bluuebunny/crossref_metadata_2025_split huggingface dataset:
120 Moral Distress Among Attending Neurosurgeons: A National Survey
Authors: Mackel Charles E. , Alterman Ron L. , Stippler Martina 
Published: March 2022

INTRODUCTION:
“Moral distress” arises from the inability to carry out one's chosen decision or action because of constraints. Within medicine, moral distress may predispose to burnout and physician attrition and arises most dramatically from being forced to inflict aggressive, unwarranted, or non-beneficial treatment upon a patient.

METHODS:
An online survey evaluating moral distress and burnout among neurosurgical attendings was emailed to all members of the Congress of Neurological Surgeons in 2020; 269 neurosurgeons answered the survey. The moral distress survey consisted of 8 questions developed in-house and fitted to neurosurgical practice; burnout was gauged using Oldenburg Burnout Inventory (OLBI). Demographic characteristics were also collected.

RESULTS:
Nearly half (46.88%) of neurosurgeons experienced significant moral distress within the past year. The scenario encountered most frequently was caring for patients lacking clear treatment plans; the scenario eliciting the greatest intensity was providing aggressive treatment at the family’s insistence contrary to the surgeon’s judgment. Moral distress led 10.43% of neurosurgeons to leave a position. Neurosurgeons with burnout had higher moral distress scores. Our 8-question moral distress survey demonstrated excellent internal consistency (Cronbach alpha = 0.89).

CONCLUSION:
We developed an internally consistent and reliable 8-question survey assessing moral distress among neurosurgeons. Nearly half of neurosurgeons suffered moral distress within the past year, particularly from a lack of clarity around patient treatment goals and pressure to operate. Moral distress caused 10% of neurosurgeons to leave a position and was correlated with burnout risk.
123 Long-Term High-Frequency (10 kHz) Spinal Cord Stimulation in Painful Diabetic Neuropathy - A Randomized Controlled Trial
Authors: Petersen Erika A. , Stauss Thomas , Scowcroft James , Brooks Elizabeth , White Judith , Sills Shawn , Amirdelfan Kasra , Guirguis Maged , Xu Jijun , Yu Cong , Nairizi Ali , Patterson Denis , Galan Vincent , Bundschu Richard , Mehta Neel , Sayed Dawood , Lad Nandan P. , DiBenedetto David , Sethi Khalid A. , Wu Paul , Argoff Charles , Nasr Christian , Taylor Rod S. , Caraway David , Mekhail Nagy 
Published: March 2022

INTRODUCTION:
World Health Organization estimates 422 million people with diabetes globally and approximately 20% with painful diabetic neuropathy (PDN). Current treatment options are ineffective for many patients; however, previous results suggest high-frequency (10 kHz) spinal cord stimulation (SCS) relieves pain and may improve sensation in patients with refractory symptoms.

METHODS:
Randomization of 216 patients assigned 1:1 to 10 kHz SCS (Nevro Corp.) combined with conventional medical management (CMM) or CMM alone. Patients had PDN symptoms ≥12 months, lower limb pain ≥5 cm (10 cm visual analog scale), and hemoglobin A1c ≤10%. Outcomes include pain, interference with daily activities and sleep, and neurological examination. Patients could opt to crossover to the other treatment arm at 6 months.

RESULTS:
At 6 months, 86% of patients in the 10 kHz SCS group were responders with at least 50% pain relief. They reported reduced pain interference with daily activities and improvements in sleep. None of the patients in the 10 kHz SCS group chose to crossover to CMM at 6 months. Treatment benefits were sustained through 12 months. A majority of patients treated with 10 kHz SCS were noted to have improvement on neurological examination. Participants in the CMM group experienced no change in pain levels, pain interference with daily activities, or sleep quality over 6 months. Eighty-two percent opted to crossover to 10 kHz SCS at 6 months. Results post-crossover were similar to those in patients originally randomized to 10 kHz SCS: 84% responders as well as reduced pain interference with daily activities, improvements in sleep, and a majority with observed improvements on neurological examination.

