bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contralateral subfrontal approach for tuberculum sellae meningioma: techniques and clinical outcomes
Authors: Kim Yeong Jin , Moon Kyung-Sub , Jang Woo-Youl , Jung Tae-Young , Kim In-Young , Jung Shin 
Published: July 2022

OBJECTIVE
Tuberculum sellae meningiomas (TSMs) present a burdensome surgical challenge because of their adjacency to vital neurovascular structures. The contralateral subfrontal approach provides an outstanding corridor for removing a TSM with an excellent visual outcome and limited complications. The authors present their long-term surgical experience in treating TSMs via the contralateral subfrontal approach and discuss patient selection, surgical techniques, and clinical outcomes.

METHODS
Between 2005 and 2021, the authors used the contralateral subfrontal approach in 74 consecutive patients presenting with TSMs. The surgical decision-making process and surgical techniques are described, and the clinical outcomes were retrospectively analyzed.

RESULTS
The mean patient age was 54.4 years, with a female predominance (n = 61, 82%). Preoperatively, 61 patients (82%) had vision symptoms and 73 (99%) had optic canal invasion by tumor. Gross-total resection was achieved in almost all patients (n = 70, 95%). The visual function improvement and stabilization rate was 91% (67/74). Eight patients (11%) showed a worsening of visual function on the less-compromised (approach-side) optic nerve. There was no occurrence of cerebrospinal fluid leakage. Four patients (5%) experienced recurrences after the initial operation (mean follow-up duration 63 months). There were no deaths in this study.

CONCLUSIONS
The contralateral subfrontal approach provides a high chance of complete tumor removal and visual improvement with limited complications and recurrences, especially when the tumor is in a unilateral or midline location causing unilateral visual symptoms or bilateral asymmetrical visual symptoms, regardless of tumor size or encasement of major vessels. With the appropriate patient selection, surgical technique, and familiarity with surrounding neurovascular structures, this approach is reliable for TSM surgery.
Identifying the therapeutic zone in globus pallidus deep brain stimulation for Parkinson’s disease
Authors: Holland Marshall T. , Jiao Jocelyn , Mantovani Alessandra , Anderson Shannon , Mitchell Katherine A. , Safarpour Delaram , Burchiel Kim J. 
Published: July 2022

OBJECTIVE
The globus pallidus internus (GPI) has been demonstrated to be an effective surgical target for deep brain stimulation (DBS) treatment in patients with medication-refractory Parkinson’s disease (PD). The ability of neurosurgeons to define the area of greatest therapeutic benefit within the globus pallidus (GP) may improve clinical outcomes in these patients. The objective of this study was to determine the best DBS therapeutic implantation site within the GP for effective treatment in PD patients.

METHODS
The authors performed a retrospective review of 56 patients who underwent bilateral GP DBS implantation at their institution during the period from January 2015 to January 2020. Each implanted contact was anatomically localized. Patients were followed for stimulation programming for at least 6 months. The authors reviewed preoperative and 6-month postsurgery clinical outcomes based on data from the Unified Parkinson’s Disease Rating Scale Part III (UPDRS III), dyskinesia scores, and levodopa equivalent daily dose (LEDD).

RESULTS
Of the 112 leads implanted, the therapeutic cathode was most frequently located in the lamina between the GPI external segment (GPIe) and the GP externus (GPE) (n = 40). Other common locations included the GPE (n = 24), the GPIe (n = 15), and the lamina between the GPI internal segment (GPIi) and the GPIe (n = 14). In the majority of patients (73%) a monopolar programming configuration was used. At 6 months postsurgery, UPDRS III off medications (OFF) and on stimulation (ON) scores significantly improved (z = −4.02, p < 0.001), as did postsurgery dyskinesia ON scores (z = −4.08, p < 0.001) and postsurgery LEDD (z = −4.7, p < 0.001).

