bluuebunny/crossref_metadata_2025_split huggingface dataset:
492 Periprocedural Polypharmacy in Lumbar Fusions Performed Under Spinal Anesthesia Compared to General Anesthesia
Authors: Olmos Michelle , Hernandez Nicholas , Kanter Matthew , Liu Penny , Riesenburger Ron I. , Kryzanski James 
Published: March 2023

INTRODUCTION:
Lumbar spinal surgery is most often performed under general endotracheal anesthesia (GEA), however spinal anesthesia (SA) is a safe and effective alternative. Postoperative cognitive dysfunction (POCD) is a complication of GEA and the risk of POCD is associated with anesthetic modality and perioperative polypharmacy. Despite the many benefits of SA described in the literature, its efficacy in decreasing polypharmacy has not yet been determined.

METHODS:
Demographic and procedural data of 424 patients undergoing single TLIF via GEA (n = 186) and SA (n = 238) were extracted from our institution’s electronic medical record. We investigated perioperative medication types, number of intraoperative hypotensive episodes, vasopressor requirement, and overall number of perioperative medications used between the two patient groups.

RESULTS:
The number of perioperative medications differed significantly between the two cohorts with the SA cohort receiving a mean of 4.5 medications and the GEA cohort receiving a mean of 10.5 medications (p < 0.0001).This reduction in perioperative medications remained significant after a multivariable analysis to control for confounders (p < 0.001 for all variables). Use of vasopressors was significantly reduced in the SA cohort (p < 0.001), which coincided with a significant reduction in hypotensive episodes in the SA cohort (p < 0.001). Patients undergoing TLIF via GEA had 3.6 times greater odds of experiencing a hypotensive episode intraoperatively (OR = 3.62, 95% CI [2.38-5.49]).

CONCLUSIONS:
Spinal anesthesia is associated with a significant decrease in perioperative medications, including lower vasopressor requirements. We postulate that SA may confer superior intraoperative hemodynamic stability which lowers pressor requirements. The decrease of perioperative medications may be an important contribution in reducing the incidence of POCD in patients undergoing TLIFs.
493 One and Two-Level Robotic MIS TLIF With Expandable Implants Demonstrates a Favorable Safety Profile and Improved Alignment Parameters
Authors: Moskalik Anzhela D. , Castillo Jose Antonio , Soufi Khadija , Perez Tess , Kercher Matthew , Karnati Tejas , Goodrich Dylan , Kim Kee , Ebinu Julius O. , Martin Allan R. 
Published: March 2023

INTRODUCTION:
Minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) is an established technique, but continues to evolve with the development of expandable titanium cages and robotic screw insertion.

METHODS:
This retrospective case series assessed clinical data, complications, and radiographic outcomes at short term follow-up. Screw placement was performed using intraoperative 3D imaging and robotic navigation, and TLIFs were performed via complete facetectomy from a unilateral trajectory in line with pedicle screws using titanium expandable cages.

RESULTS:
22 patients, 32 levels, and 108 inserted screws were analyzed. Implants included curved cages in 14 levels, 2 straight cages (diverging “V” pattern) in 12 levels, and a single straight cage in 6 levels. 21/22 patients (95%) had decreased pain. 4/22 patients (18%) experienced complications including deep infection causing screw pullout (requiring revision), painful radiculopathy, contact dermatitis (glue), and UTI. 108/108 screws (100%) showed excellent position. Increases were observed in average segmental lordosis (4.3 ± 4.9°), anterior disc height (6.6 ± 3.5 mm), posterior disc height (4.1 ± 2.1 mm), and foraminal height (5.0 ± 3.1 mm). Improved alignment was observed in 3/3 patients (100%) with SVA > 50 mm (78.3 ± 13.3 mm to 41.7 ±14.3 mm), 3/4 (75%) with pelvic tilt >=25° (30.3 ± 1.5° to 22.7 ± 4.0°), 5/5 (100%) with lumbopelvic mismatch > 10° (PI – LL: 21.4 ± 2.1° to 9.8 ± 8.5°), 13/13 (100%) with anterolisthesis (6.5 ± 2.3 mm to 1.8 ± 1.9 mm), and 4/4 (100%) with segmental coronal imbalance >5° (8.0 ± 3.2° to 2.8 ± 1.3°).