CONCLUSION:
This is the largest RCT to-date of SCS management in PDN. Substantial improvements with high-frequency (10kHz) SCS were sustained over 12 months and support this treatment for PDN patients with refractory symptoms.
129 Development and External Validation of the KIIDS-TBI Tool for Managing Children with Mild Traumatic Brain Injury and Intracranial Injuries
Authors: Greenberg Jacob K. , Ahluwalia Ranbir , Hill Madelyn , Johnson Gabbie , Hale Andrew T. , Belal Ahmed M. A. , Baygani Shawyon , Olsen Margaret , Foraker Randi , Carpenter Christopher , Yan Yan , Ackerman Laurie , Noje Corina , Jackson Eric , Burns Erin , Sayama Christina M. , Selden Nathan R. , Vachhrajani Shobhan H. , Shannon Chevis , Kuppermann Nathan , Limbrick David D. 
Published: March 2022

INTRODUCTION:
Clinical decision support may improve the post-neuroimaging management of children with mild traumatic brain injuries (mTBI) and intracranial injuries. While the CHIIDA score has been proposed for this purpose, a more sensitive risk model may have broader use.

METHODS:
We analyzed children <18 years-old with mTBI and intracranial injuries included in the PECARN head injury dataset (2004-2006). We used binary recursive partitioning to predict the composite outcome of neurosurgical intervention, intubation for >24 hours due to TBI, or death due to TBI. The new model, the KIIDS-TBI model, was externally validated in a separate dataset that included children treated between 2006-2019 at one of six centers participating in the pediatric TBI Research Consortium (PTRC).

RESULTS:
There were 839 children included in the derivation (PECARN) and 1,630 in the validation (PTRC) datasets. Derived using the PECARN dataset, the KIIDS-TBI model incorporated imaging (e.g. midline shift) and clinical (e.g. GCS score) findings. Based on the model-predicted probability of the composite outcome, three cutoffs were evaluated in the external validation (PTRC) dataset to classify patients as ‘high risk.' The most conservative cutoff (i.e. any predictor present) identified 119/119 children with the composite outcome (sensitivity 100%), but had the lowest specificity (26.3%). The other two cutoffs had worse sensitivity (94.1%-96.6%) but improved specificity (67.4%-81.3%). The CHIIDA model lacked the most conservative cutoff and otherwise showed the same or slightly worse performance compared to the other two cutoffs.

CONCLUSION:
The KIIDS-TBI model has high sensitivity and moderate specificity for risk-stratifying children with mTBI and intracranial injuries. Use of this clinical decision support tool may help improve the safe, resource-efficient management of this important patient population.
132 Same Day Discharges Following Intracranial Shunt Revision: A Retrospective Safety Analysis
Authors: Bailey David , Daggubati Lekhaj C. , Fritsche Madelaine , Lehman Morgan , Strausser Sarah , Rizk Elias B. 
Published: March 2022

INTRODUCTION:
Cerebrospinal fluid shunting is the mainstay for intracranial hydrocephalus but has a high rate of surgical revision secondary to infections and blockage. Traditionally, the hospital stay is one day post-operative for a non-complicated shunt revision. However, in the appropriate population we believe the same day discharge after a shunt revision is safe.

METHODS:
We perform a retrospective chart review of all shunt revisions performed at Penn State Milton S. Hershey Medical Center between 2014 and 2021. Patient characteristics were evaluated for the ideal demographics for same day discharge. We compared rates of emergency department visits, hospitalization, and revision at 30 and 90 days between same day discharge and control patients following shunt revision. Non-parametric, Logistic regression and Chi-squared testing was done for statistically significant with and without Propensity Score Matching.

RESULTS:
A total of 996 patient were examined with 56 (5.6%) patients being discharged on the same day as the surgery. On univariate analysis, patient with same day discharge were older (OR 1.019; 1.007-1.032), more like for distal shunt failure (OR 4.914; 2.792-8.649), more likely for elective surgery (OR 5.472; 2.346-12.763), and less likely to have visited the emergency department in the prior 30 d (OR 0.216; 0.112-0.413). On multivariate analysis, recent ED visit, elective surgery, and distal shunt failure remained significant. In unmatched data, same-day discharge patients had significantly less 30-day revisions (p=.035) but a comparable rate of 90-day revisions as well as 30-day and 90-day emergency room visits and hospitalization. Propensity-score matching compared 29 revisions in each group; all covariates were non-significant (p > 0.05) and all 30-day and 90-day outcomes were not significantly different.