CONCLUSIONS
Though the ventral GP (pallidotomy target) has been a commonly used target for GP DBS, a more dorsolateral target may be more effective for neuromodulation strategies. The assessment of therapeutic contact locations performed in this study showed that the lamina between GPI and GPE used in most patients is the optimal central stimulation target. This information should improve preoperative GP targeting.
Differences in intrinsic functional networks in patients with essential tremor who had good and poor long-term responses after thalamotomy performed using MR-guided ultrasound
Authors: Pae Chongwon , Kim Myung Ji , Chang Won Seok , Jung Hyun Ho , Chang Kyung Won , Eo Jinseok , Park Hae-Jeong , Chang Jin Woo 
Published: July 2022

OBJECTIVE
Thalamotomy at the nucleus ventralis intermedius using MR-guided focused ultrasound has been an effective treatment method for essential tremor (ET). However, this is not true for all cases, even for successful ablation. How the brain differs in patients with ET between those with long-term good and poor outcomes is not clear. To analyze the functional connectivity difference between patients in whom thalamotomy was effective and those in whom thalamotomy was ineffective and its prognostic role in ET treatment, the authors evaluated preoperative resting-state functional MRI in thalamotomy-treated patients.

METHODS
Preoperative resting-state functional MRI data in 85 patients with ET, who were experiencing tremor relief at the time of treatment and were followed up for a minimum of 6 months after the procedure, were collected for the study. The authors conducted a graph independent component analysis of the functional connectivity matrices of tremor-related networks. The patients were divided into thalamotomy-effective and thalamotomy-ineffective groups (thalamotomy-effective group, ≥ 50% motor symptom reduction; thalamotomy-ineffective group, < 50% motor symptom reduction at 6 months after treatment) and the authors compared network components between groups.

RESULTS
Seventy-two (84.7%) of the 85 patients showed ≥ 50% tremor reduction from baseline at 6 months after thalamotomy. The network analysis shows significant suppression of functional network components with connections between the areas of the cerebellum and the basal ganglia and thalamus, but enhancement of those between the premotor cortex and supplementary motor area in the noneffective group compared to the effective group.

CONCLUSIONS
The present study demonstrates that patients in the noneffective group have suppressed functional subnetworks in the cerebellum and subcortex regions and have enhanced functional subnetworks among motor-sensory cortical networks compared to the thalamotomy-effective group. Therefore, the authors suggest that the functional connectivity pattern might be a possible predictive factor for outcomes of MR-guided focused ultrasound thalamotomy.
Space-expanding flap in decompressive hemicraniectomy for stroke
Authors: Schucht Philippe , Nowacki Andreas , Osmanagic Armin , Murek Michael , Z’Graggen Werner J. , Montalbetti Matteo , Beck Jürgen , Stieglitz Lennart , Raabe Andreas 
Published: July 2022

OBJECTIVE
Decompressive hemicraniectomy (DCE) is the standard of care for space-occupying malignant infarction of the medial cerebral artery in suitable patients. After DCE, the brain is susceptible to trauma and at risk for the syndrome of the trephined. This study aimed to assess the feasibility of using temporary space-expanding flaps, implanted during DCE, to shield the brain from these risks while permitting the injured brain to expand.

METHODS
The authors performed a prospective feasibility study to analyze the safety of space-expanding flaps in 10 patients undergoing DCE and evaluated clinical and radiological outcomes.

RESULTS
The relatives of 1 patient withdrew consent, leaving 9 patients in the final analysis. No patients required removal of the space-expanding flap because of uncontrolled increase of intracranial pressure or infection. One patient required additional external ventricular drainage and 1 received mannitol. The mean (range) midline shift decreased from 6.67 (3–12) mm to 1.26 (0–2.6) mm after DCE with the space-expanding flap. The authors observed no cases of sinking skin flap syndrome, other complications, or deaths. One patient underwent further treatment due to infection of the reimplanted autologous bone flap. Two patients later refused cranioplasty, preferring to keep the space-expanding flap and thus avoid the potential risks of cranioplasty.

