bluuebunny/crossref_metadata_2025_split huggingface dataset:
Placebo-Controlled Effectiveness of Idiopathic Normal Pressure Hydrocephalus Shunting: A Randomized Pilot Trial
Authors: Luciano Mark , Holubkov Richard , Williams Michael A. , Malm Jan , Nagel Sean , Moghekar Abhay , Eklund Anders , Zwimpfer Thomas , Katzen Heather , Hanley Daniel F. , Hamilton Mark G. 
Published: January 2023

BACKGROUND:
Multiple prospective nonrandomized studies have shown 60% to 70% of patients with idiopathic normal pressure hydrocephalus (iNPH) improve with shunt surgery, but multicenter placebo-controlled trial data are necessary to determine its effectiveness.

OBJECTIVE:
To evaluate the effectiveness of cerebrospinal fluid shunting in iNPH through comparison of open vs placebo shunting groups at 4 months using a pilot study.

METHODS:
Patients were randomized to a Codman Certas Plus valve (Integra LifeSciences) set at 4 (open shunt group) or 8 (“virtual off”; placebo group). Patients and assessors were blinded to treatment group. The primary outcome measure was 10-m gait velocity. Secondary outcome measures included functional scales for bladder control, activities of daily living, depression, and quality of life. Immediately after 4-month evaluation, all shunts were adjusted in a blinded fashion to an active setting and followed to 12 months after shunting.

RESULTS:
A total of 18 patients were randomized. At the 4-month evaluation, gait velocity increased by 0.28 ± 0.28 m/s in the open shunt group vs 0.04 ± 0.17 m/s in the placebo group. The estimated treatment difference was 0.22 m/s ([P = .071], 95% CI −0.02 to 0.46). Overactive Bladder Short Form symptom bother questionnaire significantly improved in open shunt vs placebo (P = .007). The 4-month treatment delay did not reduce the subsequent response to active shunting, nor did it increase the adverse advents rate at 12 months.

CONCLUSION:
This multicenter, randomized pilot study demonstrates the effectiveness, safety, and feasibility of a placebo-controlled trial in iNPH, and found a trend suggesting gait velocity improves more in the open shunt group than in the placebo group.
Racial Differences in Postoperative Opioid Prescribing Practices in Spine Surgical Patients
Authors: Letchuman Vijay , He Liangliang , Mummaneni Praveen V. , Agarwal Nitin , Campbell Liam J. , Shabani Saman , Chan Andrew K. , Abrecht Christopher R. , Miller Catherine , Sankaran Sujatha , Rambachan Aksharananda , Croci Rhiannon , Berven Sigurd H. , Chou Dean , Holly Langston T. , Guan Zhonghui 
Published: January 2023

BACKGROUND:As the opioid epidemic accelerates in the United States, numerous sociodemographic factors have been implicated its development and are, furthermore, a driving factor of the disparities in postoperative pain management. Recent studies have suggested potential associations between the influence of race and ethnicity on pain perception but also the presence of unconscious biases in the treatment of pain in minority patients.OBJECTIVE:To characterize the perioperative opioid requirements across racial groups after spine surgery.METHODS:A retrospective, observational study of 1944 opioid-naive adult patients undergoing a neurosurgical spine procedure, from June 2012 to December 2019, was performed at a large, quaternary care institute. Postoperative inpatient and outpatient opioid usage was measured by oral morphine equivalents, across various racial groups.RESULTS:Case characteristics were similar between racial groups. In the postoperative period, White patients had shorter lengths of stay compared with Black and Asian patients (P< .05). Asian patients used lower postoperative inpatient opioid doses in comparison with White patients (P< .001). White patients were discharged with significantly higher doses of opioids compared with Black patients (P< .01); however, they were less likely to be readmitted within 30 days of discharge (P< .01).CONCLUSION:In a large cohort of opioid-naive postoperative neurosurgical patients, this study demonstrates higher inpatient and outpatient postoperative opioid usage among White patients. Increasing physician awareness to the effect of race on inpatient and outpatient pain management would allow for a modified opioid prescribing practice that ensures limited yet effective opioid dosages void of implicit biases.
Distinguishing Brain Metastasis Progression From Radiation Effects After Stereotactic Radiosurgery Using Longitudinal GRASP Dynamic Contrast-Enhanced MRI
Authors: Berger Assaf , Lee Matthew D. , Lotan Eyal , Block Kai Tobias , Fatterpekar Girish , Kondziolka Douglas 
Published: January 2023

BACKGROUND:
Differentiating brain metastasis progression from radiation effects or radiation necrosis (RN) remains challenging. Golden-angle radial sparse parallel (GRASP) dynamic contrast-enhanced MRI provides high spatial and temporal resolution to analyze tissue enhancement, which may differ between tumor progression (TP) and RN.

