bluuebunny/crossref_metadata_2025_split huggingface dataset:
179 Measuring Real Time Radiation Exposure to Spine-Focused Neurosurgeons
Authors: Chauhan Daksh , Ahmad Hasan Shahzad , Singh Shikha , Albayar Ahmed , Patel Arjun , Welch William Charles , Yoon Jang Won 
Published: March 2023

INTRODUCTION:
C-arm fluoroscopy and O-arm navigation are vital tools in modern spine surgeries, but their repeated usage can endanger spine surgeons. While a surgeon’s chest and abdomen are protected by lead aprons, the eyes and extremities generally receive less protection.

METHODS:
This prospective cohort study includes 65 consecutive spine surgeries performed by a single spine-focused neurosurgeon over a 9-month period. Radiation exposure to the primary surgeon was measured through dosimeters worn over the lead apron, under the lead apron, on surgical loupes, and as a ring on the dominant hand. Differences were assessed with rigorous statistical testing and radiation exposure per surgical case was extrapolated.

RESULTS:
During the study, the measured radiation exposure over the apron, 176 mrem, was significantly greater than that under the apron, 8 mrem (p = .0020), demonstrating shielding’s protective effect. The surgeon’s dominant hand was exposed to 329 mrem while the eyes were exposed to 152.5 mrem of radiation. Compared to the surgeon’s protected abdominal area, the hands (p = .0002) and eyes (p=.0002) received significantly greater exposure. Calculated exposure per case was 2.8 mrem for the eyes and 5.1 mrem for the hands. It was determined that a spine-focused neurosurgeon operating 400 cases annually will incur a radiation exposure of 60,750 mrem to the hands and 33,900 mrem to the eyes over a 30-year career.

CONCLUSIONS:
Our study found that spine surgeons encounter significantly more radiation exposure to the eyes and the extremities compared to protected body regions. Lifetime exposure exceeds the annual limits set by the International Commission on Radiological Protection for the extremities (50,000 mrem/yr) and the eyes (15,000 mrem/yr), calling for increased awareness about the dangerous levels of radiation exposure that a spine surgeon incurs over one’s career.
182 Comparison of Post-operative Functional Recovery Following Awake Endoscopic Transforaminal Lumbar Interbody Fusion Versus Lumbar Laminectomy Under General Anesthesia
Authors: Bashti Malek , Basil Gregory , Ahmad Hasan Shahzad , Singh Shikha , Jiao Kenneth , Yang Andrew Il , Jamshidi Aria , Welch William Charles , Wang Michael Y. , Won Yoon Jang 
Published: March 2023

INTRODUCTION:
Minimally invasive techniques and awake surgery have changed the nature of fusion surgery, though these effects are not yet fully characterized due to the subjective nature of patient reported outcome measures (PROMs). Physical activity data measured from smartphone accelerometers offer the ability to objectively quantify the benefits of surgical intervention and time to functional recovery.

METHODS:
Patients undergoing single-level open lumbar decompression and awake, endoscopic lumbar fusion under an enhanced recovery after surgery (ERAS) protocol over a 5-year period were eligible for inclusion in this retrospective multi-institution study. Included patients were required to own an Apple iPhone (Apple Inc., Cupertino, CA) and have at least eight months of continuous pre-operative smartphone accelerometer data. Pre-operative demographics and changes in peri-operative activity levels were compared between the two patient groups.

RESULTS:
A total of 33 patients met inclusion criteria, of which 17 underwent awake, endoscopic fusion and 16 underwent open lumbar laminectomy. Fifteen of the 17 patients (88.2%) receiving endoscopic fusion achieved functional recovery within 1 year of surgery. The average length of time to reach functional recovery was 113.8 ± 28.8 days. In comparison, 13 of 16 patients (81.3%) receiving lumbar laminectomy without fusion achieved functional recovery, requiring 105 ± 18.2 days on average. There was no statistical difference in time-to-recovery between groups (p = 0.798).

