bluuebunny/crossref_metadata_2025_split huggingface dataset:
166 Predictors of Incomplete Aneurysm Occlusion After Treatment with Pipeline Embolization Device: PREMIER Trial 1-year Analysis
Authors: Monteiro Andre , Kallmes David , Lopes Demetrius K. , Nelson Peter K. , Hanel Ricardo A. 
Published: March 2022

INTRODUCTION:
Failure of treatment with Pipeline Embolization Device (PED) occurs in 16.1% to 24.6% of aneurysms. Studies investigating mechanisms behind PED failure are mostly retrospective series with conflicting findings. We performed an analysis of aneurysms that failed to achieve complete occlusion in the Prospective Study on Embolization of Intracranial Aneurysms with the Pipeline Device (PREMIER) trial.

METHODS:
PREMIER was a prospective, multicenter and single-arm interventional. Assessment images was done by independent core laboratory. We retrospectively analyzed patients who failed the primary efficacy endpoint. Aneurysms with incomplete occlusion (RR > 1) were further analyzed and compared to completely occluded aneurysms.

RESULTS:
Twenty-five (18.1%) aneurysms were incompletely occluded at 1-year. Twenty-two patients had RR-3 and 3 had RR-2. There was a median reduction of 0.9 mm (IQR 0.41-2.43) in maximum-diameter between pre-procedure and 1-year follow-up. Mean age of patients with incomplete occlusion was significantly higher than in those with complete occlusion (mean ±SD; 59.9 ± 10.4 vs 53.6 ± 11.2, P = 0.011). Smoking (P = 0.045) and C6 segment location (P = 0.005) were significantly associated with complete occlusion, while location at V4 (P = 0.01) and C7 (P = 0.007) segments and involvement of a side branch (<0.001) were significantly associated with incomplete occlusion. There was no difference in the rate of inadequate wall apposition between complete and incomplete occlusion groups (12% vs 12.4%, P = 1). In multivariable logistic regression, significant predictors of incomplete occlusion were non-smoker status (adjusted OR, 4.49; 95% CI, 1.11-18.09; p = 0.03), and side branch involvement (adjusted OR, 11.68; 95% CI, 3.84-35.50; P < 0.0001), while the C6 location had reduced odds of incomplete occlusion versus those at other segment locations (adjusted OR, 0.29; 95% CI, 0.10-0.84; p = 0.02).

CONCLUSION:
In the PREMIER cohort, non-smoking status and vessel branch involvement were the strongest predictors of incomplete occlusion at 1-year. Although the presence of side branches can lead to incomplete occlusion, we observed decrease in aneurysm size and stable remodeling. The efficacy of protecting against rupture remains to be confirmed in longer follow-up. The results from our prospective study is consistent with previous retrospective series and warrants considerations for technique adaptations to achieve higher occlusion rates.
178 Multicenter Prospective Trial of Anti-Epileptics for Early Seizure Prevention in Mild Traumatic Brain Injury with a Positive CT Scan
Authors: Zaher Mazen , Pease Matthew , Lopez Alejandro , Yu Siyuan , Egodage Tanya , Semroc Suzan , Arefan Dooman , Jankowitz Brian T. 
Published: March 2022

INTRODUCTION:
Post-traumatic seizures (PTS) are a major source of disability after traumatic brain injury (TBI). The Brain Trauma Foundation Guidelines recommend prophylactic anti-epileptics (AEDs) for early PTS in severe TBI, but high-quality evidence is lacking in mild or moderate TBI.

METHODS:
We performed a prospective, multicenter study evaluating consecutive patients who presented to a level 1 trauma center from January 2017 through December 2020. Patients were excluded for previous seizure history, current AED use, or a neurosurgical procedure. Patients were given a 7-day course of prophylactic AEDs on a week-by-week basis and followed with in-person clinic visits, in-hospital evaluation, or a validated phone questionnaire.

RESULTS:
490 patients were enrolled, 349 (71.2%) had follow-up, and 139 (39.8%) were given prophylactic AEDs. There was no difference between seizure rates for the prophylactic AED group (0.7%) and those without (2.9%; p = 0.25). Patients who had a PTS were on average older (81.4 years) than patients without a seizure (64.8 years; p = 0.02). Seizure rate increased linearly by age groups: <60 years-old (0%); 60-70 years-old (1.7%); 70-80 years-old (2.3%); and >80 years-old (4.6%).