CONCLUSIONS
This feasibility study showed that the concurrent use of space-expanding flaps appeared to be safe in patients who underwent DCE for malignant infarction of the medial cerebral artery. Moreover, space-expanding flaps may permit patients to avoid a second surgery for reimplantation of the autologous bone flap and the risks inherent to this procedure.
A systematic review of the clinicopathological features and prognostic outcomes of DICER1-mutant malignant brain neoplasms
Authors: Vuong Huy Gia , Le Minh-Khang , Dunn Ian F. 
Published: July 2022

OBJECTIVE
DICER1-mutant malignant brain neoplasms are very rare tumors, and published data have relied on case reports or small case series. In this review, the authors aimed to systematically summarize the types and distribution patterns of DICER1 mutations, clinicopathological characteristics, and prognostic outcomes of these tumors.

METHODS
The authors searched PubMed and Web of Science for relevant studies. They included studies if they provided individual patient data of primary malignant brain tumors carrying DICER1 mutations.

RESULTS
The authors found 16 studies consisting of 9 embryonal tumors with multilayered rosettes (ETMRs), 30 pineoblastomas, 52 primary intracranial sarcomas, and 27 pituitary blastomas. Pineoblastoma, ETMR, and pituitary blastoma were more likely to carry DICER1 germline mutations, while only a small subset of primary intracranial sarcomas harbored these mutations (p < 0.001). Nearly 80% of tumors with germline mutations also had another somatic mutation in DICER1. ETMR and primary intracranial sarcoma were associated with an increased risk for tumor progression and relapse compared with pituitary blastoma and pineoblastoma (p = 0.0025), but overall survival (OS) was not significantly different. Gross-total resection (GTR) and radiotherapy administration were associated with prolonged OS.

CONCLUSIONS
ETMR, pineoblastoma, primary intracranial sarcoma, and pituitary blastoma should be considered rare phenotypes of the DICER1 syndrome, and families should be counseled and screened for associated tumors. ETMR and primary intracranial sarcoma had a higher risk of relapse. GTR and radiotherapy appeared to improve the OS of patients with DICER1-mutant malignant intracranial tumors.
Changes in venous drainage after posterior cranial vault distraction and foramen magnum decompression in syndromic craniosynostosis
Authors: Cinalli Giuseppe , Russo Carmela , Vitulli Francesca , Parlato Raffaele Stefano , Spennato Pietro , Imperato Alessia , Quarantelli Mario , Covelli Eugenio , Aliberti Ferdinando 
Published: July 2022

OBJECTIVE
The authors’ objective was to measure the effect of posterior cranial vault distraction (PCVD) plus foramen magnum decompression (FMD) on dural sinus volume and venous flow in patients with syndromic craniosynostosis.

METHODS
The volumes of the sagittal, straight, transverse, and sigmoid sinuses of 5 consecutive patients with syndromic craniosynostosis who underwent PCVD+FMD were calculated in cubic centimeters with T2-weighted volumetric MRI sequences before surgery, immediately after surgery, and after the end of the distraction process. Tridimensional reconstructions of phase-contrast magnetic resonance angiography (PC-MRA) images were obtained with multiplanar reconstruction (MPR).

RESULTS
The average total volume of all dural sinuses increased immediately after surgery (from 10.06 cm3 to 12.64 cm3) and continued to increase throughout the 30-day distraction period (from 12.64 cm3 to 14.71 cm3) (p = 0.04), except that the right sigmoid sinus remained stable after the initial increase. The most important increases were observed for the left transverse sinus (+113.2%), right transverse sinus (+104.3%), left sigmoid sinus (+91.3%), and sagittal sinus (+41.8%). Less important modifications were evident for the right sigmoid sinus (+33.7%) and straight sinus (+23.4%). Significant improvements in venous flow were noted on the tridimensional reconstructions of the PC-MRA images. Venous obstruction grading score improved in 4 patients (average [range] 2.4 [ 2–5]) (p = 0.023) and remained stable in 1 patient. All patients had chronic tonsillar herniation (CTH) (mean [range] 16.6 [8–26] mm), and 3 had syringomyelia. CTH showed improvement on the last follow-up MRI evaluation in 4 patients (mean [range] 10.5 [0–25] mm) and worsened from 15 mm to 19 mm in 1 patient. Syringomyelia improved in 2 patients and remained unchanged in 1.