CONCLUSIONS:
Robotic MIS TLIF with expandable cages has a favorable safety profile, successful short-term clinical results, and is effective at correcting mild spinal malalignment.
496 Erector Spine Plane Block Improves Analgesia After Minimally Invasive Awake Spine Surgery
Authors: De Biase Gaetano , Colontonio Matthew , Quinones-Hinojosa Alfredo , Abode-Iyamah Kingsley O. , Bojaxhi Elird 
Published: March 2023

INTRODUCTION:
There is an emerging interest in lumbar spine surgery under spinal anesthesia (SA). Bilateral lumbar erector spinae plane (ESP) blocks are also described as a useful regional anesthetic technique to reduce post-operative pain after lumbar surgery.

METHODS:
A retrospective chart review was performed analyzing time in OR, first pain score in PACU after spinal wore off, pain scores throughout POD0, opioid requirements, PONV requiring rescue agent, and length of stay in patients that underwent spine surgery under SA before our practice adopted ESP blocks for back surgery versus patients that received an ESP block. For patients that received an ESP block, the injection was performed after skin closure above the level of the surgical intervention. Under ultrasound guidance, the erector spinae muscle layer was visualized and the block was performed with 15 ml of 0.5% bupivacaine mixed with 15 ml of liposomal bupivacaine (30 ml of local anesthetic per side).

RESULTS:
There was no significant difference in age, sex, ASA class, and BMI. Perioperative opioid use on POD0 was more than double in those not receiving a block (p = 0.0032). First pain score in recovery following conclusion of the spinal was greater than those who had received the intervention, p = 0.0209. Median length of stay in days was the same with a larger range in the non-intervention group. Incidence of nausea/vomiting was decreased in the group receiving ESP blocks.

CONCLUSIONS:
An ESP block can be used as an adjunct for minimally invasive spine surgery for enhancing recovery. Preliminary data suggests there is a trend for lower incidence of PONV as well as average pain scores on POD0 and a significant decrease in perioperative opioid use, increased same-day discharges, and improved pain scores upon conclusion of SA.
498 Feasibility and Efficacy of Postoperative Diffusion Basis Spectrum Imaging to Evaluate Recovery After Surgery in Cervical Spondylotic Myelopathy
Authors: Zhang Justin , Javeed Saad , Greenberg Jacob K. , Dibble Christopher , Jayasekera Dinal , Blum Jacob , Song Sheng-Kwei , Ray Wilson Zachary 
Published: March 2023

INTRODUCTION:
Previous studies evaluating diffusion tensor imaging (DTI) in cervical spondylotic myelopathy (CSM) have demonstrated limitations in assessing postoperative outcomes following surgery. Diffusion basis spectrum imaging (DBSI), capable of providing granular assessments of spinal cord microstructure, may help address these shortcomings.

METHODS:
Twenty-seven CSM patients underwent preoperative diffusion-weighted MRI followed by cervical decompressive surgery and repeat imaging at two-years follow-up. DTI and DBSI metrics were extracted from the C3 spinal cord level. Diffusion-weighted MRI anisotropic tensors evaluated white matter tracts through fractional anisotropy, axial diffusivity, radial diffusivity, and fiber fraction. DBSI isotropic tensors assessed extra-axonal pathology through restricted and non-restricted fraction. Improvement after surgery was defined as a 2-point increase in the mJOA at two-years follow-up. Support vector machine classification algorithms were used to predict surgical outcomes.

RESULTS:
Fifteen mild (mJOA 15-17), 7 moderate (12-14) and 5 severe (0-11) CSM patients underwent surgical decompression and were followed-up to 23.2 (5.6, range 11.1-32.8) months postoperatively. Among DBSI metrics, isotropic diffusion components changed significantly from baseline to latest follow-up (p < 0.01), whereas anisotropic components remained stable (p > 0.05). When predicting improvement in the mJOA, SVM models built with DTI metrics had an accuracy of 74.1 [95% CI: 73.6, 74.6] compared to 85.2 [84.5, 85.3] in the DBSI model.

CONCLUSIONS:
Postoperative DBSI metrics predicted long-term outcomes with high accuracy. DBSI may have utility in assessing recovery trajectories for CSM patients following surgery.
501 Patient-Specific Targeting Method for Improved Quality-of-Life Outcomes from MRgFUS Treatment of Essential Tremor
Authors: Datta Anjali , Loo Kung Gustavo Chau , Barbosa Daniel , Quah Kristen , Purger David Arnold , Ren Alexander , Wang Allan , Chodakiewitz Yosefi , Tov Lior Lev , Ghanouni Pejman , McNab Jennifer , Buch Vivek 
Published: March 2023

INTRODUCTION:
MRI-guided-focused-ultrasound (MRgFUS) ablation of the ventral intermediate nucleus (VIM) is an FDA-approved treatment for essential tremor (ET). However, the VIM cannot be directly visualized on standard imaging, and the ideal ablation zone within the putative VIM varies inter-individually. Suboptimal lesion location can lead to side effects that impair quality of life (QoL). Patient-specific methods to locate the “go-zone” for MRgFUS ablation for ET that can predict QoL outcome could provide significant benefit over current methods.