CONCLUSION:
Prophylactic AEDs did not provide a benefit for PTS reduction in mild TBI patients with a positive CT head scan. Future studies should be appropriately powered for the small effect size of AEDs in mild TBI and evaluate the effects between age and prophylactic AED use.
194 Why Do Ventricles Not Dilate in Pseudotumor Cerebri? A Circuit Model of Cerebral Windkessel
Authors: Wang Zhe , Yang Liu , Djuric Petar M. , Egnor Michael R. 
Published: March 2022

INTRODUCTION:
Pseudotumor cerebri is characterized by elevated intracranial pressure (ICP) without ventricular dilation. The pathophysiology of pseudotumor is traditionally viewed as chronic cerebrovenous hypertension which causes impaired cerebrospinal fluid (CSF) resorption. Increased resistance to CSF absorption results in ventriculomegaly in obstructive hydrocephalus. In pseudotumor, however, lack of ventriculomegaly cannot be explained by this mechanism. In this study, we model the cerebral windkessel as a CSF pulsation absorber. We hypothesize that inability to absorb CSF pulsation diverts pulsatile energy to ventricles, causing ventriculomegaly, whereas effective CSF pulsation absorption leaves ventricles normal in size.

METHODS:
Cerebral windkessel is a band-pass filter considering arterial blood pressure (ABP) as input and ICP as output. We used a tank circuit with parallel inductance and capacitance to model windkessel and compare with the transfer function between ABP and ICP in normal dogs. Normal CSF dynamics were simulated by setting circuit parameters to correlate physiological recordings from dogs: frequency for heart rate, input and output voltages for ABP and ICP, and CSF and capillary resistance for resistance to pulsatile and pulseless flow, respectively. CSF path resistance was increased to simulate CSF space narrowing in hydrocephalus. Capillary resistance was increased to simulate impaired venous flow in pseudotumor.

RESULTS:
The circuit output shows agreement with physiological recordings, in which ICP pulse precedes ABP pulse. Windkessel is most effective at a given pulse frequency. In hydrocephalus, increased resistance to CSF flow disrupts cerebral windkessel, leading to ineffective pulse dampening and increased ICP phase lead. In pseudotumor, increased capillary resistance does not change cerebral windkessel effectiveness or ICP phase lead.

CONCLUSION:
The cerebral windkessel is a CSF pulsation absorber. An ineffective windkessel in hydrocephalus inhibits CSF pulsation absorption and diverts pulsatile energy to dilate ventricles, whereas an effective one in pseudotumor leaves ventricles normal. Our model of CSF dynamics emphasizes that ventricular dilation is a result of ineffective windkessel and decreased CSF pulsation absorption. This model provides a novel perspective on the pathophysiology of abnormal CSF dynamics and offers new directions for future research.
199 Electronic Clinical Decision Support for Children with Mild Traumatic Brain Injuries and Intracranial Injuries: A Sociotechnical Analysis
Authors: Greenberg Jacob K. , Otun Ayodamola , Carpenter Christopher , Brownson Ross , Kuppermann Nathan , Limbrick David D. , Yen Po-Yin , Foraker Randi 
Published: March 2022

INTRODUCTION:
The management of children with mild traumatic brain injuries (mTBI) and intracranial injuries is not evidence-based and may place some children at risk of harm. Evidence-based electronic clinical decision support (CDS) may improve patient safety and decrease resource use.

METHODS:
We conducted semi-structured qualitative focus group interviews to identify sociotechnical influences on CDS implementation. Physicians from neurosurgery, emergency medicine, critical care, and pediatric general surgery were included, along with information technology specialists. Participants were recruited from nine hospitals in the United States. Focus group transcripts were coded and analyzed using thematic analysis. The final themes were cross-referenced with previously defined sociotechnical dimensions.

RESULTS:
We included 28 physicians and four information technology specialists in seven focus groups. Ten participants had administrative leadership positions, and the largest group (34%) was from neurosurgery. Through inductive thematic analysis, we identified five primary themes: 1) clinical impact; 2) stakeholders and users; 3) tool content; 4) clinical practice integration; and 5) post-implementation evaluation measures. Participants generally supported using CDS to determine an appropriate level-of-care for these children, and also noted potential secondary uses (e.g., informing family discussions). However, some also identified potential harm that could result from misuse (e.g., conflict across specialties). Feedback from the interviews helped refine the tool content, highlight potential implementation barriers, and identify appropriate measures to evaluate after implementation.