CONCLUSIONS:
Minimally invasive fusion surgery in the setting of awake spinal anesthesia and peri-operative ERAS protocols allow for a recovery time that is statistically equivalent to post-operative recovery periods of less anatomically invasive decompression surgeries. These findings warrant further investigation and comparison of the functional outcomes of ultra-minimally invasive surgical procedures to traditional standard of care treatments.
188 American Spinal Injury Association (ASIA) Impairment Scale (AIS) Conversion Underestimates Neurological Recovery Following Traumatic Spinal Cord Injury
Authors: Choy Winward , Kyritsis Nikolaos , Fernandez Xuan Duong , Ferguson Adam , Hemmerle Debra P. , Pascual Lisa U. , Singh Vineeta , Talbott Jason , Pan Jonathan , Torres Abel , Whetstone William , Huie J. Russell , Fond Kenneth , Keller Anastasia , Bresnahan Jacqueline , Beattie Michael , DiGiorgio Anthony Michael , Dhall Sanjay S. , Saigal Rajiv 
Published: March 2023

INTRODUCTION:
The predominant tool used in the evaluation of neurological outcomes following spinal cord injury (SCI) is the American Spinal Injury Association (ASIA) Impairment Scale (AIS), calculated within the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). However, there are significant clinical and functional differences within AIS grades A-E that can be better captured by ISNCSCI 0-100 full motor scores.

METHODS:
55 patients with acute traumatic SCI who underwent surgery were retrospectively analyzed as part of a prospective cohort study, Transforming Research and Clinical Knowledge in SCI (TRACK-SCI). Clinical, radiographical and treatment parameters were collected, including AIS grades and full motor scores on presentation and discharge, Brain and Spinal Injury Center (BASIC) scores. Multivariable analysis was utilized to evaluate predictors of neurological recovery utilizing AIS grade and motor scores as endpoints.

RESULTS:
Improvement of at least 1 AIS grade from presentation was noted in 27% of patients (mean improvement of 0.3 AIS grades, p < 0.001) upon discharge. Improvement of total motor scores was noted in 67% with a mean recovery of 8.4 points. The discordance between rate of AIS grade conversion and motor score recovery was greatest in patients with initial AIS grade D (16% vs 72%, respectively). Total motor score improvement was greatest for patients with initial AIS grade C, with a mean improvement of 20 points. Utilizing multivariate analysis, BASIC score and initial total motor score were significant predictors of motor score recovery. However, no variables were prognostic when utilizing AIS conversion as the endpoint.

CONCLUSIONS:
AIS conversion underestimates true degree of functional improvement following SCI. Changes in full motor score is a more robust outcome metric in the evaluation of factors prognostic of neurological recovery following injury.
191 Treatment with GM-CSF Reverses TBI-Induced Immune Suppression in a Combined Injury Model
Authors: Sribnick Eric Anthony , Warner Timothy , Hall Mark 
Published: March 2023

INTRODUCTION:
Traumatic brain injury (TBI) is a potentially devastating injury for which there are no pharmacotherapies. Frequently, TBI is accompanied by injuries outside the CNS, and we have previously shown that TBI with concurrent extra-cranial injury reliably leads to post-injury immunosuppression, which puts patients at risk for infection and ultimately a poor outcome. To reverse post-injury immune suppression, we have proposed the use of the cytokine granulocyte macrophage colony-stimulating factor (GM-CSF).

METHODS:
To induce post-injury immunosuppression, we used a previously described model. 28 day old rats were injured via controlled cortical impact and then had 25% blood volume removed. Following injury, animals were treated with vehicle, 5 μg/kg, or 50 μg/kg GM-CSF daily for 7 days. Blood was obtained pre-injury, and on 1, 3, and 7 days post-injury. Brain and spleen were harvested at 7 days post-injury. Adaptive and innate immune function (measured by ex vivo cytokine production in response to an immunostimulant) were assessed in blood and spleen. Flow cytometry was performed on blood and spleen samples. Cytokine levels at the lesion and penumbra were measured by ELISA.