CONCLUSION:
These findings validate the safety profile for same day discharge in post-operative shunt patients as well as describe the preferred characteristics of our patient cohort. Elective, distal shunt failure patients are preferred for early discharge post-operatively.
159 Outcomes of Ventriculoperitoneal Shunt Placement with or without Laparoscopic Assistance: An Analysis of the National Inpatient Sample
Authors: Zhao Kevin , Maloney Monica , Hilden Patrick , Turner Amber , Merchant Aziz , Agarwalla Pankaj K. 
Published: March 2022

INTRODUCTION:
Ventriculoperitoneal shunt (VPS) can be placed solely by a neurosurgeon often via an open-laparotomy approach, or laparoscopically as a collaborative effort between a neurosurgeon and a general surgeon. Prior studies have shown conflicting results when examining outcomes regarding infection, revision rate, hospital charges, length of stay, and mortality between the open mini-laparotomy and the laparoscopic approaches.

METHODS:
We performed a retrospective database study of the NIS from October 2015-December 2017 utilizing International Classification of Diseases, 10th Revision coding to identify all cases of VPS placement. All analyses accounted for the sampling design of the NIS.

RESULTS:
A total of 6,580 cases (4,969 with open mini-laparotomy approach and 1,611 with laparoscopic collaborative approach) met inclusion criteria. Hospital charges (median $91, 900 v. $84,400; p = 0.231) and revision rate (3.2% v. 3.1%; p = 0.796) were similar between approaches. There were no significant differences in length of stay, mortality, or complication rates between the two approaches.

CONCLUSION:
The collaborative, laparoscopic approach to VPS placement has similar outcomes and is non-inferior to the traditional open mini-laparotomy approach.
188 Outcomes in Patients Undergoing Kyphoplasty for Spinal Metastasis and Associated Compression Fractures: The Moffitt Experience
Authors: Farooq Jeffrey , Rabil Maximilian , Goldman-Daleo Hannah , Tran Nam D. 
Published: March 2022

INTRODUCTION:
Nearly two thirds of patients with metastatic cancer will experience painful spinal metastasis and pathologic compression fractures that negatively impact their quality of life and function status. Furthermore, invasive surgical interventions to treat these spinal lesions could delay chemoradiation for the treatment of their underlying disease.

METHODS:
The authors performed a retrospective chart review of all patients who underwent kyphoplasty procedures for the treatment of cancer-associated vertebral compression fractures at the Moffitt Cancer Center from 2009-2019. Patient demographics, tumor characteristics, pain severity, concurrent palliative therapies and complications were assessed.

RESULTS:
625 patients underwent kyphoplasty procedures. 119 patients required additional kyphoplasty at additional levels. Greater than 1500 spinal levels were performed ranging from C2-S1. SINS score ranged from 4-13. Tumor types include multiple myloma (23%), breast (13%), lung (13%), lymphoma (6%). Significant pain reduction with reduction in VAS was observed in at 2 weeks and persisted beyond 3 months (p < 0.01). Nearly all patient experienced reduction in 24hr opioid usage. Greater than 25% had 2 column tumor involvement. Less than 1% required additional stabilization procedures.

CONCLUSION:
Kyphoplasty is safe and effective in controlling pain and stability. Kyphoplasty should be offered to any patient with spinal metastasis and compression fracture with significant pain (VAS >4).
191 Clinical and Economic Outcomes of Patients Undergoing Surgical Intervention for Trigeminal Neuralgia: Analysis From a National Database
Authors: Alexander Yohan , Doherty Ronan , Alvi Mohammed A. , Yolcu Yagiz , Kerezoudis Panagiotis , Brown Desmond A. , Agarwal Vijay , Van Gompel Jamie J. , Ghogawala Zoher , Link Michael J. , Meyer Fredric B. 
Published: March 2022

INTRODUCTION:
The management of trigeminal neuralgia (TN) has evolved significantly in the past century. In the current manuscript, we compare clinical and economic outcomes of patients undergoing surgical intervention for TN between microvascular decompression (MVD), percutaneous procedures and stereotactic radiosurgery (SRS) using a national database.

METHODS:
The national inpatient sample (NIS) was queried for cases undergoing a surgical intervention for TN between 2002-2015 3rd quarter using the International Classification of Disease 9th Revision Clinical Modification (ICD-9-CM) and procedure codes (ICD-9-PCS). Outcomes assessed included length of stay (LOS), discharge disposition and cost.