CONCLUSION:
We identified key factors impacting the implementation of electronic CDS for children with mTBI and intracranial injuries, providing a strong foundation for prospective implementation efforts.
348 Multi-Center MRI Radiomic Texture Analysis Pre-Operatively Discriminates Between Primary Central Nervous System Lymphoma, Glioblastoma, and Brain Metastasis
Authors: Pease Matthew , Ak Murat , Ayoub Mira , Mamindla Priyadarshini , Kamal Abdallah , Peddagangireddy Vishal , Zinn Pascal O. , Moron Fanny , Colen Rivka R. 
Published: March 2022

INTRODUCTION:
Primary Central Nervous System Lymphoma (PCNSL), glioblastoma (GBM), and brain metastasis (BM) collectively account for almost 75% of malignant brain tumors. Due to their similar radiographic appearance, the current standard of care is to perform an invasive biopsy for histological diagnosis. Radiomic approaches may allow for non-invasive identification of tumor histology to guide patient care.

METHODS:
We retrospectively identified 632 patients from three institutions with untreated solitary, pathology confirmed cases of PCNSL (133), GBM (129), and breast or lung BM (370). For each tumor, we segmented edema, contrast enhancement, necrosis, and contralateral white matter (cWM) regions of interest (ROI) for T2 FLAIR and T1 post-contrast sequences. A total of 205 texture features were extracted from each sequence’s ROI including 10 first-order features and 195 second-order features using gray-level co-occurrence matrices. We divided the 195 second level features by the volumes of each ROI to generate another 195 volume-independent features and 2,400 features total. We removed all highly correlated feautres, performed feature selection with Least Absolute Shrinkage and Selection Operator (LASSO), and built a model using gradient boosting. We split the cohort into 80% training and 20% testing with 5-fold cross-validation. We report area under the curve (AUC) for classifying each tumor type against all others (i.e., BM versus PCNSL and GBM).

RESULTS:
LASSO identified 173 independent features, of which 35 most relevant were used for model building. Our three-classification model robustly differentiated (p < 0.001) between PCNSL (AUC 0.95), GBM (AUC 0.93), and BM (AUC 0.93). Our accuracy was 84% and we achieved favorable sensitivity (PCNS 0.74; GBM 0.73; BM 0.91) and specificity (PCNSL 0.97; GBM 0.92; BM 0.83). With a specificity of 1 (i.e., never incorrectly classifying a tumor subtype), the sensitivity for PCNSL and BM was over 40% and approached 80% for GBM.

CONCLUSION:
MRI radiomic analysis may achieve enough classification accuracy to allow for avoidance of intracranial biopsy in select patients and differentiate between PCNSL, GBM, and BM.
361 Prevalence and Trends of Surgical Intervention for Trigeminal Neuralgia in the Inpatient Setting in the United States: Analyses from a National Database from 2002-2015
Authors: Alexander Yohan , Alvi Mohammed , Doherty Ronan , 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:
Trigeminal neuralgia is a debilitating neurological condition characterized by sharp, stabbing pain in the distribution of the trigeminal nerve and its branches. For trigeminal neuralgia that is refractory to medical therapy, surgery is generally indicated. Herein, we sought to assess the prevalence of trigeminal neuralgia among inpatient admissions, utilization of surgical intervention, and trends of utilization of common surgical approaches for TN using a national database.

METHODS:
The National Inpatient Sample (NIS) was queried for all patients with trigeminal neuralgia using international classification of disease 9th revision clinical modification (ICD-9-CM) diagnosis code (350.1) between the 1st quarter of 2002 and the 3rd quarter of 2015. Cases were also classified into surgical groups using ICD-9 procedure codes which included MVD, percutaneous procedures and stereotactic radiosurgery. Using weighted discharge methodology, national estimates for prevalence, primary admissions, and utilization of each surgery type were computed.

RESULTS:
A total of 405,445 patients with trigeminal neuralgia were identified between the 1st quarter of 2002 and the 3rd quarter of 2015. The inpatient prevalence of trigeminal neuralgia in this 14 year cohort was found to be 63.8 per 100,000, and was found to increase from 54.9 per 100,000 in 2002 to 76 per 100,00 in 2015. A total of 67,768 patients had a primary diagnosis of trigeminal neuralgia. Of these, 41,473 (61.2%) underwent a surgical procedure; surgical utilization increased from 59.7% cases in 2002 to 69.1% in 2015. Of the cases undergoing a surgical intervention for trigeminal neuralgia, an MVD was performed for the majority of patients (87%, n=36,083) followed by percutaneous procedures (7.3%, n=3,036) and stereotactic radiosurgery (7.1%, n=2,940). Furthermore, the percent-utilization of MVD among patients undergoing surgical intervention increased form 67.3% in 2002 to 98% in 2015, the percent utilization of percutaneous procedures fell from 17.9% to 2%, and the percent utilization of stereotactic radiosurgery fell from 15.5% to 0.4%.