RESULTS:
As shown previously, injury induced reduction of both innate and adaptive immune function (approximately 50% decrease), which was reversed with GM-CSF. Treatment with GM-CSF significantly expanded the percentage of monocytes. In spleen, injury was associated with an increase in percentage of CD4 cells expressing programmed death-1 (PD-1), and this was also reversed with GM-CSF. ELISA for cytokines in brain samples from lesion and penumbra from GM-CSF treated animals were not significantly different from vehicle.

CONCLUSIONS:
These data add to a body of literature suggesting that severe trauma leads to immune suppression. Our findings suggest that treatment with GM-CSF may normalize post-injury immune response.
197 A Multidisciplinary Approach to Posterior Quadrant Disconnective Epilepsy Surgery in Pediatric Patients
Authors: Limpo Hiria , Candela Santiago , Hinojosa Jose , Rumia Jordi 
Published: March 2023

INTRODUCTION:
Extensive lesions of the posterior quadrant are a relevant cause of pediatric drug-resistant epilepsy. Early surgery is the best treatment in these cases but conventional multilobar resections carry a significant risk in pediatric patients. Despite temporo-parieto-occipital (TPO) disconnection being the preferable technique due to the preservation of motor function, studies reporting long-term longitudinal outcomes are still limited.

METHODS:
A prospective analysis was carried out on 12 children who underwent TPO disconnection. (Image 1 and 2)

RESULTS:
TPO disconnection was performed in 12 pediatric patients aged between 14 months and 18 years (median 6.29 years). The average age of seizure onset was 0.97±1.22 years. Causes of TPO included perinatal ischemia in 4 and malformation of cortical development (MCD) in 8. The presenting seizure types were focal motor impaired awareness seizures in 7 children and generalized in 5. The affected hemisphere was the right one in 9 patients and the left in 3. In half of the patients the temporal approach was performed through T1 and in the other 50% through T2. After neuropsychological examination, 2 children improved, 7 remained stable, 2 patients presented stagnation and 1 declined. Regarding postoperative complications, a non-resorptive hydrocephalus and an asymptomatic caudate nucleus infarct were observed. After a median follow-up of 2 years, 9 patients were in Engel’s Class I seizure outcome.

CONCLUSIONS:
TPO disconnection is a safe and effective motor-sparing epilepsy surgery for children with refractory seizures located in the posterior quadrant, which prevents further cognitive deterioration.
200 Peripheral Nerve Transfer for Spinal Cord Injury: Lower Motoneuron Solutions for Upper Motoneuron Problems
Authors: Jack Andrew Steven , Witiw Christopher , Jacques Line G. , Morhart Michael , Olson Jaret , Chan Ming 
Published: March 2023

INTRODUCTION:
Nerve transfers (NTs) have been recognized as a promising strategy to improve traumatic spine cord injury (tSCI) patient function. Although different tSCI NT options have been detailed, little is known about the epidemiological and injury-related aspects of this patient population.

METHODS:
TSCI patients presenting to our institution were identified through a prospectively collected tSCI data registry. Inclusion criteria consisted of: i) admission with cervical tSCI (C1-T1) between 2005-2019, ii);18-years-old, iii) documented tSCI severity using the ASIA Impairment Scale (AIS). Two peripheral nerve (PN) experts independently evaluated each patient’s suitability for NT. Demographic, and traumatic and neurological injury-related variables were collected and analyzed.

RESULTS:
A total of 224 (32%) patients were selected for based on tSCI level (C1-T1). After initial review, there was 94% agreement between PN experts with discordant cases being discussed before reaching a final consensus. A total of 108 patients (15% of tSCIs and 48% of cervical tSCIs) were deemed appropriate NT candidates. Average age was 43-years-old and the majority were male (82/108, 76%). TSCI severity range included: 54 (50%) patients being AIS A, 17 (16%) AIS B, 34 (31%) AIS C, and 3 (3%) AIS D. AIS motor level range included: 7 (6%) C4, 40 (37%) C5, 22 (20%) C6, 38 (35%) C7, and 1 (1%) C8 patient.