METHODS:
We retrospectively studied 26 ET patients treated with MRgFUS at Stanford. Probabilistic tracking from the thalamus to M1 using each subject’s standard, low-resolution preoperative diffusion MRI generated patient-specific cerebello-thalamic-cortical tracts. Within the thalamus, the personalized hotspot with high probability of being connected to M1 defined the “go-zone.” The normative DISTAL-atlas VIM, which some centers use to target deep brain stimulation, provided a comparison. The lesion was segmented in postoperative MRIs and transformed to the preoperative-MRI space. Similarity/overlap between the “go-zone” and lesion was quantified using the Sorensen-Dice coefficient. Postoperative QoL ("better," "same," or "worse") was determined from each subject’s last-available follow-up.

RESULTS:
Probabilistic thalamus-to-M1 tracking robustly identified cerebello-thalamo-cortical tracts using standard, clinical diffusion MRIs. Lesion similarity to the patient-specific tractographic "go-zone" was associated with better QoL outcomes. Dice coefficients of the "worse" group were significantly lower than of the combined “same”/”better” group (p = 0.014). This was not seen with the DISTAL-atlas VIM.

CONCLUSIONS:
We proposed a clinically-feasible probabilistic-tractography-based targeting method for MRgFUS treatment of ET. Lesion similarity to the personalized “go-zone” is associated with better QoL outcome, unlike similarity to the normative DISTAL-atlas VIM. This illustrates the value of our patient-specific targeting approach.
502 Clinical Outcomes for Treatment of Peri-Rolandic Epilepsy
Authors: Lee Anthony T. , Spiedel Benjamin , Knowlton Robert C. , Rao Vikram , Chang Edward 
Published: March 2023

INTRODUCTION:
Treatment of epileptogenic foci within the eloquent peri-Rolandic region (pre- and post-central gyri) is challenging. Advances in surgical techniques and implantable neuromodulation devices have broadened the available treatment options.

METHODS:
We retrospectively studied all consecutive patients who underwent intracranial seizure monitoring from 2013 to 2021. We studied demographic and imaging variables, stimulation results, seizure outcomes, and neurological function at various stages of recovery.

RESULTS:
22 patients encompassing 25 procedures were included in this study. 12 of the patients had non-lesional MRIs with surgical intervention involving the dominant hemisphere. 9 patients underwent peri-Rolandic resections, and 11 patients received peri-Rolandic RNS. The rest had a combination of non-peri-Rolandic resection, multiple subpial transection, and peri-Rolandic RNS. When comparing resection against RNS cohorts, more patients who elected for resection had failed prior surgical interventions. Although most resection patients had a neurological deficit at discharge (78% for resection vs 0% for RNS), those who received resection had better rates of seizure control (Engel I at last follow-up: 78% for resection vs 27% for RNS). Almost all patients with neurological deficits experienced significant functional recovery over time.

CONCLUSIONS:
Resection of peri-Rolandic seizure foci can lead to excellent outcomes with neurological morbidity that improves over time. Treatment selection should be tailored based on risk-benefit analysis and patient preference.
507 Apathy Following Bilateral Subthalamic Deep Brain Stimulation for Parkinson’s Disease: The INTREPID Randomized Controlled Trial
Authors: Stiep Tamara , Ramirez-Zamora Adolfo , Tröster Alexander , Jain Roshini , Chen Lilly , Malekmohammadi Mahsa , Okun Michael S. 
Published: March 2023

INTRODUCTION:
Motivational disturbances including apathy have been reported following bilateral subthalamic deep brain stimulation (STN-DBS). Many studies suggest apathy is associated with dopaminergic denervation and can be unmasked by drug withdrawal and by aggressive drug tapering following surgery. Additionally, it is suspected that stimulation of the limbic-associative sub-regions of STN might serve as a catalyst, an independent cause, or possibly act synergistically with dopaminergic medication reduction.

METHODS:
INTREPID (NCT01839396) is a multi-center, prospective, double-blinded RCT. Participants with advanced Parkinson's disease (PD) received bilateral STN-DBS and completed a neuropsychological battery at screening (prior to DBS) and at follow up (12-months). Apathy was assessed using the Starkstein Apathy Scale (SAS). Demographic and clinical data including age, gender, disease duration, levodopa-equivalent daily dose (LEDD), and imaging correlates of DBS (including location and volume of stimulated tissue) were analyzed.