CONCLUSIONS
This study has provided the first radiological evidence of the impact of craniofacial surgery on dural sinus anatomy and venous drainage. The venous anomalies described in patients with syndromic craniosynostosis are not static, and PCVD+FMD triggers a dynamic process that can lead to significant modifications of intracranial venous drainage. The traction exerted by the distracted bone flap onto the occipitoparietal dura mater adherent to the inner calvaria may account for the enlargement of the dural sinus throughout the distraction period. The impact of these modifications on venous pressure, intracranial pressure, CTH, and hydrocephalus remains to be determined.
High prevalence of gram-negative and multiorganism surgical site infections after pediatric complex tethered spinal cord surgery: a multicenter study
Authors: Alexiades Nikita G. , Shao Belinda , Ahn Edward S. , Blount Jeffrey P. , Brockmeyer Douglas L. , Hankinson Todd C. , Nesvick Cody L. , Sandberg David I. , Heuer Gregory G. , Saiman Lisa , Feldstein Neil A. , Anderson Richard C. E. 
Published: July 2022

OBJECTIVE
Complex tethered spinal cord (cTSC) release in children is often complicated by surgical site infection (SSI). Children undergoing this surgery share many similarities with patients undergoing correction for neuromuscular scoliosis, where high rates of gram-negative and polymicrobial infections have been reported. Similar organisms isolated from SSIs after cTSC release were recently demonstrated in a single-center pilot study. The purpose of this investigation was to determine if these findings are reproducible across a larger, multicenter study.

METHODS
A multicenter, retrospective chart review including 7 centers was conducted to identify all cases of SSI following cTSC release during a 10-year study period from 2007 to 2017. Demographic information along with specific microbial culture data and antibiotic sensitivities for each cultured organism were collected.

RESULTS
A total of 44 SSIs were identified from a total of 655 cases, with 78 individual organisms isolated. There was an overall SSI rate of 6.7%, with 43% polymicrobial and 66% containing at least one gram-negative organism. Half of SSIs included an organism that was resistant to cefazolin, whereas only 32% of SSIs were completely susceptible to cefazolin.

CONCLUSIONS
In this study, gram-negative and polymicrobial infections were responsible for the majority of SSIs following cTSC surgery, with approximately half resistant to cefazolin. Broader gram-negative antibiotic prophylaxis should be considered for this patient population.
Characterizing syringomyelia and its clinical significance in 140 patients with lipomyelomeningocele
Authors: Abraham Ananth P. , Vora Tarang K. , Selvi Bernice T. , Rajshekhar Vedantam 
Published: July 2022

OBJECTIVE
The aims of this study were to characterize syringomyelia in patients with lipomyelomeningocele (LMMC) and investigate the association between the presence of a syrinx and patient neurological deficits.

METHODS
Patients with LMMC who had been admitted between 2007 and 2020 were included in the study. Syringomyelia on magnetic resonance imaging (MRI) was classified into three groups: true syrinx, early syrinx, and presyrinx. The correlation of clinical deficits (at birth, new onset, and progressive) and type of lipoma with the presence and type of syrinx was studied.

RESULTS
Among a total of 140 patients, the median age was 2.5 (IQR 1.3–9) years. Neurological deficits were present at birth in 75 (53.6%) patients, but 67 (47.9%) had new-onset deficits or progression of their birth deficits. The most common type of spinal lipoma was the transitional type (75.7%). Thirty-nine (27.9%) patients had a syrinx (37 with a true syrinx, 2 with an early syrinx), and 25 (17.9%) patients had a presyrinx. There was no significant correlation between the presence of a syrinx and patient neurological deficits. However, patients with a syrinx that was not adjacent to the lipoma (≥ 1 vertebral level away) had a higher incidence of deficits at birth (p = 0.045), whereas those with a syrinx spanning ≥ 5 vertebral levels had a higher incidence of progressive neurological deficits (p = 0.04). Six (75%) of 8 patients in whom serial MRI had shown syrinx progression had clinical worsening.