CONCLUSION:
The trends within surgical management of trigeminal neuralgia have been rapidly evolving over the past two decades with a steady trend towards MVD.
372 Pediatric Abusive Head Trauma During the First Year of Covid-19
Authors: Singer Timothy , Mehl Steven , Kralik Stephen , Desai Nilesh , Orman Gunes , Sarpong Kwabena , Donaruma Marcella , Cain Cary , Warner Claire , Huisman Thierry , Naik-Mathuria Bindi , Weiner Howard L. , Donoho Daniel , Risen Sarah 
Published: March 2022

INTRODUCTION:
During the Covid-19 pandemic parental burnout was associated with increases in child abuse. However, the effects of the pandemic on Abusive Head Trauma (AHT) have not yet been described.

METHODS:
We included all patients <5 years old with expert-confirmed AHT at our freestanding children's hospital from 3/2018-2/2021. Demographic and clinical data were excerpted, and pediatric neuroradiologists reviewed neuroimaging. Descriptive and inferential analyses were conducted with RStudio. Early morbidity was assessed using gross-motor milestones and developmental quotients with the Capute Scales (CAT/CLAMS).

RESULTS:
103 patients suffered AHT (64 pre-Covid-19, 39 Covid-19). The Covid-19 cohort was younger (median age 115 v. 152 days, p=0.027) and lived in homes with higher maternal unemployment (51% v. 22%, p=0.003), smaller spaces (apartments 56% v. 31%, p=0.043) and more people (median 5 v. 4, p=0.047). Clinical findings including Glasgow Coma Scale, Injury Severity Score, and multi-organ injury were similar. Neurosurgical intervention was similar (31% v. 20%, p=0.23). Neuroimaging found that during Covid-19 children suffered more extensive sub-arachnoid hemorrhage (32% v 14%, p=0.040) and spinal hemorrhage (6/39 v. 3/64 cases, p=0.046). Notably, mortality was 19% in both groups (p=0.92). During Covid-19 children removed from parental care were more likely to be placed with relatives (61% v. 36%, p=0.039) versus foster care (8.3% v. 30%, p=0.039). At 2-month follow-up, no differences were observed in new motor (43% v. 54%, p=0.45), language (33% v. 18%, p=0.59), or cognitive (36% v. 48%, p=0.36) developmental delays nor in severity of new deficits.

CONCLUSION:
Pediatric AHT is a serious public health problem and occurs especially at times of high family stress.(3) During Covid-19 children suffering AHT were younger and more likely to live in homes experiencing greater socioeconomic stressors compared with pre-pandemic levels.
374 Multi-omic Analysis Identifies a SPAK Kinase-regulated Ensemble of Choroid Plexus Ion Transport Proteins Relevant for Post-infectious Hydrocephalus
Authors: Robert Stephanie , Reeves Benjamin , Karimy Jason K. , Marlier Arnaud , Kiziltug Emre , DeSpenza Tyrone , Singh Amrita , Allington Garrett , Phan Duy , Zhang Jinwei , Kahle Kristopher Thomas 
Published: March 2022

INTRODUCTION:
Postinfectious hydrocephalus (PIH) is the most common cause of acquired hydrocephalus worldwide. Treatment is typically through CSF diversion via ventriculoperitoneal shunting, which has high rates of morbidity and is often unavailable in developing countries.

METHODS:
SPAK knockout (KO) rats were generated using Crispr/CAS9. Control and SPAK KO male rats were implanted with an infusion catheter to introduce E. coli (genetically engineered +/-LPS) or LPS into the lateral ventricles over 72 hours. CSF secretion was measured by catheter placement into the lateral ventricle, and ventricular size by MRI. ChP were harvested for immunohistochemistry (IHC), western blot (WB), genomic/proteomic analysis, and single-cell RNA sequencing (scRNAseq). To investigate SPAK-associated ChP targets, we purified the SPAK-protein complex, identified physical interactors using liquid chromatography/dual mass spectroscopy (LC-MS/MS), and validated top candidates by WB/IHC.

RESULTS:
Robust bumetanide-sensitive, SPAK-dependent, CSF hypersecretion and ventriculomegaly was observed and dependent on the presence of LPS. LPS triggered significant up-regulation of activating SPAK phosphorylation (Thr233/185), and the bumetanide-sensitive cation-chloride cotransporter NKCC1 (Thr203/207/212). LC-MS/MS pull-down assay additionally revealed three other important SPAK-bound ion transporters, alpha-1 subunit of Na/K ATPase, K+ channel KCNJ13/Kir7.1, and Cl- channel CLIC6. All SPAK-bound targets co-localized with pSPAK at the ChP apical membrane in LPS conditions. This interaction, as well as CSF hypersecretion and ventriculomegaly, were abrogated in LPS-treated SPAK KO animals.