RESULTS:
There were a total of 160 subjects evaluated at 1-year following STN-DBS, 44 (27.5%) reported an improvement in apathy scores of at least 5-points, and 7 (4.4%) an improvement >10 points. Eighteen (11.3%) participants had worsening apathy scores >5 points, and 8 (5%) reported worsening >10 points. Aggregation of stimulation field models (SFM) across the cohorts, indicated that worsening of apathy was associated with activation of limbic and associative areas of the STN.

CONCLUSIONS:
Bilateral STN-DBS in this prospective dataset revealed both improvement and worsening of apathy at 1-year follow-up visits. Further analysis of LEDD, dopamine agonist use, and volume of tissue activation may help us to understand the clinical factors underpinning apathy following DBS. Appropriate counseling preoperatively coupled with post-operative monitoring is important for setting expectations and for employing appropriate treatment when necessary.
512 Mapping High Gamma Neural Signals in Hand Primary Somatosensory Cortex Using a Multi-Thousand Channel Platinum Nanorod Microelectrode Grid
Authors: Shahin Maryam Nour , Ramos Christian Lopez , Tchoe Youngbin , Nerison Caleb , Lee Jihwan , Lee Keundong , Bourhis Andrew , Dayeh Shadi , Raslan Ahmed M.T. , Collins Kelly 
Published: March 2023

INTRODUCTION:
Neurological deficits secondary to pathologies such as stroke, tumor, trauma, and neurodegeneration lead to enduring disability for many patients. Therefore, the development of neurorestorative technologies utilizing brain computer interfaces (BCIs) is an important goal in applied neuroscience. The high-gamma electrocorticographic (ECoG) neural signals from surgically implanted brain electrodes can be used as an indirect proxy for neuronal spiking activity and local neuronal output, which has translated into an effective control signal for BCIs. Direct electrical stimulation (DES) of primary somatosensory cortex has been used to provide sensory feedback in bi-directional sensorimotor BCIs (BBCIs).

METHODS:
During an awake craniotomy for tumor resection, a PtNRGrid was placed over primary hand somatosensory cortex while touches were applied to the ipsilateral and contralateral hand and arm.

RESULTS:
Here, we demonstrate the mapping of the high gamma signal in single digit and individual carpal distribution.

CONCLUSIONS:
This is the first analysis of high gamma signal in human hand primary somatosensory cortex utilizing PtNRGrids.
513 Presurgical Identification of Seizure Onset and Propagative Zones Without Ictal Recordings: A Combined Diffusion MRI and SEEG Study
Authors: Johnson Graham Walter , Doss Derek , Shless Jared , Paulo Danika Lea , Morgan Victoria , Bick Sarah K.B. , Englot Dario J. 
Published: March 2023

INTRODUCTION:
Increasing evidence has suggested that identification of regions involved in early seizure propagation (“Propagation Zones”, PZ) is important to predict seizure freedom after epilepsy surgery (Andrews 2019). Resting-state connectivity analyses using stereo-electroencephalography (SEEG) have shown promise in efficiently characterizing seizure onset zones (SOZ) but have found difficulty in distinguishing both SOZs and PZs from non-involved brain regions. Recently, evidence has suggested that ictal structure-function coupling can be used to delineate brain regions important in seizure dynamics (Shah 2019).

METHODS:
We calculated the resting-state SEEG directed connectivity of 26 consented patients with focal epilepsy undergoing presurgical evaluation. Using preoperative diffusion MRI, we then implemented a custom technique to obtain structural connectivity metrics between SEEG contacts. We calculated the structural connectivity and structure-function coupling of SOZs, PZs (spread within 10 seconds), and non-involved regions over a range of Euclidean distances. Finally, we generated models using a support vector machine to classify SOZs, PZs, and non-involved regions.

RESULTS:
SOZs and PZs exhibit comparably high local structural connectivity compared to non-involved regions despite SOZs demonstrating significantly greater functional connectivity to both PZs and non-involved regions. However, PZs exhibit significantly higher local structure-function coupling to that of non-involved regions, with SOZs exhibiting the highest local structure-function coupling. A support vector machine to classify SOZs, PZs, and non-involved regions and was able to significantly increase model accuracy by incorporating local structure-function coupling.

