at the index level (35, 4.2%), adjacent level (16, 1.9%), or both (5, 0.6%). Mean follow-up was 13.4 months.

CONCLUSIONS:
MED-PCF can be performed safely in the ambulatory setting with excellent efficacy and low reoperation rates.
368 Development, Outcome and Costs of a Simulation-Based Neurosurgery Bootcamp at the National Level
Authors: Bakhshi Saqib , Ahmad Rida , Hussain Merchant Asma Altaf , Noorali Ali Aahil , Rahim Komal Abdul , Qadeer Namra , Afzal Noreen , Ali Lakhdil Maryam Piyar , Shamim Shahzad M. , Haider Adil Hussain 
Published: March 2023

INTRODUCTION:
With a growing interest in simulation-based training to develop clinical proficiency, bootcamps have been utilized for imparting basic skills to medical trainees. Some research on the topic has been published from high income countries, with considerable costs of the course. No such neurosurgical teaching standards have been employed in Low-and Middle-Income Countries

METHODS:
It was a cross-sectional study. Twenty two participants hailing from 6 institutes attended 12 lectures, and practiced 12 hands-on skills. Burr-holes and craniotomies were done on 3D printed skulls. Lumbar drain insertion was practiced on a lumbar puncture mannequin. For laminectomy, we used an indigenously designed simulator. Knowledge was assessed via a pre and post study design using a validated tool, while the modified Objective Structured Assessment of Technical Skills tool was utilized for skills Assessment. Feedback from faculty and residents was collected via a standard 5-point Likert scale.

RESULTS:
Only one participant (4.55%) had previously attended a neurosurgical skills workshop. Comparison of knowledge assessment scores of the participants on topics taught showed significant improvement (p value = 0.034). Comparison of outcomes on 1st and 3rd attempts of cranial and spinal skills showed a significant improvement in all 14 domains assessed. Positive feedback was received ranging from 3.9 up to 4.8 on a 5 point Likert scale. Overall cost per participant culminated to $145, significantly lower than previously reported data.

CONCLUSIONS:
Our findings report the effectiveness of sustainable, low-cost training models which can be easily reproduced elsewhere. This indigenously designed inexpensive simulator can be modified for variable difficulty level and serve as an effective educational strategy in improving learners’ skills, knowledge and confidence.
372 IPSC-Derived NK cells Exhibit Potent In Vitro and In Vivo Tumorcidal Activity Against Patient-Derived Glioblastoma Stem Cells (GSCs)
Authors: Ning Jianfang , Davis Zachary , Cichocki Frank , Wang Hongbo , Tuininga Katie , Bjordahl Ryan , Lee Tom , Miller Jeffrey , Chen Clark C C. 
Published: March 2023

INTRODUCTION:
Natural Killer (NK) cells play pivotal roles in cancer immune surveillance and harbor potent anti-tumor activities. We have engineered an induced pluripotent stem cells (iPSCs) derived, NK cell (termed FT538) that express 1) a high-affinity non-cleavable CD16 Fc receptor to facilitate antibody engagement 2) a membrane-bound IL-15/IL-15 receptor fusion to enhance NK activity and persistence and 3) a knock-out of CD38 to enhance NK metabolic fitness. FT538 is produced in a GMP-compliant manner as an off-the-shelf immunotherapy. Clinical experiences with FT538 have shown evidence of durable anti-tumor immunity after single administration in select lymphoma patients.

METHODS:
Laboratory characterization and murine modeling.