CONCLUSION:
Multi-omic analysis identified a SPAK-regulated ensemble of ion transport proteins relevant for PIH at the ChP apical membrane. Given the recent development of SPAK kinase inhibitors, our findings uncover a targetable mechanism for the pharmacological treatment of PIH and potentially other forms of inflammation-associated acquired hydrocephalus.
377 Complications of Pediatric Tethered Cord Release: Seattle Children’s Hospital Experience
Authors: Pan James , Hauptman Jason S. , Susarla Srinivas , Ellenbogen Richard G. , Lee Amy , Browd Samuel R. , Ojemann Jeffrey G. 
Published: March 2022

INTRODUCTION:
We describe six years of surgical experience at our pediatric neurosurgery center, with a wide variety of operative complexity and etiologies related to tethered cord syndrome. While complications are well-described, the risk of complications associated with complexity of the procedure needs further investigation. Based on our findings, we propose guidelines to minimize complications and give attention to certain high-risk groups of patients.

METHODS:
Medical records of children who underwent surgery for tethered cord release (CPT 63200) from July 2014 to December 2020 were retrospectively reviewed after approval by the Institutional Review Board at Seattle Children's Hospital. Data collected included demographics, surgical technique, follow-up, and complications. We defined surgeries as complex if they involved usage of any of the following: plastic surgeon assistance, drain placement, duraplasty, or operative laser. Univariate analysis and multivariate logistic regression were used to determine covariates that were protective or risk factors for development of complications.

RESULTS:
In 242 contiguous tethered cord operations (51.8% male, mean age 74.8 months), the overall complication rate of any type was 10.7% (3.45% simple, 17.46% complex). Median time until complication was 11 days. Complications were associated with usage of the operative laser, increasing hospital length of stay, and increasing operative time. Plastic surgery assistance (OR 0.357, 95% CI 0.197-0.647, p=0.0007) and placement of a drain (OR 0.314, 95% CI 0.134-0.739, p=0.008) for complex cases were protective against development of complications.

CONCLUSION:
Our complication rate is comparable to those of others (1-4). However, multivariate logistic regression analysis suggests that plastic surgery assistance and drain placement can be protective factors, and should be considered in complex tethered cord operations.
404 Anatomy of the Dorsal Meningeal Artery Including its Variations: Application to Skull Base Surgery and Diagnostic and Interventional Imaging
Authors: McCormack Isabella G. , Lu Xu , Nerva John D. , Berry John F. , Melgar Miguel A. , Wysiadecki Grzegorz , Walocha Jerzy A. , Iwanaga Joe , Dumont Aaron S. , Tubbs R. Shane 
Published: March 2022

INTRODUCTION:
The skull base vasculature is critical to surgeons operating in this region. However, one vessel with a vast skull base distribution, the dorsal meningeal artery (DMA), has had few anatomical studies performed to investigate not only its normal anatomy but also its variations.

METHODS:
In ten adult latex-injected cadaveric heads (twenty sides), the DMA was dissected using a surgical microscope and its branches were measured.

RESULTS:
A DMA was identified on all sides. In most (85%), it branched from the meningohypophysial trunk or common stem with either the inferior hypophysial or tentorial arteries and on three sides (15%), arose as a separate branch from the internal carotid artery. Within Dorello’s canal, the DMA was the most medial structure with the abducens nerve and the inferior petrosal sinus found laterally in most specimens. On one side (5%), the artery had two branches that traveled on either side of the abducens nerve distal to the petroclival ligament. Toward the midline, many (70%) of the clival branches pierced the clivus. Most (80%) clival branches anastomosed with their counterparts contralaterally and all traveled deep to the abducens nerve. Dural branches were found traveling to the clival dura and to the dura forming Meckel’s cave. Neural branches were identified traveling to the abducens and hypoglossal nerves. In two sides (10%), the DMA provided an ascending branch to the posterior pituitary gland. On 15% of sides, vascular branches traveled to the adventitia of the cavernous internal carotid artery and most sides (80%) had a descending branch to the inferior petrosal sinus which then anastomosed with jugular branches of the ascending pharyngeal artery.

CONCLUSION:
The DMA is a constant, although variable, vascular structure of the skull base and contributes to multiple structures in addition to the dura.