OBJECTIVE:
To investigate the utility of longitudinal GRASP MRI in distinguishing TP from RN after gamma knife stereotactic radiosurgery (SRS).

METHODS:
We retrospectively evaluated 48 patients with brain metastasis managed with SRS at our institution from 2013 to 2020 who had GRASP MRI before and at least once after SRS. TP (n = 16) was pathologically confirmed. RN (n = 16) was diagnosed on either resected tissue without evidence of tumor or on lesion resolution on follow-up. As a reference, we included a separate group of patients with non–small-cell lung cancer that showed favorable response with tumor control and without RN on subsequent imaging (n = 16). Mean contrast washin and washout slopes normalized to the superior sagittal sinus were compared between groups. Receiver operating characteristic analysis was performed to determine diagnostic performance.

RESULTS:
After SRS, progression showed a significantly steeper washin slope than RN on all 3 follow-up scans (scan 1: 0.29 ± 0.16 vs 0.18 ± 0.08, P = .021; scan 2: 0.35 ± 0.19 vs 0.18 ± 0.09, P = .004; scan 3: 0.32 ± 0.12 vs 0.17 ± 0.07, P = .002). No significant differences were found in the post-SRS washout slope. Post-SRS washin slope differentiated progression and RN with an area under the curve (AUC) of 0.74, a sensitivity of 75%, and a specificity of 69% on scan 1; an AUC of 0.85, a sensitivity of 92%, and a specificity of 69% on scan 2; and an AUC of 0.87, a sensitivity of 63%, and a specificity of 100% on scan 3.

CONCLUSION:
Longitudinal GRASP MRI may help to differentiate metastasis progression from RN.
Association Between Frontal Lobe Hemodynamics and Neurocognitive Dysfunction in Adults With Moyamoya Disease: Retrospective Cohort Analysis
Authors: Tsunoda Sho , Inoue Tomohiro , Ohwaki Kazuhiro , Takeuchi Naoko , Shinkai Takako , Fukuda Akira , Segawa Masafumi , Kawashima Mariko , Akabane Atsuya , Miyawaki Satoru , Saito Nobuhito 
Published: January 2023

BACKGROUND:
Adult patients with moyamoya disease (MMD) may present with mild cognitive dysfunction, even those without evidence of conspicuous brain parenchymal damage. This cognitive dysfunction might be caused by local frontal lobe ischemia.

OBJECTIVE:
To explore the relationship between frontal lobe hemodynamic insufficiency and cognitive dysfunction in patients with MMD.

METHODS:
Thirty adult patients with MMD without conspicuous brain parenchymal damage were retrospectively examined. Patients with MMD with frontal lobe intracerebral steal phenomenon on single photon emission computed tomography were defined as group S (n = 13) and those without it were defined as group P (n = 17). A comparative group comprising patients with unruptured intracranial aneurysm was defined as group C (n = 30). The results of various cognitive and intelligence tests and a composite cognitive score were compared between groups.

RESULTS:
The digit span test forward version (P = .041), frontal assessment battery (P = .022), and composite cognitive score (P = .015) z-scores were significantly lower in group S than group C. Adjusting for sex and age, patients in group S had a significantly lower composite cognitive score compared with those in group C in multiple regression analysis (P = .037). Executive dysfunction and working memory dysfunction may be involved in the cognitive decline observed in group S.

CONCLUSION:
Mild cognitive dysfunction in MMD was associated with frontal lobe hemodynamic insufficiency. Future studies should examine whether revascularization can improve cerebral hypoperfusion and neurocognitive function in these patients.
Evaluating Match and Attrition Rates for Women and African Americans in Neurosurgery
Authors: Kabangu Jean-Luc K. , Heskett Cody A. , Bhargav Adip G. , Yekzaman Bailey R. , Morey Kennedy , Rouse Adam G. , Chamoun Roukoz B. 
Published: January 2023

BACKGROUND:
Previous efforts to increase diversity in neurosurgery have been aimed primarily at female inclusion while little analysis of other under-represented groups has been performed.

