bluuebunny/crossref_metadata_2025_split huggingface dataset:
455 Radiographic Features Predict Genomic Subtype in Meningioma
Authors: Gadot Ron , Khan Basit , Katlowitz Kalman , Gupta Mayuri , Bayley James , Klisch Tiemo , Patel Akash J. 
Published: March 2023

INTRODUCTION:
Meningiomas are the most common primary intracranial neoplasms. While most meningiomas demonstrate benign behavior with low rates of recurrence, a large percentage are more aggressive and are currently most widely prognosticated by histological grade. Several groups have published classification systems grouping meningiomas into distinct subtypes based on transcriptomic, cytogenetic, and methylomic signatures that better characterize their activity compared with traditional grading. Methods to preoperatively predict genomic subtype are desired.

METHODS:
Resected tumor samples that were genomically classified through a protocol described in previous publications were included in this analysis. Corresponding preoperative MRIs were gathered. The tumors were characterized using a standardized sheet of semantic variables. Chi-square and Wilcoxon rank-sum tests followed by univariable generalized linear regression were used for feature selection. Random forest algorithms were trained to classify genomic subtype based on radiographic features alone and tested using an 80/20 pseudorandom split.

RESULTS:
One-hundred tumors were included (n = 69 MenG-A/B, 31 MenG-C). Males were significantly more likely to develop MenG-C tumors than females (OR 3.44 [1.43, 8.52] p = 0.006). MenG-C tumors had significantly lower recurrence-free survival than MenG-A/B tumors (log-rank p value <0.01). Supratentorial status, parafalcine location, larger volume, moderate-severe edema, irregular enhancement, hypointensity on T1 non-contrast sequence, and indistinct tumor margins were significant predictors of more aggressive genomic class. A random forest model based on these features blindly predicted MenG-A/B class with 85% accuracy (sensitivity 83%, specificity 100%). Tumor volume, location grouping, and T1 hypointensity were the most important features in accurate classification.

CONCLUSIONS:
Aggressive genomic status in meningioma can be predicted on routine preoperative imaging. These results may aid in preoperative counseling and treatment planning and should be validated across multi-institutional datasets.
459 Neuro-Oncology Spectral Fingerprint Biorepository: A Novel Approach Leveraging a Surgical and Clinical Detailed Repository in a Diverse Patient Population
Authors: Quinones-Hinojosa Alfredo , Basil Aleeshba , Garcia Diogo P. , Meade Paola Suarez , Szymkiewicz Ewa , Jentoft Mark E. , Guerrero-Cazares Hugo , Chaichana Kaisorn L. , Meyer Fredric B. 
Published: March 2023

INTRODUCTION:
Despite advances in the understanding of brain cancer, surgery and extent of resection (EOR) continue to be the main predictors of patient outcome. However, currently available public biorepositories do not include extent of resection for individual patients raising important questions regarding confounding effects for some molecular markers. Further, emerging data has supported important novel biomarkers in tumor’s lipidome and optical attenuation properties which could serve as new therapeutic opportunities.

METHODS:
All neuro-oncology surgical cases at our institution were eligible for collection since 2016. Blood was collected from every patient pre-operatively. Cerebrospinal fluid was collected whenever surgically safe. Genomic and transcriptomic analysis was performed. Intra-operative spectral and optical attenuation data was obtained through desorption electrospray ionization mass spectrometry (DESI-MS) over 0 to 1000 m/z and optical coherence tomography, respectively, for biomarker discovery.

RESULTS:
A total of 912 unique patient collections have been performed including 286 gliomas and 205 other rare brain tumors. Demographic, clinical, imaging, surgical and survival data was curated for each individual patient. Extent of resection (EOR) was determined for each patient, with an average of 78.6% for chordomas, 85.9% in glioblastoma, 88.3% in other high-grade gliomas and 72% in low-grade gliomas with predictive of progression-free survival (p < 0.01) and overall survival (p < 0.01). Comprehensive sequencing has been completed for 131 gliomas. Of those, lipid and optical profiling has been completed for multiple tumor samples (330) from a total of 79 patients.