RESULTS:
Without specific antibody to engage CD16, FT538 exhibited potent in vitro activity against ∼80% of a panel of isocitrate dehydrogenase wild-type patient derived xenograft (PDX) glioblastoma lines, including MGG8. When directly injected into the murine brain, 50% of the FT538 persisted for >2 weeks without addition of exogenous cytokine. Moreover, the mice exhibited no evidence of neurologic compromise, and brains harvested after injection show no signs of FT538 activation. In vivo intratumoral injection of FT538 into an orthotopically established MGG8 glioblastoma caused an ∼20 fold increase in granzyme B release by FT538, with a comparable increase of cleaved Caspase 3 in the tumor proper. In independent experiments, >90% of mice orthotopically implanted MGG8 survived beyond 100 days after intra-tumoral FT538 while all mice treated with mock injection died by 60 days. For glioblastoma PDX refractory to FT538, such as MGG4, tumoricidal activity of FT583 can be induced in vitro and in vivo by the addition of a tri-specific engager targeting B7H3, a surface protein highly expressed in glioblastomas.

CONCLUSIONS:
Our results suggest that FT538 great promise as a glioblastoma therapy, with plans for translation into a first-in-human clinical trial.
377 Evaluating Large-Scale Brain Networks Patients With Brain Tumors: A Machine Learning Analysis of 100 Consecutive Patients
Authors: Morell Alexis Andres , Eichberg Daniel Green , Shah Ashish Harish , Luther Evan , Lu Victor M. , Merenzon Martin , Kader Michael , Higgins Dominique , Patel Nitesh Vijay , Komotar Ricardo Jorge , Ivan Michael E. 
Published: March 2023

INTRODUCTION:
Large-scale brain networks and higher cognitive functions are frequently altered in neuro-oncology patients, but comprehensive non-invasive brain mapping is difficult to achieve in the clinical setting.

METHODS:
We retrospectively included patients who underwent surgery for brain tumor resection at our Institution. Preoperative MRI with T1-weighted and DTI sequences were uploaded into the Quicktome platform. We categorized the integrity of nine large-scale brain networks: language, sensorimotor, visual, ventral attention, central executive, default mode, dorsal attention, salience and limbic. Networks were correlated with preoperative clinical data.

RESULTS:
One-hundred patients were included in the study. The most affected network was the central executive network (49%), followed by the default mode network (42%) and dorsal attention network (33%). Patients with preoperative deficits showed a significantly higher number of altered networks before the surgery (3.44 vs 2.16, p < .001), compared to patients without deficits. Furthermore, we found that patients without neurologic deficits had an average 2.16 networks affected and 1.56 networks at risk, with most of them being related to non-traditional eloquent areas (p = .014).

CONCLUSIONS:
Our results show that large-scale brain networks are frequently affected in patients with brain tumors, even when presenting without evident neurologic deficits. In our study, the most commonly affected brain networks were related to non-traditional eloquent areas. Integrating non-invasive brain mapping machine-learning techniques into the clinical setting may help elucidate how to preserve higher-order cognitive functions associated with those networks.
390 Real World Analysis of Outcomes After Revascularization Surgery for Symptomatic Non-stenotic Carotid (SyNC) Artery Disease
Authors: Madhani Sarosh Irfan , Alvi Mohammed Ali , Oushy Soliman , Borg Nicholas , Pando Alejandro , Alotaibi Naif M. , Savastano Luis 
Published: March 2023

INTRODUCTION:
Symptomatic non-stenotic carotid (SyNC) artery disease is emerging as one of the primary causes of embolic stroke of unknown source. The optimal secondary prevention strategies including medical therapy and revascularization (Carotid Endarterectomy (CEA) versus Carotid Artery Stenting (CAS)) continue to be controversial.

METHODS:
The National Surgical Quality Improvement Program (NSQIP) targeted dataset for CEA and CAS was queried for symptomatic patients with <50% stenosis of the ipsilateral carotid artery undergoing CEA and CAS between 2012-2019. Data analysis for continuous and categorical variables was carried out.