OBJECTIVE:
To evaluate match and retention rates of under-represented groups in neurosurgery, specifically Black and female applicants compared with non-Black and male applicants.

METHODS:
Match lists, Electronic Residency Application Service data, and National Resident Matching Program data were retrospectively reviewed along with publicly available residency program information for successful matriculants from 2017 to 2020. Residents were classified into demographic groups, and analysis of match and retention rates was performed.

RESULTS:
For 1780 applicants from 2017 to 2020, 439 identified as female while 1341 identified as male. Of these 1780 applicants, 128 identified as Black and 1652 identified as non-Black. Male and female applicants matched at similar rates (P = .76). Black applicants matched at a lower rate than non-Black applicants (P < .001). From 2017 to 2020, neither race nor sex was associated with retention as 94.1% of male applicants and 93.2% of female applicants were retained (P = .63). In total, 95.2% of Black residents and 93.9% of non-Black residents were retained (P = .71). No intraregional or inter-regional differences in retention were found for any group.

CONCLUSION:
Although sex parity has improved, Black applicants match at lower rates than non-Black applicants but are retained after matriculation at similar rates. Neurosurgery continues to recruit fewer female applicants than male applicants. More work is needed to extend diversity to recruit under-represented applicants. Future studies should target yearly follow-up of retention and match rates to provide trends as a measure of diversification progress within the field.
Reappraisal of Intracerebral Hemorrhages and Intracerebral Hemorrhage Grading Scale Score in Surgically and Medically Managed Cerebellar Intracerebral Hemorrhage
Authors: Won Sae-Yeon , Walter Johannes , Hernandez-Duran Silvia , Alhalabi Obada T. , Behmanesh Bedjan , Bernstock Joshua D. , Czabanka Marcus , Dinc Nazife , Dubinski Daniel , Flüh Charlotte , Freiman Thomas M. , Grosch Anne S. , Herrmann Eva , Kang Young Sill , Konczalla Juergen , Kramer Andreas , Lehmann Felix , Lemcke Johannes , Melkonian Ruzanna , Mielke Dorothee , Müller Lukas , Ringel Florian , Rohde Veit , Schneider Matthias , Senft Christian , Schuss Patrick , Turgut Merih Öznur , Synowitz Michael , Ullmann Joana M. , Vatter Hartmut , Zweckberger Klaus , Kilinc Fatma , Gessler Florian 
Published: January 2023

BACKGROUND:
As compared with supratentorial intracerebral hemorrhages (ICH), bleeds that occur within the cerebellum require special consideration given the nature of the posterior fossa.

OBJECTIVE:
To validate ICH and ICH grading scale (ICH-GS) scores in patients with cerebellar hemorrhage and examine the outcomes of patients managed surgically as compared with those who underwent conservative treatment.

METHODS:
This observational multicenter study included 475 patients with cerebellar hemorrhage from 9 different neurosurgical departments in Germany between 2005 and 2021. The prognostic accuracy of ICH and ICH-GS scores were calculated by the area under the curve of the receiver operating characteristic curves. Analyzed outcomes were the in-hospital mortality, mortality at 6 months, in-hospital outcome, and outcome at 6 months.

RESULTS:
Of 403 patients, 252 patients (62.5%) underwent surgical treatment and 151 patients (37.5%) conservative treatment. Both ICH and ICH-GS scores demonstrated good prognostic accuracy regarding both overall mortality and functional outcomes. In those patients presenting with severe cerebellar hemorrhages, ie, ICH score >3 and ICH-GS score >11, overall mortality was significantly lower in surgically treated patients. Mortality was significantly higher in those patients managed surgically who presented with ICH scores

3; in such patients, improved outcomes were noted when the hematoma was treated conservatively.