CONCLUSIONS:
We have curated a large biorepository of neuro-oncology tumors with detailed patient information including for the first time to our knowledge detailed surgical, imaging, spectral and optical information. Efforts are ongoing at large-scale biomarker discovery leveraging the unique spectral and optical fingerprint of each tumor to their genomic/transcriptomic profile.
465 Defining the Immune Profile of Radiation Necrosis Through Single-cell Analysis of Intracranial Lesions
Authors: Robert Stephanie , Lu Benjamin , Arnal-Estape Anna , Nguyen Don , Chiang Veronica 
Published: March 2023

INTRODUCTION:
The incidence of radiation necrosis (RN), a common and morbid side effect of radiosurgical management of brain metastases, is growing as patient survival and use of immunotherapy increases. RN is thought to be immunologically driven; however, its pathophysiology remains poorly understood. Further, difficulty distinguishing it radiographically from recurrent metastatic disease often necessitates invasive brain biopsies for diagnosis.

METHODS:
Over 12 months, we collected intraoperative samples from patients undergoing craniotomy for RN and/or metastatic tumor. We created a bank of these 16 patient samples and processed them for scRNAseq analysis. Using fluorescence-activated cell sorting (FACS) and 10x Genomics single cell RNA sequencing, we analyzed the cellular immune profile of lesional tissue and time-matched blood from each patient.

RESULTS:
Compared to metastases, RN demonstrates decreased expression of FOXP3, NKG7, and GZMB, markers of regulatory and cytotoxic T cells, and natural killer (NK) cells, and increased expression of interleukin 7 receptor (IL7R), a marker of naÏve and memory T cells – profiles reflective of bystander transcriptional signatures. In contrast, metastases demonstrate an antigen-reactive profile, including commonly observed exhaustion signatures. Importantly, blood samples from patients reflect these differences as well. Interestingly, increased IL7R is implicated in autoimmune disorders, suggesting an iatrogenically-induced autoreactive process underlying RN.

CONCLUSIONS:
These findings demonstrate, firstly, the feasibility of extracting live cells from RN tissue, and, secondly, suggest RN and metastases have unique immune profiles that can be detected in patient blood. Therefore, in addition to beginning to define the immune landscape of this poorly understood pathology, this work has the potential to open new avenues for the development of improved diagnostic and therapeutic approaches to allow for earlier detection and more effective treatment of RN in metastatic brain tumors patients.
469 Palliative Care Effect on Survival in Glioblastoma: Who Receives Palliative Care?
Authors: Pando Alejandro , Patel Aman , Shaari Ariana , Choudhry Hannaan , Eloy Jean Anderson , Goldstein Ira M. , Liu James K. 
Published: March 2023

INTRODUCTION:
High grade glioma has a poor overall survival with profoundly negative effects on the patient’s quality of life and their caregivers.

METHODS:
The National Cancer Database was analyzed for patterns of care in patients ≥18-years-old who were diagnosed with histologically confirmed grade IV GBM between 2004 and 2017. All statistical analyses were conducted based on univariate and multivariate regression models.

RESULTS:
A total of 85,380 patients with the diagnosis of GBM were identified. Of the study population, 2,803(3.28%) patients received palliative therapy. On multivariate logistic regression analysis, age ≥70 Years (odds ratio[OR] = 1.28, 95% Confidence Interval [CI] = 1.04-1.58; p < 0.001), Medicare (OR = 1.348, CI = 1.13-1.61; p = 0.001), tumor size ≥5 cm (OR = 1.15, CI = 1.01-1.31; p = 0.036), tumor multifocality (OR = 1.69, CI = 1.47-1.96; p < 0.001), lobe overlapping tumor (OR = 2.09, CI = 1.13-3.86; p = 0.018), Charlson-Deyo score >0, receiving treatment at a non-academic/research program, and medium volume of cancers managed at the treatment facility (OR = 1.19, CI = 1.02-1.38; p = 0.026) were independent risk factors associated with an increased chance of receiving palliative care. In contrast, a household income of ≥$40,227 and high volume of cancer managed at the treatment facility (OR = 0.75, CI = 0.58-0.96; p = 0.02) were independent risk factors associated with decreased palliative care. Patients who received no palliative care had a 2-year overall survival rate longer than those who received palliative care (22% vs. 8.8%; p < 0.001). In patients receiving palliative care, those who received recommended treatment had a 2-year overall survival rate longer than those who declined part or whole recommended treatment (9.1% vs. 3.8%; p = 0.009).