RESULTS:
A total of 363 symptomatic patients with <50% stenosis of the ipsilateral carotid artery were identified of which 22 underwent CAS and 341 underwent CEA. Statistical analysis showed that patients undergoing CEA were more likely to be male as compared to those undergoing CAS (68% vs 54.5%, p < 0.001). Additionally, patients in the CAS group were more likely to present with high-risk anatomy features compared to patients in the CEA group (31.8% vs 11.7%, p = 0.007) whereas patients undergoing CEA were more likely to have <50% stenosis contralateral ICA stenosis when compared to patients undergoing CAS (65.1% vs 36.4%, p = 0.001). Furthermore, patients undergoing CAS were more likely to experience post procedural stroke at 30 days compared to those undergoing CEA (13.6% vs 3.8%, p = 0.03). Upon multivariable analysis, CEA was associated with lower odds of post procedural stroke as compared to CAS (OR = 0.17, 95% CI 0.033-0.82, p = 0.027).

CONCLUSIONS:
Carotid revascularization for SyNC is being performed despite current guidelines and CEA is associated with lower odds of post-procedural stroke compared to CAS.
393 Sonolucent Cranioplasty for Real-Time Ultrasound Monitoring of Extra-to-Intracranial Bypass: Early Multicenter Experience of 44 Cases
Authors: Salem Mohamed M. , Ravindran Krishnan , Hoang Alex Nguyen , Doron Omer , Esparza Rogelio , Raper Daniel , Jankowitz Brian T. , Tanweer Omar , Lopes Demetrius K. , Langer David J. , Nossek Erez Zeev , Burkhardt Jan-Karl 
Published: March 2023

INTRODUCTION:
The new sonolucent cranioplasty implant (clear polymethyl methacrylate, PMMA) adds functionality besides reconstruction during and after surgery. One possible application uses transcranioplasty ultrasound (TCUS) technique after PMMA cranioplasty to assess graft patency of extracranial-intracranial (EC-IC) bypass procedures.

METHODS:
Multicenter analysis of consecutive EC-IC bypass patients from 5 US centers between 2019-2022 with closure post bypass using the translucent PMMA cranioplasty implant.

RESULTS:
Forty-four patients (median-age 53, 68.2% females) were included. The most common indication for bypass was Moyamoya disease/syndrome (77.3%) and superficial temporal artery to middle cerebral artery (STA-MCA) bypass was the most common procedure (79.5%). Pre-treatment modified Rankin Scale of 0 and 1-2 was noted in 11.4% and 59.1% of the patients, respectively, with hypertension being the most common comorbidity (72.7%). Intraoperative imaging for bypass patency involved utilizing combination of modalities in all patients, with intraoperative doppler being the most commonly utilized monitoring modality (90.9%) followed by indocyanine green (ICG) and catheter angiography (86.4% and 61.4%, respectively). Qualitative TCUS assessment of the graft patency was feasible in all cases without technical difficulties. Post-operative inpatient TCUS confirmation of the bypass patency was recorded in 56.8% of the cases, and outpatient TCUS surveillance for monitoring bypass patency through the implant was recorded in 22.7% of the patients. There were no cases of bypass failure noted in this cohort necessitating retreatment. Similarly, no implant-related complications were encountered in the cohort. Major complications requiring additional surgery occurred in 2 patients (4.6%) including epidural hematoma requiring surgical evacuation (2.3%) and post-operative surgical site infection (2.3%) that was unrelated to the implant.

CONCLUSIONS:
This multicenter study supports the safety and feasibility of using the sonolucent PMMA implant in the setting of EC-IC bypass surgery with the goal to monitor bypass patency using TCUS.
402 Disparities in Traumatic Brain Injury Patients’ Length of Stay: An Analysis of NTDB Data
Authors: Tantry Evelyne Kezia , Yue John K. , Krishnan Nishanth , Strelko Oleksandr , Spiro Ergi , Tarapore Phiroz E. , Haddad Alexander F. , Huang Michael C. , Manley Geoffrey T. , DiGiorgio Anthony Michael 
Published: March 2023

INTRODUCTION:
Traumatic brain injury (TBI) presents a disproportionate biopsychosocial and economic burden on certain patient populations compared to others. Inpatient length of stay (LOS) emerges as a proxy measure of injury severity, resource utilization, and access to post-acute care. Identifying determinants of prolonged LOS following TBI admission allows for the evaluation of disparities in care.