CONCLUSION:
ICH and ICH scores are useful tools for prediction of survival and outcome in patients with cerebellar ICH. Surgical management may be beneficial for those who present with severe cerebellar ICH as reflected by ICH scores >3, while conservative management seems reasonable in patients with lower ICH scores.
Effects of Neuroanatomic Structural Distances on Pituitary Function After Stereotactic Radiosurgery: A Multicenter Study
Authors: Ironside Natasha , Chen Ching-Jen , Xu Zhiyuan , Schlesinger David , Lee Vance Mary , Hong Gregory K. , Jane John A. , Patel Samir , Bindal Shray K. , Niranjan Ajay , Lunsford L. Dade , Liscak Roman , Chytka Thomas , Jezkova Jana , Saifi Omran , Trifiletti Daniel M. , Berger Assaf , Alzate Juan , Bernstein Kenneth , Kondziolka Douglas , Speckter Herwin , Hernandez Wenceslao , Lazo Erwin , Peker Selcuk , Samanci Yavuz , Zacharia Brad E. , Mau Christine , Wegner Rodney E. , Shepard Matthew J. , Mathieu David , Maillet Michel , Sheehan Jason P. 
Published: January 2023

BACKGROUND:
Delayed hypopituitarism is the most common complication after stereotactic radiosurgery (SRS) for pituitary adenomas.

OBJECTIVE:
To investigate the relationship between neuroanatomic structure distances from the radiation target and anterior pituitary function preservation after SRS through multicenter study.

METHODS:
We retrospectively reviewed the International Radiosurgery Research Foundation database from January 2002 to December 2021 for adult patients undergoing SRS for pituitary adenomas with >6 months of follow-up. Distances between centers or edges of hypothalamic-pituitary axis structures and SRS target volumes were measured using MRI. The primary outcome was anterior pituitary function preservation. Predictors were analyzed using multivariable logistic regression and area under the receiver operating curve (AUROC) curve analyses.

RESULTS:
Four hundred eighty-seven patients were categorized by preservation (n = 384) and no preservation (n = 103) of anterior pituitary function. The mean margin dose was 19.1(6.2) Gy. Larger distance from the center of the stalk to the tumor margin isodose was a positive predictor (adjusted odds ratio [aOR] = 1.162 [1.046-1.291], P = .005), while pre-SRS hypopituitarism (aOR = 0.646 [0.405-1.031], P = .067) and larger treatment volume (aOR = 0.965 [0.929-1.002], P = .061) were near negative predictors of the primary outcome. An interaction between the treatment volume and center stalk to margin isodose distance was found (aOR = 0.980 [0.961-0.999], P = .045). Center stalk to margin isodose distance had an AUROC of 0.620 (0.557-0.693), at 3.95-mm distance. For patients with treatment volumes of <2.34 mL, center stalk to margin isodose distance had an AUROC of 0.719 (0.614-0.823), at 2.95-mm distance.

CONCLUSION:
Achieving a distance between the center of the pituitary stalk and the tumor margin isodose ≥3.95 mm predicted anterior pituitary function preservation. For smaller treatment volumes <2.34 mL, the optimal distance was ≥2.95 mm. This may be modifiable during trans-sphenoidal resection to preserve pituitary function.
Radiological Evolution of Fat Graft Used for Optic Neuropexy During Surgery for Parasellar Meningiomas
Authors: Diaz Simon , Starnoni Daniele , Tuleasca Constantin , Dunet Vincent , Peters David , Messerer Mahmoud , Levivier Marc , Daniel Roy Thomas 
Published: January 2023

BACKGROUND:
Stereotactic radiosurgery (SRS) is an effective adjuvant therapy for residual tumor after subtotal resection of parasellar meningiomas. Fat graft placement between the optic nerve/chiasm and residual tumor (optic neuropexy [OPN]) allows for safe SRS therapy.

OBJECTIVE:
To evaluate the radiological temporal profile of the fat graft after OPN, immediately after surgery and at 3, 6, and 12 months intervals, to elucidate the optimal time point of adjuvant SRS.

METHODS:
A single-center, retrospective, cohort study of 23 patients after surgery for parasellar meningioma was conducted. Fat graft volume and MRI signal ratios were calculated. SRS dosimetric parameters (tumor/optic nerve) were measured at the time of SRS and compared with a hypothetical dosimetric plan based on an early postoperative MRI.

RESULTS:
Of 23 patients, 6 (26%) had gross total resection and 17 (74%) had subtotal resection. Fat grafts showed a progressive loss of volume and signal ratio over time. Radiosurgery was performed in 14 (82.3%; 8 hypofractionated radiosurgery and 6 single fraction). At 3 months, there is a loss of 46% of the fat volume and degradation of its tissue intensity, decreasing differentiation from tumor and nerve. The hypothetical treatment plan (performed on an early postoperative MRI) showed that single-fraction SRS would have been possible in 6 of the 8 hypofractionated cases.