RESULTS:
A total of 8,317 patients undergoing a surgical intervention for TN were identified between 2002 and 2015 3rd quarter, of which 7,202 (86.6%) underwent MVD, 548 (6.6%) underwent percutaneous procedures and 567 (6.8%) underwent SRS. Patients undergoing percutaneous and SRS procedures were more likely to be older compared to those undergoing MVD (>65: 58.1% and 72.1% vs 32.2%, respectively; p < 0.001). MVD was significantly more likely to be performed in an urban academic institution compared to percutaneous procedures and SRS (84.8% vs 75.1% and 75.8%; p < 0.001). Patients undergoing SRS had the lowest LOS (1.34 days vs 3.2 days and 3.5 days; p < 0.001) and lowest odds for a prolonged LOS (OR = 0.29; CI: 0.18-0.46; p < 0.001) and non-routine discharge (OR = 0.44; CI: 0.28-0.71; p < 0.001). Percutaneous procedures had the highest odds for a prolonged LOS (OR = 2.07; CI: 1.65-2.61; p < 0.001). The total charges billed by the hospital were highest for patients undergoing MVD ($50,432.30) followed by those undergoing SRS ($38,450.90) and percutaneous procedures ($18,655.10) (p < 0.001). The total reimbursed cost was highest for SRS ($18,265.70) followed by MVD ($17,590.20) and percutaneous procedures ($8,183.30).

CONCLUSION:
In the current era of value-based care, these analyses are important in helping physicians, hospitals and other stakeholders devise appropriate policies to ensure optimal patient outcomes, as well as optimal reimbursements.
192 Meckel's Cave Meningoencephaloceles Causing Typical Trigeminal Neuralgia
Authors: Santos Jaime L. M. , Domingo Ricardo , Rowland Nathan C. , Vandergrift William A. 
Published: March 2022

INTRODUCTION:
The culprit of trigeminal neuralgia (TGN) may occur on any point from the nerve’s root entry zone(REZ) to Meckel’s cave. Meckel’s cave meningoencephaloceles are rare middle cranial fossa defects that usually remain asymptomatic but may contain prolapsed trigeminal nerve rootlets and result in TGN.

METHODS:
A systematic review was conducted in accordance with the PRISMA guidelines for all reports of middle cranial fossa defects causing trigeminal nerve-related symptoms. The pathophysiology, presentation, surgical management and outcomes are illustrated with clinical case.

RESULTS:
Initial search from inception to March 2021 identified 33 articles for screening. After applying inclusion and exclusion criteria, 6 articles were included representing a total of 8 cases in addition to our case (n = 9). All 9 patients were females and 33.3% (n = 3) presented with classic trigeminal neuralgia. The preferred treatment modality was surgical with subtemporal extradural repairs using various combinations of autologous fat and muscle grafts and synthetic dura. Postoperative outcomes were only available in 55.5% (n = 5) of the cases and nearly all reported complete symptom resolution, except for one case in which the meningoencephalocele wall was incised, along with trigeminal rootlets adhered to it. Our patient had immediate and durable symptom relief after a 4-year follow-up.

CONCLUSION:
MEC containing prolapsed trigeminal fascicles can cause typical trigeminal neuralgia from chronic pulsatile stress. This supports the hypothesis that the compressive or demyelinating culprit can locate more ventrally on the course of the trigeminal nerve. Subtemporal extradural surgical repairs can be safe, effective and durable. Incising the MEC wall should be avoided as it may have trigeminal rootlets adhered to it.
333 First FDA Cleared Thin Film Electrode for Intracranial Recording and Monitoring of Brain Activity – Device Testing and Initial Clinical Use
Authors: Kullmann Aura , Mertens Steve , Christianson Mark , Rosa Dave , Botia Camilo D. 
Published: March 2022

INTRODUCTION:
Subdural strip and grid (SDG) electrodes are routinely used for pre-surgical evaluation of patients with drug resistant epilepsy (DRE). Although these electrodes have been in the US market since their first FDA clearance in 1985, their fabrication, materials and properties have hardly changed. They are made of silicone, are thick (>0.5 mm), manufactured by hand, and do not optimally conform to brain convolutions. Technological solutions that overcome these limitations are needed.