METHODS:
The NTDB compiles trauma registry data across various U.S. trauma centers. Our study’s inclusion criteria were adult patients who were admitted after a TBI. xLOS was defined as 99th percentile or greater LOS. Patients with xLOS were compared to patients below the xLOS threshold (sLOS). A generalized losgistic regression analysis was performed to assess the effect of covariates on xLOS.

RESULTS:
257,836 patients were included and the mean, median and IQR LOS were 7.1 days, 4.0d and 1-7d, resepectively. The xLOS threshold was ≥49d (range: 49–357d). xLOS patients, compared to sLOS, were more often associated with Medicaid insurance (32.5% vs. 13.5%.; p<0.001), a lower age quintile (29–46 years: 30.3% vs. 20.3%; 47–60 years: 29.9% vs. 20.5%; p<0.001), and greater injury severity (moderate :19.8% vs. 4.7%; severe: 47.6% vs. 5.2%; p<0.001). The xLOS were also more commonly Black (22.2% vs. 13.5%; p< 0.001) and hispanic (8.8% vs. 5.4%; p < 0.001). Fewer xLOS patients were discharged home (17.4% vs. 61.8%; p< 0.001). Multivariate analysis showed that xLOS is associated with younger age, greater injury severity, discharge to post-acute facillities, and, Medicaid or self-pay insurance. Relative to non-hispanic whites, Black(OR: 1.45; p< 0.001), Hispanic (OR: 1.54; p < 0.001), and Asian(OR: 1.32; p = 0.02) patients are more likely have xLOS.

CONCLUSIONS:
There are multiple socioeconomic factors that dispose patients to xLOS after TBI, even when adjusting for injury severity. Examining the heterogeneity of LOS within demographic categories provides one avenue to evaluate disparities in TBI care.
403 Inferior Clinical Outcomes for Patients with Medicaid Insurance Following Surgery for Degenerative Lumbar Spondylolisthesis: A Prospective Registry Analysis of 608 Patients
Authors: Chan Andrew K. , Letchuman Vijay , Mummaneni Praveen V. , Burke John Frederick , Agarwal Nitin , Randy Bisson Erica Fay , Bydon Mohamad , Foley Kevin T. , Shaffrey Christopher I. , Glassman Steven D. , Wang Michael Y. , Park Paul , Potts Eric A. , Shaffrey Mark Edwin , Coric Domagoj , Knightly John J. , Fu Kai-Ming G. , Slotkin Jonathan , Asher Anthony L. , Virk Michael S. , Kerezoudis Panagiotis , Alvi Mohammed , Guan Jian , Haid Regis W. , DiGiorgio Anthony Michael 
Published: March 2023

INTRODUCTION:
It remains unclear how type of insurance coverage impacts long-term, spine-specific patient-reported outcomes (PROs).

METHODS:
The prospective Quality Outcomes Database registry was queried for patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment surgery. 24-month PROs compared included Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), NRS Leg Pain (NRS-LP), EuroQol-5D (EQ-5D), and North American Spine Society (NASS) Satisfaction.

RESULTS:
608 patients undergoing surgery for grade 1 degenerative lumbar spondylolisthesis (mean age 62.5 ± 11.5 years and 59.2% women) were selected. Insurance types included private insurance (n = 319, 52.5%), Medicare (n = 235, 38.7%), Medicaid (n = 36, 5.9%), and VA/government (n =17, 2.8%). 1 patient (0.2%) was uninsured and was removed from the analyses. In adjusted multivariable analyses, when compared to patients with private insurance, Medicaid was associated with worse 24-month postoperative ODI β = 10.2, 95% CI 3.9 - 16.5) and NRS-LP β = 1.3, 95% CI 0.3 - 2.4). Medicaid was associated with worse EQ-5D scores compared to private insurance (β = -0.07, 95% CI -0.01 - -0.14), but not when compared to Medicare and VA/government insurance (p > 0.05). Medicaid was associated with lower odds of reaching ODI minimal clinically important difference (OR = 0.2, 95% CI 0.03 - 0.7) compared to VA/government insurance. NRS-BP and NASS satisfaction did not differ by insurance coverage (p > 0.05).