CONCLUSIONS:
SOZs and PZs demonstrate a distinct local structure-function coupling to that of non-involved regions and each other. This distinct coupling profile can be used to accurately classify SOZs, PZs and non-involved regions.
514 A Functional Ultrasound Brain-Machine Interface: Real-Time Decoding of Eight Movement Directions
Authors: Griggs Whitney , Norman Sumner , Rabut Claire , Deffieux Thomas , Christopoulos Vasileios , Liu Charles Y. , Tanter Mickael , Shapiro Mikhail , Andersen Richard 
Published: March 2023

INTRODUCTION:
Brain-machine interfaces (BMIs) can be transformative for people living with chronic paralysis. By translating brain signals into computer commands, BMIs can bypass neurological impairments, enabling users to control computers, robots, and more. State-of-the-art BMIs have already made this future a reality in limited clinical trials. However, these BMIs requires inserting highly invasive electrodes into the brain. Device degradation limits longevity to 3-5 years and the field of view of brain activity is small. These factors limit BMI’s widespread adoption. The next generation of BMIs must be longer lasting, less invasive, and scalable. Functional ultrasound neuroimaging (fUSI) is a recently developed technique that meets these criteria.

METHODS:
We collected data from two nonhuman primates (NHPs). We used real-time fUSI to measure activity in the posterior parietal cortex, an important area for motor planning. We fed this fUSI data into real-time machine learning classifiers to predict the monkey’s intended movement direction and control a behavioral task in real-time.

RESULTS:
We could predict the monkey’s intended movement direction significantly above chance level (binomial test, p<0.001 for 2- and 8-directions) using the real-time fUSI-BMI. Most direction misclassifications were for neighboring directions (permutation test, p<0.001). The most important voxels for decoding eye movements were within small subpopulations of the lateral intraparietal area (LIP). We found that these LIP subpopulations had a stable encoding of movement direction and the NHPs could accurately control the task more than 40 days after training the decoder model.

CONCLUSIONS:
This work establishes, for the first time, the feasibility of a real-time ultrasound-based BMI and we have begun translating this work into human applications. This work contributes to the next generation of high-performing, yet minimally-invasive, BMIs that can restore function to patients with neurological impairments.
517 Glioblastoma Induces the Recruitment of Anti-Tumoral Immunostimulatory Neutrophils from Skull Bone Marrow
Authors: Lad Meeki , Beniwal Angad , Gill Sabraj , Jain Saket , Aghi Manish Kumar 
Published: March 2023

INTRODUCTION:
The effects of tumor-associated neutrophils (TANs) on glioblastoma biology remain poorly understood. While TANs are generally considered immunosuppressive, recent studies have demonstrated their ability to present antigen to T cells, warranting investigation of this phenotype in glioblastoma.

METHODS:
Flow cytometry was used to sort and characterize surface protein expression among neutrophils across 5 newly diagnosed glioblastoma fresh tissue specimens. Samples were evaluated transcriptomically via single-cell RNA sequencing (scRNA-seq) or phenotypically via coculture with autologous T cells. TANs were further evaluated in a syngeneic glioma mouse model (Balb/c), treated with either neutrophil-depleting antibody (αLy6G) or isotype control; tumor size was ascertained by bioluminescent imaging. Skull bone marrow was tagged with fluorescent dye in neutrophil tracing experiments.

RESULTS:
21.0-34.1% of patient glioblastoma TANs express MHCII, a marker of antigen-presenting cells not canonically associated with neutrophils and not expressed in matched peripheral blood (PBNs). scRNA-seq pseudotime analysis demonstrates that antigen-presenting neutrophils are a developmental lineage seen uniquely in TANs and not PBNs, with enriched expression of MHCII subunits (HLA-DR), chaperones (HLA-DM), and costimulatory ligands (CD86/83;). Consequently, TANs activate T cells in an MHCII-dependent manner (CD25 MFI fold-change, PBNs vs TANs: 1.1 vs 3.2, p < 0.001), and depleting neutrophils in a murine model yields endpoint tumors that have 53% lower CD8+ T cell infiltration (n = 13, p = 0.0024) and are 2.4-fold larger (p = 0.0383). The lack of MHCII+ neutrophils in blood suggests that these cells may be recruited from local marrow niches and not circulation; indeed, in vivo, we observe that compared to all TANs, MHCII+ TANs are disproportionately derived from skull bone marrow (41.7% vs 9.3%).

CONCLUSIONS:
Given the recruitment of immunostimulatory TANs from the calvarium to the glioblastoma microenvironment, mechanisms to enhance neutrophil transmarrow migration may have therapeutic value.