METHODS:
Thin film electrode (0.08 mm) arrays were manufactured from polyimide with platinum contacts (multiple configurations, 3 mm contact diameter, spaced 10 mm apart). Electrochemical and electrical testing include electrolyte interface impedance, cyclic voltammetry and other impedance and isolation tests, according to the International Electrotechnical Commission 60601 for proving device safety and performance. Biocompatibility was tested using standard methods according to International Organization for Standardization 10993. Post-market data were collected employing a user feedback questionnaire using a rating scale (1 to 5, with 5 being the highest).

RESULTS:
Thin film electrodes passed all electrochemical, electrical and biocompatibility testing required for FDA clearance (obtained Nov 2019). Electrodes (n = 19) were used in clinical practice between Nov 23, 2020 and May 3, 2021 in the epilepsy monitoring units and for intraoperative monitoring (IOM) for recording brain activity in (a) DRE patients undergoing evaluation for potential surgical resection, and (b) patients undergoing tumor resection. Users (neurosurgeons; n = 6) provided ratings between 4 and 5 regarding the properties (thickness, flexibility, weight), features (ease of placement, conformability to the brain areas) and performance (qualitative signal recording quality) of the electrodes during surgical implantation.

CONCLUSION:
This is the first thin film electrode technology FDA cleared for use in clinical practice. The properties of these thin, flexible polyimide electrode arrays may overcome many limitations of the existing technology. Initial clinical use indicated that the technology is feasible for surgical implantation with greater flexibility compared to silicone based cortical electrodes.
410 Total Hospital Cost of Middle Meningeal Artery Embolization Compared to Surgery for Chronic Subdural Hematomas: A Propensity Matched Analysis
Authors: Catapano Joshua , Srinivasan Visish M. , Koester Stefan , Rumalla Kavelin , Baranoski Jacob F. , Rutledge Caleb , Cole Tyler S. , Winkler Ethan A. , Lawton Michael T. , Jadhav Ashutosh , Ducruet Andrew F. , Albuquerque Felipe 
Published: March 2022

INTRODUCTION:
Fewer treatment failures have been found with middle meningeal artery (MMA) embolization compared to surgical evacuation for chronic subdural hematomas (cSDH).

METHODS:
All patients who presented with a cSDH to a single center from January 1st, 2018 to December 31, 2020 were retrospectively reviewed. Patients with one-year of post-treatment hospital cost data were included. Patients were placed into two cohorts based on initial treatment: surgery versus MMA embolization. Total hospital cost was obtained by the hospital financial department. A propensity match analysis(matching for age, sex, Charlson Comorbidity Index(CCI), presenting symptoms, previous trauma, use of pre-operative anticoagulants/antiplatelets(AC/AP), and maximal diameter of cSDH on pre-treatment CT image) was performed. The primary outcome was the mean hospital cost difference between surgery and MMA embolization after propensity match analysis.

RESULTS:
One-hundred-and-seventy patients met inclusion criteria, 48(28%) in the MMA and 122(72%) in the surgical cohort. There was no significant difference between the groups in mean age, CCI, preoperative AC/AP use, and initial presenting symptoms. The surgical cohort was found to have larger pre-treatment cSDHs (20.5mm,sD 6.7) and longer index hospital admissions (9.8 days,sD 7) compared to the MMA cohort(cSDH size:16.9 mm,sD 4.6; hospital days: 5.7,sD 2.4) (p<0.001). A higher percentage of patients in the surgical cohort required an unplanned additional hematoma treatment (N=20, 16.4%) and hospital readmission(N=34, 28%) compared to the MMA group (additional treatment and hospital readmission:N=2, 4%)(p=0.04 and p=0.004, respectively). There was no significant difference in complications between the two cohorts. After propensity matching, the total hospital cost for the surgical cohort(N=28, $59,809,sD $27,730) was significantly higher compared to MMA embolization (N=28, $44,273, sD $17,622) (p=0.015). Linear regression analysis found an unexpected additional treatment as the only variable significant for total hospital cost in the match cohort (difference of $20,772,sD $10,037) (p=0.04).

CONCLUSION:
MMA embolization is associated with a decreased hospital cost compared to surgery. This lower cost is directly related to the decreased need for additional treatment interventions in the MMA group. This analysis further supports the overall clinical and financial efficacy of MMA embolization in select cSDH patients.