CONCLUSIONS:
To our knowledge, this is the first study to detail the number of tSCI patients that may qualify for NT from a large prospective database. A large proportion of cervical tSCI patients were found to be candidates. Better characterizing the epidemiological and injury patterns of this patient population will form an important first step to increase awareness and inform tSCI NT candidate identification.
205 Liquid Biopsy Biomarker for Differentiating Neurofibroma/Schwannoma From Other Solid Mass Mimics
Authors: Patel Neel T. , Khristov Vladimir , Smith Nataliya , Harbaugh Kimberly , Rizk Elias Boulos , Connor James R. 
Published: March 2023

INTRODUCTION:
Interleukin13 receptor alpha 2 (IL13Ra2) is a high-affinity receptor for the interleukin 13 (IL13) cytokine. With the exception of the testes, in normal conditions, IL13Ra2 demonstrates little normal cell expression. Prior work in our laboratory has demonstrated that IL13Ra2 is expressed on benign and malignant peripheral nerve sheath tumors in sporadic and syndromic cases. We have shown in in vitro and in murine MPST models that the receptor can be utilized to facilitate the treatment of malignant peripheral nerve sheath tumors. While mice have membrane-bound and soluble forms of IL13Ra2, humans lack the soluble form. We have previously shown the detection of IL13Ra2 exosomes in the cerebrospinal fluid and plasma of patients with glioblastoma.

METHODS:
IL13Ra2 levels were obtained from plasma and tumor specimens of 17 patients with diagnoses of Schwannoma/Neurofibroma (n = 13) and Lipoma/AVM (n = 4). Plasma and Tumor specimens were collected pre-operatively on the day of tumor resection. Plasma levels of IL13Ra2 were measured with ELISA. The tumor specimen was placed in NP40 buffer for extraction then levels were measured with ELISA.

RESULTS:
The plasma level of IL13Ra2 is significantly elevated in patients with schwannoma/neurofibroma compared to patients with lipomas/AVMs. Increased level of IL13Ra2 in tumors correlates with the increased levels of IL13Ra2 in the plasma.

CONCLUSIONS:
Plasma level of IL13Ra2 has the potential for diagnosis and may serve as a liquid biopsy biomarker to help differentiate solid tumors like neurofibroma/schwannoma from lipomas /arteriovenous malformations.
214 Impact of Cochlear Dose on Hearing Preservation Following Stereotactic Radiosurgery in Treatment of Vestibular Schwannomas: A Multi-Center Study
Authors: Klein Andrea Lauren , Chang Steven D. , Muacevic Alexander , Sherman Jonathan H. , Romanelli Pantaleo , Maria Peter Santa , Fuerweger Christoph , Zanetti Isa Bossi , Beltramo Giancarlo , Vaisbuch Yona , Tran Emma , Feng Austin Y. , Teng Hao , Meola Antonio , Gibbs Iris , Tolisano Anthony , Kutz Joe Walter , Wardak Zabi , Nedzi Lucien , MacRae Don , Sohal Preet , Kapoor Elina , Sabet-Rasekh Parisa , Moncada Paola , Zaleski-King Ashley , Monfared Ashkan 
Published: March 2023

INTRODUCTION:
Stereotactic radiosurgery (SRS) is a well-established treatment option for patients with vestibular schwannomas (VS). Hearing loss remains one of the main morbidities of VS and its treatments, including SRS. Effects of radiation parameters of SRS on hearing remains largely unknown.

METHODS:
Multicenter retrospective analysis of 611 patients who underwent SRS for VS from 1990 to 2020 and had pre- and post-treatment audiograms.