CONCLUSION:
OPN is a technique that can be safely performed after resection of parasellar meningiomas. Because of the reduction of the fat volume and tissue differentiation between fat and tumor/nerves, adjuvant radiosurgery is better performed within the first 3 months after surgery.
Sinonasal Outcome After Endoscopic Transnasal Surgery—A Prospective Rhinological Study
Authors: Conrad Jens , Blaese Marco , Becker Sven , Huppertz Tilman , Ayyad Ali , Ringel Florian 
Published: January 2023

BACKGROUND:
The sinonasal outcome after transnasal skull base surgery has often been neglected aside from major outcome criteria as extent of tumor resection, ophthalmological, and endocrinological parameters.

OBJECTIVE:
To analyze rhinological outcome after endoscopic transnasal neurosurgery.

METHODS:
Patients were treated using a middle turbinate–preserving transnasal endoscopic approach for sellar/parasellar lesions. As major variables, olfactory function and nose breathing ability were assessed. The study participants were investigated by odor testing (“Sniffin’ sticks”), rhinomanometry, and endoscopic inspection of the nasal cavity before and 6 months after surgery. Furthermore, sinonasal-associated quality of life was measured before, immediately and 6 months after surgery with a standardized questionnaire (SNOT-20-GAV).

RESULTS:
Eighty-two patients (47 male, 35 female, median age 55 years) matched the inclusion criteria. Before surgery, the average odor was found to be 30.75 (≥31 = normosmia); in the postinterventional examination at 6 months, the average increased to 33.08 (n.s.). Rhinomanometric examination of binostril nasal airflow showed an average of 590.42 mL/s on inspiration before and an increase to 729.78 mL/s at 6 months after surgery. SNOT-20 symptom scores had a maximum score right after and no difference at 6 months after surgery (scores 23.76 and 14.91 vs 15.53 before surgery).

CONCLUSION:
Based on the study, the endoscopic transnasal technique preserving the middle turbinate has no significant negative effects on the rhinological outcome.
Long-Term Results of Endoscopic Endonasal Marsupialization of Rathke Cleft Cysts With Bioabsorbable Steroid-Eluting Stents—Technical Case Series and Review of the Literature
Authors: Carroll Christopher P. , Andaluz Norberto O. , Kosty Jennifer A. , Zuccarello Mario , Zimmer Lee A. 
Published: January 2023

BACKGROUND:
Rathke cleft cysts (RCCs) are common benign skull-base lesions arising from embryologic remnants of Rathke pouch. Though frequently asymptomatic, RCCs can become symptomatic because of compression of adjacent neural structures. Transcranial and neuroendoscopic surgical treatments have been described for symptomatic RCCs, but recurrence rates remain as high as 30%. Bioabsorbable steroid-eluting (BASE) stents significantly decrease adhesions and recurrent ostia obstruction after endoscopic sinus surgery. We sought to use BASE stents to aid marsupialization of symptomatic RCCs.

OBJECTIVE:
To present long-term results of our initial experience with endoscopic-endonasal fenestration and placement of BASE stents for RCCs.

METHODS:
Patients undergoing neuroendoscopic transsphenoidal fenestration of RCCs with BASE stent placement were identified and their medical records retrospectively reviewed.

RESULTS:
Four patients underwent neuroendoscopic transsphenoidal fenestration and BASE stent placement from March 2016 to April 2018 for symptomatic RCCs. After the cyst contents were evacuated, a BASE stent was deployed in the cyst fenestration to prevent cyst wall regrowth or closure and facilitate marsupialization to the sphenoid sinus. No perioperative complications were encountered, and all patients reported symptom resolution by 2 weeks postoperatively. Postoperative endoscopic evaluation demonstrated epithelization of the cyst wall opening and patent marsupialization into the sphenoid sinus in all cases. After a mean follow-up of 56 ± 12 months, all patients remained asymptomatic with baseline visual function and no radiographic evidence of recurrence.

CONCLUSION:
Bioabsorbable steroid-eluting stent placement is a safe, facile, viable augmentation of neuroendoscopic technique for symptomatic RCCs with the potential to reduce long-term recurrence rates.