CONCLUSIONS:
In patients with high grade glioma, receiving palliative care is associated with decreased survival. When receiving palliative care, recommended treatment improves survival almost three-fold compared to those declining part or whole treatment.
482 Triple Therapy Versus Dual Antiplatelet Therapy for Dolichoectatic Vertebrobasilar Fusiform Aneurysms Treated With Flow Diverters: The Last Frontier?
Authors: Siddiqui Adnan Hussain , Monteiro Andre , Hanel Ricardo , Kan Peter , Mohanty Alina , Cortez Gustavo , Rabinovich Margarita , Matouk Charles Christian , Sujijantarat Nanthiya , Romero Charles Edward , Stone Jeremy Guy , Ebersole Koji C. , Fry Lane , Natarajan Sabareesh Kumar , Thomson Brittany Owusu-Adjei , Ortega-Gutierrez Santiago , Vivanco-Suarez Juan , Wakhloo Ajay K. , Levy Elad I. 
Published: March 2023

INTRODUCTION:
Dolichoectatic vertebrobasilar fusiform aneurysms (DVBFAs) have poor natural history when left untreated and high morbimortality when treated with microsurgery. Flow diversion (FD) with dual-antiplatelet therapy (DAPT) is feasible but carries a high risk of perforator occlusion and progression of brainstem compression. Seeking better hopes for these patients, experts across the US started using triple-therapy (DAPT plus oral anticoagulation) after FD treatment in attempt to improve their clinical outcomes. The rationale was to preserve perforator patency while vessel remodeling occurs. The current study is the result of this multicenter effort.

METHODS:
Retrospective data collection from 8 US centers. Only DVBFAs treated with flow-diversion and either triple-therapy or DAPT alone were included. Patient and aneurysms' characteristics, and clinical and angiographic outcomes were compared.

RESULTS:
The groups (DAPT, n = 13 vs Triple-therapy, n = 14) were similar in age, sex, clinical presentation, baseline disability, aneurysm characteristics, median number of flow-diverters, and adjunctive coiling. Radial access use was significantly higher in the triple-therapy group (71.4% vs. 15.3%, P = 0.006). Acute ischemic stroke rate was lower in the triple-therapy group (7.1% vs. 30.8%, P = 0.167). Overall rate of modified Rankin Scale score decline due to either ischemic stroke or worsening of brainstem compression was significantly lower in the triple-therapy group (7.1% vs. 69.2%, P = 0.001). Overall rate of hemorrhagic complications was numerically higher in the triple-therapy group (28.6% vs. 7.7%, P = 0.162). The rate of moderate-to-severe disability at last follow-up was significantly lower in the triple-therapy group (21.4% vs. 76.9%, P = 0.007). I.

CONCLUSIONS:
Patients with DVBFAs treated with FD and triple-therapy had less ischemic strokes, less symptom progression, and overall better outcomes at last follow-up than similar patients and aneurysms managed with DAPT alone.
483 Partial Treatment as a Risk Factor in Up-Conversion of Type 1 dAVFs
Authors: Walker Erin , Srienc Anja I. , Guniganti Ridhima Rao , Brinjikji Waleed , Chen Ching-Jen , Abecassis Isaac Josh , Levitt Michael Robert , Durnford Andrew , Polifka Adam J. , Derdeyn Colin P. , Samaniego Edgar A. , Kwasnicki Amanda M. , Alaraj Ali , Potgieser Adriaan R.E. , Sur Samir , Tada Yoshiteru , Winkler Ethan A. , Lai Rosalind , Du Rose , Abla Adib Adnan , Satomi Junichiro , Starke Robert M. , Van Dijk Marc C. , Amin-Hanjani Sepideh , Hayakawa Minako , Gross Bradley A. , Fox William C. , Butlers Diederik , Kim Louis J. , Sheehan Jason P. , Lanzino Giuseppe , Osbun Joshua William , Zipfel Gregory J. 
Published: March 2023

INTRODUCTION:
Type 1 dural arteriovenous fistulas (dAVFs) lack cortical venous drainage and occasionally necessitate intervention depending on patient symptoms. Up-conversion is the rare transformation of a dAVF to a higher-grade. Causes for up-conversion are unknown. We tested the hypothesis whether partial treatment of type 1 dAVFs increases their likelihood of up-conversion.

METHODS:
We used the multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database to perform a retrospective analysis of all patients with type 1 dAVFs. Propensity score analysis was utilized to determine if partial treatment was an independent risk factor for up-conversion. A regression model identified secondary risks that contributed to up-conversion.