RESULTS:
Pure tone averages (PTA)s increased and word recognition scores (WRS)s decreased in the treated ears at 12 - 60 months while it remained stable in the untreated ears. Higher baseline PTA, higher tumor radiation dose, higher maximum cochlear dose, and usage of single fraction resulted in higher post radiation PTA; WRS was only predicted by baseline WRS and age. Of these parameters, higher baseline PTA, single fraction treatment, higher tumor radiation dose, and higher maximum cochlear dose resulted in a faster deterioration in PTA. Below a maximum cochlear dose of 3 Gy, there were no statistically significant changes in PTA or WRS.

CONCLUSIONS:
Decline of hearing at 1 year in VS patients after SRS is directly related to maximum cochlear dose, single versus 3-fraction treatment, total tumor radiation dose, and baseline hearing level. The maximum safe cochlear dose for hearing preservation at 1 year is 3 Gy, and the use of 3 fractions instead of 1 fraction was better at preserving hearing.
319 Precision Medicine for Meningiomas: Machine Learning Using Radiomic Feature Analysis Identifies Ki-67 Proliferative Index as a Prognostic Marker of Clinical Outcomes
Authors: Khanna Omaditya , Kazerooni Anahita Fathi , Arif Sherjeel , Baldassari Michael P. , Mahtabfar Aria , Andrews Carrie Elizabeth , Hafazalla Karim , Farrell Christopher James , Evans James J. , Andrews David W. , Shi Wenyin , Davatzikos Christos 
Published: March 2023

INTRODUCTION:
An elevated Ki-67 is one crucial factor that influences meningioma behavior. Machine learning(ML) using radiomic feature analysis can identify phenotypic pixel-level imaging signatures for enhanced tumor diagnostics.

METHODS:
Radiomic feature extraction using least-absolute-shrinkage-and-selection-operator(LASSO) wrapped with support vector machine (SVM) through nested cross-validation is used to stratify tumors based on Ki-67 <5% and ≥5%. Clinical outcomes were evaluated based on the predictive power of this algorithm.

RESULTS:
343 patients are included (WHO grade I:291, grade II:43, grade III:9). Overall mean follow-up time is 33.9 months (range: 0-105). The rate of recurrence is 14.4%, 44.2% and 77.8% for grade I, II, and III tumors, respectively. The mean Ki-67% for grade 1, 2 and 3 meningiomas is 4.79+/-3.87 (range: 0.3-33.6), 16.07+/-13.83 (range: 1.5-49), and 35.7+/-13.3 (range: 18-57.4), respectively (p = 0.03). However, there is no difference in tumor and peritumoral edema volumes between meningioma WHO grades 1-3. A total of 46 high-ranking radiomic features were selected to build a ML model. ROC curves for the ML algorithm reveals AUC’s of 0.83 [95% CI: 0.78-0.89] and 0.84 [0.75-0.94] for the discovery (N = 257) and validation (N = 86) cohort, respectively, for classifying Ki-67% based on a 5% cutoff, independent of WHO grade. Kaplan-Meier curves using the ML algorithm reveals decreased progression-free-survival (PFS) for predicted Ki-67 >5% (p < 0.001) for all tumors in the cohort, as well as in sub-analyses of non-skull base tumors (p < 0.001) and skull-base tumors (p < 0.001). A comparison of histopathological PFS versus ML-predicted outcomes based on Ki-67 reveals good concordance for grade I, II and III tumors.

CONCLUSIONS:
ML using radiomic feature analysis can be used to stratify meningiomas based on Ki-67 with excellent accuracy. The predictive power of this model reveals distinctly divergent PFS outcomes, and can be used to guide treatment strategy.
333 Intraventricular Ziconotide Improves Cognitive Outcomes following Lateral Fluid Percussion Injury in a Rat Model
Authors: Jude Morgan Blair , Izadi Ali , Shahlaie Kiarash , Gurkoff Gene G. 
Published: March 2023

INTRODUCTION:
Traumatic brain injury (TBI) is a major source of morbidity and mortality worldwide. In previous studies, intravenous ziconotide, a selective N-type voltage-gated calcium channel blocker, reduced brain calcium accumulation, improved brain mitochondrial respiration, and improved cognitive and motor outcomes in rodent models of TBI. Attempts to translate intravenous ziconotide therapy to humans were halted due to peripheral side-effects. However, ziconotide is now FDA-approved for treatment of severe pain syndromes when administered intrathecally instead of intravenously. We hypothesize that following TBI intraventricular ziconotide will improve cognitive function in the absence of significant side effects.