CONCLUSIONS
Syrinx location with respect to the spinal lipoma, syrinx length, and progressive syringomyelia may have clinical significance in patients with LMMC.
Operative treatment outcomes for adult cervical deformity: a prospective multicenter assessment with mean 3-year follow-up
Authors: Elias Elias , Bess Shay , Line Breton G. , Lafage Virginie , Lafage Renaud , Klineberg Eric , Kim Han Jo , Passias Peter , Nasser Zeina , Gum Jeffrey L. , Kebaish Khaled , Eastlack Robert , Daniels Alan H. , Mundis Gregory , Hostin Richard , Protopsaltis Themistocles S. , Soroceanu Alex , Hamilton D. Kojo , Kelly Michael P. , Gupta Munish , Hart Robert , Schwab Frank J. , Burton Douglas , Ames Christopher P. , Shaffrey Christopher I. , Smith Justin S. , _ _ 
Published: July 2022

OBJECTIVE
Adult cervical deformity (ACD) has high complication rates due to surgical complexity and patient frailty. Very few studies have focused on longer-term outcomes of operative ACD treatment. The objective of this study was to assess minimum 2-year outcomes and complications of ACD surgery.

METHODS
A multicenter, prospective observational study was performed at 13 centers across the United States to evaluate surgical outcomes for ACD. Demographics, complications, radiographic parameters, and patient-reported outcome measures (PROMs; Neck Disability Index, modified Japanese Orthopaedic Association, EuroQol-5D [EQ-5D], and numeric rating scale [NRS] for neck and back pain) were evaluated, and analyses focused on patients with ≥ 2-year follow-up.

RESULTS
Of 169 patients with ACD who were eligible for the study, 102 (60.4%) had a minimum 2-year follow-up (mean 3.4 years, range 2–8.1 years). The mean age at surgery was 62 years (SD 11 years). Surgical approaches included anterior-only (22.8%), posterior-only (39.6%), and combined (37.6%). PROMs significantly improved from baseline to last follow-up, including Neck Disability Index (from 47.3 to 33.0) and modified Japanese Orthopaedic Association score (from 12.0 to 12.8; for patients with baseline score ≤ 14), neck pain NRS (from 6.8 to 3.8), back pain NRS (from 5.5 to 4.8), EQ-5D score (from 0.74 to 0.78), and EQ-5D visual analog scale score (from 59.5 to 66.6) (all p ≤ 0.04). More than half of the patients (n = 58, 56.9%) had at least one complication, with the most common complications including dysphagia, distal junctional kyphosis, instrumentation failure, and cardiopulmonary events. The patients who did not achieve 2-year follow-up (n = 67) were similar to study patients based on baseline demographics, comorbidities, and PROMs. Over the course of follow-up, 23 of the total 169 enrolled patients were reported to have died. Notably, these represent all-cause mortalities during the course of follow-up.

CONCLUSIONS
This multicenter, prospective analysis demonstrates that operative treatment for ACD provides significant improvement of health-related quality of life at a mean 3.4-year follow-up, despite high complication rates and a high rate of all-cause mortality that is reflective of the overall frailty of this patient population. To the authors’ knowledge, this study represents the largest and most comprehensive prospective effort to date designed to assess the intermediate-term outcomes and complications of operative treatment for ACD.
Improving the quality of inpatient discharge summaries
Authors: Patel Samit , Utting Isabel , Ang Wan Wei , Fautz Tessa , Radmore Rebecca , Vourou Panayiota , Beaumont Lara , Ryeland Paula , Lillis Ashling 
Published: July 2022