RESULTS:
358 out of 1077 patients within the consortium had type 1 dAVFs. 12% of patients who were partially treated for a type 1 dAVF experienced an up-conversion, while less than 1% of patients who received no treatment experienced up-conversion, and 0% of patients who had a complete treatment of their dAVF experienced up-conversion. Higher proportions of tinnitus, bruits, and intracranial hemorrhage at initial presentation were found in patients who up-converted. The majority of up-converted dAVFs were located in the transverse-sigmoid sinus and all received embolization as part of their treatment.

CONCLUSIONS:
Partial treatment is an independent risk factor for up-conversion when compared to no treatment or complete treatment. In the partial treatment group, hemorrhage at inital presentation and use of embolization as a treament modality are factors that increase risk for up-conversion.
484 Predictors of Outcome Clusters for Anterior Circulation Mechanical Thrombectomy: An Unsupervised Machine Learning Analysis of Prospective Data
Authors: Naik Anant , Catapano Joshua , Hartke Joelle Nicole , Koester Stefan Wolfgang , Winkler Ethan A. , Jadhav Ashutosh , Ducruet Andrew F. , Albuquerque Felipe 
Published: March 2023

INTRODUCTION:
Endovascular thrombectomy for select patients with anterior circulation stroke can be lifesaving if done in an appropriate therapeutic window. However, studies have demonstrated that failure of treatment ranges from 30-70%. Early determination of patients that are most likely to benefit from early revascularization is of pivotal importance.

METHODS:
We prospectively collected data from a high-volume stroke center for patients receiving MT for anterior circulation strokes. Outcomes evaluated included final Thrombolysis in Cerebral Infarction (TICI) score, the number of passes, complications from endovascular intervention, discharge NIHSS. Outcomes were clustered using a k-means model after the number of optimal clusters were obtained using a silhouette algorithm. Uniform manifold projections (UMAP) were used to project the four outcomes into a 2-D space. Upon cluster determination, multivariate regression was used to determine predictors of cluster membership. Univariate comparisons leveraged chi-square and t-tests.

RESULTS:
187 consecutive patients were selected for analysis. Included patients had an average age 69.96 (SD – 15.14). Two distinct clusters were obtained, confirmed by the Silhouette model (1B). Cluster 2 was found to be associated with improved outcomes on univariate regression. Multivariate regression was used to identify predictors of cluster membership. ICA occlusion (OR = 7.63 (1.40 – 48.6), p = 0.02). A one-point increase in admission NIHSS was associated with an 11% increase in cluster 2 risk.

CONCLUSIONS:
In this study, we consolidate 4 outcomes using unsupervised machine learning. We found that cluster 2 patients did worse. We also demonstrated that ICA occlusion, Admission NIHSS, and smoking status were significantly associated with cluster 2 membership. Machine learning can be used to identify novel morphological characteristics of specific patient groups.
486 Macroscale Forces Drive Targetable Microscale Fibrotic Mechanosensing in Degenerative Spinal Disease
Authors: Hadzipasic Muhamed , Sten Margaret , Massaad Elie , Kiapour Ali , Nageeb George , Sharif Muneeb , Bradley Joseph , Nielsen Gunnlaugur , Coumans Jean-Valery , Borges Lawrence F. , Shin John H. , Grodzinsky Alan , Nia Hadi , Shankar Ganesh 
Published: March 2023

INTRODUCTION:
Mechanical forces are emerging as key drivers of fibrosis. Elucidating this pathophysiology is relevant in degenerative spinal disease (DSD) where mechanical stress on the spine is associated with fibrotic changes in ligament and bone, with resultant compression of the neural elements. Though DSD affects most people as they age and costs $3.6 billion annually, the crucial bridge between macroscale mechanical forces driving pathologic degenerative mechanosensing remains unknown.

METHODS:
Validated lumbo-pelvic finite element models (FEMs) were used to calculate LF macroscale stress; LF was collected from 120 patients undergoing surgery and studied via histology, Western blot and novel Atomic Force Microscopy (AFM) stiffness mapping. A novel device to apply strain to LF was engineered to further investigate the real-time effect of resulting stress on myofibroblast accumulation and transcriptome-level gene expression.

RESULTS:
Spinopelvic FEM predicted LF adjacent to a fused level experiences increased stress during spine flexion. Supporting this model, LF resected adjacent to a fused level was observed to have significant increases in pro-fibrotic myofibroblasts (4.3-fold) and downstream ROCK effectors compared with LF from non-DSD and DSD patients without prior fusion. AFM and mathematical modeling revealed myofibroblasts localize to islands of elevated stiffness and microstress within LF. Through application of strain on LF explants, we observed stress-dependent myofibroblast accumulation (3.66-fold, P < .0002) and blocked this accumulation through ROCK inhibition. Finally, through transcriptomic analysis on human LF, we identify a stress-driven hyperacute transcriptional response and find this response is also altered by ROCK inhibition.