METHODS:
Seventy-seven Sprague-Dawley rats underwent sham (n = 11 males, n = 11 females) or lateral fluid percussion (LFP) injury (n = 21 males, n = 23 females). One-hour post-injury, rats received either an intraventricular injection of saline (n = 22 sham, n = 23 LFP) or ziconotide (n = 21 LFP). A catheter was implanted in the left lateral ventricle and connected to an Alzet micro-osmotic pump to allow for 72 hours of continuous infusion. Cognitive outcomes were evaluated using Morris water maze (MWM; days 10-15).

RESULTS:
TBI-saline rats performed significantly worse than shams on MWM (p < 0.01). Ziconotide treated rats had an intermediate phenotype on MWM. TBI-saline rats swam a less efficient path than sham animals (p < 0.01); ziconotide path efficiency was not significantly different from shams. Performance on the MWM was likely not related to motor deficits as there was no significant effect of group on mean swimming speed in either males or females. Female sham animals performed significantly better on probe trials compared to TBI-saline (p < 0.05); ziconotide animals were not different from shams.

CONCLUSIONS:
These findings support centrally delivered Ziconotide as a potential neuroprotective agent to improve cognitive performance following TBI. Further studies are required to characterize the neuroprotective effects of Ziconotide therapy.
347 Management of Rathke Cleft Cysts in Children: The Rady Children’s Hospital Approach
Authors: Brandel Michael G. , Plonsker Jillian Hannah , Rennert Robert , Khan Usman , Nation Javan , Crawford John R. , Levy Michael L. 
Published: March 2023

INTRODUCTION:
Rathke cleft cysts (RCCs) are benign, epithelial-lined sellar lesions that arise from remnants of the craniopharyngeal duct. Due to their rarity in the pediatric population, data are limited regarding the natural history and management of growing or symptomatic RCCs.

METHODS:
We performed a retrospective study of RCC patients age ≤18 years treated between 2006-2022 at our institution.

RESULTS:
567 patients with a diagnosis of pituitary mass or cyst were identified. Of these, 31 underwent surgery and had a histopathological diagnosis of RCC, 58% female and 42% male. Mean age was 13.2 +/- 4.2 years. Presenting symptoms included headache (58%), visual changes (35%), and endocrinopathies or growth delay (26%); 13% were identified incidentally and grew significantly on serial imaging. Six percent presented with intralesional hemorrhage. Surgical approach was transsphenoidal for 90% of patients and orbitozygomatic for 10%. Preoperative headaches resolved in 61% of patients after surgery. New pituitary axis deficits were seen in 9.7%. Only two complications occurred from a first-time surgery: one cerebrospinal fluid leak requiring lumbar drain placement, and one case of epistaxis requiring cauterization. No patients experienced new visual or neurological deficits. Patients were followed postoperatively with serial imaging. Mean follow-up was 62.9 +/- 58.4 months. Recurrence requiring reoperation occurred in 32% of patients (transsphenoidal n = 8, pterional n = 2). Five-year progression-free survival was 47.9%. Except for one patient with multiple neurological deficits from a concurrent tectal glioma, all patients had a modified Rankin Scale score of 0 or 1 (good outcome) at last follow-up.

CONCLUSIONS:
Due to their secretory epithelium, RCCs may demonstrate rapid growth and recurrence. Incidental RCCs can be managed conservatively, whereas symptomatic or growing lesions may be fenestrated or resected. Due to their dynamic and variable nature, careful patient selection and close postoperative surveillance are critical to optimizing patient outcomes.