BACKGROUND: Discharge summaries (DCS) are vital in facilitating handover to community colleagues. Unfortunately, at Whittington Health, General Practitioners (GPs) found it difficult to identify relevant information in DCS, and use of medical jargon meant patients did not understand details of their admission. With this quality improvement project, the team aimed to improve DCS to enhance patient-centered care. OBJECTIVE: The aim of this quality improvement project (QIP) was to improve the quality of DCS by critiquing the ones produced within our trust and implementing various interventions. METHODS: Multiple Plan-Do-Study-Act (PDSA) cycles were completed. A multi-disciplinary meeting was conducted to identify the needs of each party in a DCS. A new template was subsequently launched. Teaching was conducted and educational leaflets were disseminated hospital-wide. Quality of written communication was audited quarterly, and evaluated against quality indicators. Problems with DCS were identified via GP and patient feedback, and these became the focus of subsequent PDSA cycles. RESULTS: From March 2019 to February 2020, all the audited categories improved, with an overall improvement from 67% to 92%. We also received positive feedback from GPs. CONCLUSIONS: Quality of DCS can be improved with appropriate interventions, leading to improved patient care. A similar PDSA cycle could be utilized elsewhere to achieve similar results.
PENGARUH BERBAGAI KOSENTRASI SUKROSA DAN NICOTINIC ACID TERHADAP PERTUMBUHAN SUBKULTUR TANAMAN ANGGREK Dendrobium sp
Authors: Saleh Restu 
Published: July 2022

Anggrek Dendribium sp merupakan tanaman hias yang sangat populer karena memiliki jenis yang beragam. Penelitian ini bertujuan untuk mengetahui Pengaruh Berbagai Konsentrasi Sukrosa dan Nicotinic Acid Terhadap Pertumbuhan Eksplan Anggrek Dendrobium sp.. Rancangan yang digunakan dalam penelitian ini adalah Rancangan Acak Lengkap (RAL) Faktorial terdiri dari 2 taraf perlakuan (A= Sukrosa dan B= Nicotinic Acid) dengan 3 kali ulangan.Yaitu : A0 (Tanpa Sukrosa), A1 (Sukrosa 10 mg/l), A2 (Sukrosa 20 mg/l), A3 (Sukrosa 30 mg/l), dan B0 (Tanpa Nicotinic Acid), B1 (Nicotinic Acid 0,1 mg/l), B2 (Nicotinic Acid 0,5 mg/l), B3 (Nicotinic Acid 0,9 mg/l). Berdasarkan hasil penelitian pemberian berbagai konsentrasi Sukrosa secara tunggal berpengaruh terhadap parameter yang diamati, dimana perlakuan terbaik terdapat pada A2 dengan rata-rata jumlah akar 8,20 buah, jumlah daun 8,79 helai, panjang daun 1,84 cm, panjang akar 1,37 cm pada eksplan anggrek Dendrobium sp.. Untuk perlakuan berbagai konsentrasi Nicotinic Acid berpengaruh nyata terhadap jumlah akar, jumlah daun, panjang daun dan panjang akar eksplan anggrek Dendrobium sp, dan pertumbuhan eksplan anggrek Dendrobium sp yang terbaik terdapat pada perlakuan (B2) pemberian Nicotinic Acid sebanyak 0,5 mg/l kedalam media MS dengan rata-rata jumlah akar 7,92 buah, jumlah daun 8,79 helai, panjang daun 1,73 cm dan panjang akar 1,25 cm pada eksplan anggrek Dendrobium sp. Dari hasil penelitian diperoleh bahwa Interaksi berbagai konsentrasi Sukrosa dan Nicotinic Acid berpengaruh nyata terhadap parameter jumlah daun dengan perlakuan terbaik A2B2 Pemberian Sukrosa 20 mg/l dan Nicotinic Acid 0,5 mg/l MS) dengan rata-rata jumlah daun 8,79 helai pada eksplan anggrek Dendrobium sp.