CONCLUSIONS:
These findings implicate stress-driven myofibroblast accumulation as a mechanosensitive pro-fibrotic pathway in DSD. These observations warrant detailed future investigation into ROCK inhibitors as a potentially surgery-sparing adjunct to non-operative therapy in ASD and DSD-mediated spinal stenosis.
488 Prospective Evaluation of Racial Disparities in Surgical Treatment Of Degenerative Spondylolisthesis Using PROMIS Pain Interference And Physical Function Scores
Authors: Massaad Elie , Taylor Mitchell , Shin John H. , Williamson Theresa 
Published: March 2023

INTRODUCTION:
Spine surgery for degenerative spondylolisthesis is indicated in patients who remain symptomatic despite a course of nonsurgical therapy. Patient’s report of pain interference and physical function are key indicators for intervention. We know that Black and indigenous patients of color have poorer outcomes in back pain. This study aims to identify trends in intervention for degenerative spondylolisthesis based on race and patient-reported outcomes.

METHODS:
A prospective cohort study of degenerative spondylolisthesis patients seen in Harvard Medical School-affiliated clinics from 2015 to 2022 and who completed the routinely collected PROMIS patient-reported outcome measures (PROMs): Physical Function (PF) and pain Interference (PI). PROMIS scores are standardized to the U.S. population (mean score = 50). Regression analyses were performed to determine factors associated with treatment assignment.

RESULTS:
In this study, 22 374 patients (mean Age, 66.91(14.22); Female, 64%; BIPOC, 3019 (13%)) completed PROMs at baseline. Medicaid coverage was more prevalent among BIPOC (13% vs. 3.1%; P < 0.001) who were less likely to receive an interventional treatment (351/ 3,019 (12%) vs. 3,021 / 19,355 (16%); P < 0.001) despite a significantly higher pain interference score (62.32 (8.37) vs. 61.51 (8.35); P < 0.001). White race was associated with higher odds of receiving surgical treatment than BIPOC after adjusting for age, comorbidities, medical coverage, physical function, and pain interference at baseline (OR = 1.20; 95 CI, 1.15-1.26; P < 0.001).

CONCLUSIONS:
Despite higher pain interference scores, BIPOC patients were less likely to be offered spine surgery for degenerative spondylolisthesis, indicating that race is a predictor of spine surgery after accounting for comorbidities, physical function, and disability at diagnosis.
489 Complications Associated With Single Position Prone Lateral Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis
Authors: Farber Samuel Harrison , Cecchi Bayron Valenzuela , O'Neill Luke , Chapple Kristina , Zhou James , Snyder Laura A. , Turner Jay D. , Uribe Juan S. 
Published: March 2023

INTRODUCTION:
Lateral lumbar interbody fusion (LLIF) is a workhorse surgical approach for lumbar arthrodesis. There is now emerging interest in performing single position surgery in which both LLIF and pedicle screw fixation are performed in the prone position. To date, most studies of prone LLIF are of poor quality and without long-term follow up; and as such, the complication profile related to this novel approach is not well known.

METHODS:
A systematic review of the literature and a meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reporting prone LLIF were assessed for inclusion. Studies not reporting complication rates were excluded.

RESULTS:
A total of 10 studies met inclusion criteria and were included in the analysis. Overall, 286 patients were treated with prone LLIF across these studies with an average of 1.3 (0.2) levels per patient. There were 18 reported intra-operative complications including cage subsidence (3.8%), rupture of the anterior longitudinal ligament (ALL) (2.3%), cage repositioning (2.1%), aborted prone interbody placement (0.82%), and durotomy (0.6%). There were no reported major vascular or peritoneal injuries. A total of 68 post-operative complications occurred. These included thigh/groin sensory symptoms (13.3%), hip flexor weakness (17.8%), wound infection (1.9%), psoas hematoma (1.3%), motor neural injury (1.2%), and revision surgery (3.8%).

CONCLUSIONS:
Single position LLIF in the prone position appears to be a safe surgical approach with a low complication profile. Longer term follow up and prospective studies are needed in order to better characterize long-term complication rates related to this approach.