CONCLUSIONS:
Despite adjusting for potential confounding variables, Medicaid coverage was independently associated with worse 24-month PROs following lumbar spondylolisthesis surgery compared to other payer types. While all improved postoperatively, those with Medicaid coverage had relatively inferior improvements.
413 Addressing Healthcare Disparities in Patients Undergoing Cervical Spine Surgery
Authors: Gonzalez Glenn A. , Mitchell Dwight , Wang Victor , Leibold Adam T. , Harrop James S. , Schmidt Richard 
Published: March 2023

INTRODUCTION:
Health disparities may be observed across pre and post-operative hospital courses amongst patients undergoing cervical spine surgery across racial minorities and their white counterparts.

METHODS:
Retrospective data analysis of the Thomas Jefferson University Center City Department of Neurosurgery undergoing cervical spine surgeries (based on select CPT codes) between January 1, 2018, and January 6, 2021, was conducted to evaluate healthcare disparities across the post-operative management of cervical myelopathy cases as part of a quality improvement initiative. Outcomes evaluated included: hospital length of stay, the 30-day hospital readmission rate, and discharge disposition (home vs non-home). Normality was assessed using Kolmogorov-Smirnov test. Readmission rates, length of stay (LOS) in days, and discharge disposition (DD) (home vs. non-home) were analyzed using the Student's T-test, ANOVA, and Mann-Whitney test.

RESULTS:
Two thousand twenty-five patients were identified that met inclusion criteria, of which 298 (15%) were readmitted within 30 days to the Emergency Department at Thomas Jefferson University Hospital. Of the 15% readmitted, 74% (223/298) were white, while 25% (75/298) were non-white. Non-white LOS was higher compared to the white population (5.7 days vs 4.3 days, p < 0.0001. Non-white readmission rate was higher compared to the white population (22.3% vs 16%) p < 0.001. Non-white DD was higher compared to the white population (61.9% vs 50%) p < 0.001.

CONCLUSIONS:
Significant disparities exist in the post-operative management of patients with cervical myelopathy, particularly affecting the non-white population. Health disparities exist across multiple aspects of the discharge process for post-cervical spine surgery cases. Future investigations and interventions are required to address this quality gap.
416 On-Call Junior Neurosurgery Residents Spend 9 Hours of Their On-Call Shift Actively Using the Electronic Health Record
Authors: Patel Arati , Zheng Jeff , Rosner Benjamin , Thombley Robert , Sorour Omar , Theodosopoulos Philip V. , Aghi Manish Kumar , Berger Mitchel , Chang Edward , Chou Dean , Manley Geoffrey , Mummaneni Praveen V. , DiGiorgio Anthony Michael 
Published: March 2023

INTRODUCTION:
The Electronic Health Record (EHR) is central to clinical workflow, yet few studies to date have explored EHR usage patterns among neurosurgery trainees.

METHODS:
We utilized the EHR audit logs, time-stamped records of user activities, to review EHR usage of PGY-2 and 3 neurosurgery residents scheduled for 1 or more on-call days across 2 calendar years at the University of California San Francisco. We focused on the PGY-2 and 3 years, which in our training program represent the primary participants in the in-house on-call pool.

RESULTS:
Over 723 call days, 12 different residents took at least one on-call shift. The median (IQR) number of minutes that residents spent per on-call shift actively using the EHR was 536.8 (203.5), while interacting with an average (SD) of 68.1 (14.7) patient charts. There was no significant difference between active EHR time between residents as PGY-2 and PGY-3 on paired t-tests. Residents spent the most time on the following EHR activities: patient reports, notes, order management, patient list, and chart review.

CONCLUSIONS:
Residents spent, on average, 9 hours of their on-call shift actively using the EHR, and there was no improved efficiency as residents gained experience. We noted several areas of administrative EHR burden which could be reduced.