bluuebunny/crossref_metadata_2025_split huggingface dataset:
492 Development of Subdural Hematomas According to Size of the Subarachnoid Space in Benign External Hydrocephalus
Authors: Holste Katherine , Wieland Clare , Parmar Hemant , Ibrahim Mohannad , Garton Hugh , Maher Cormac O. 
Published: March 2022

INTRODUCTION:
Benign External Hydrocephalus (BEH) is a common condition seen by pediatric neurologists and neurosurgeons in macrocephalic infants. It is accepted that patients with BEH are at increased risk of spontaneous subdural hematoma (SDHs) formation.

METHODS:
A large retrospective chart review was performed at a single institution for patients 2 years or younger with a diagnosis of BEH by neurology or neurosurgery and head circumference >85th percentile. Demographic data, head circumference, and occurrence of subdural hematoma were extracted. MRIs were reviewed by two neuroradiologists and the SAS size measured. SAS size was graded per the Tucker et al grading system (<5 mm width is grade 0, 5-9 mm is grade 1 and > 10 mm is grade 2) for consistency.

RESULTS:
Over 2.5 million patients' charts were queried from a single institution and 480 patients met the inclusion criteria. Of that population, 187 children had an MRI of the brain available for review. The prevalence of spontaneous SDH in this BEH population over 25 years was 8.12% (39 patients of 480). The average size of the SAS was 5.86 mm (± 2.29 mm). A majority, 64.7%, had grade 1 SAS. About 39% had ventriculomegaly. There was no significant association between SAS grade and prevalence of SDHs (p = 0.124). SAS size was not significantly different between those with and without SDH (p= 0.402).

CONCLUSION:
BEH is a common condition seen by pediatric neurologists and neurosurgeons. Infants with BEH are thought to have increased risk of spontaneous SDH formation compared to the general population. A majority of infants had grade 1 SAS. The grade of SAS was not significantly associated with SDH formation and development of SDH was not associated with larger SAS size.
499 Seizures in a Dish: Demonstrating and Analyzing Coordinated Network Activity in Human and Mouse Brain Slice with Calcium Imaging
Authors: Alexander Allyson L. , Brzezinski Christine , Kushner Keenan , Hoffman Paige , Baca Serapio 
Published: March 2022

INTRODUCTION:
Childhood epilepsy is a common and often devastating disease, and chronic seizures lead to a significant increase in premature mortality and developmental delay. Focal cortical dysplasia (FCD), a malformation of cortical development, is the primary cause of pharmacoresistant epilepsy in children undergoing resective surgery. There are no targeted medical or surgical therapies for FCD patients who have failed surgery or who are not surgical candidates.

METHODS:
Human tissue from patients with MCDs was resected during epilepsy surgery. Comparison tissue from CD1 mouse brains was also used. 400-µm brain slices were made with a vibratome. The slices were then incubated the slices in Fluo-8L, a low-affinity calcium-sensitive indicator for 40-180 minutes. Slices were imaged using an sCMOS imager at 15 fps on an upright microscope and standard patch-clamp rig with a custom-built temperature-controlled chamber with high aCSF flow rate (5-15mL per minute) to optimize tissue oxygenation. Network bursts are induced with a pro-ictal ACSF containing high potassium (8 mM) and 4-aminopyridine (100 micromolar).

RESULTS:
We developed a workflow for calcium imaging in human tissue as follows. Preliminary semi-manual analysis on each image stack was performed using ImageJ. Image stacks were motion corrected using the NoRMCorre algorithm and then processed using the calcium imaging analysis workflow (CaImAn) appropriate for 1-photon imaging. Hundreds of cells can be analyzed simultaneously. Ictal network activity may be induced with the pro-ictal ACSF, or with gabazine (1 mM, a GABA-A receptor antagonist, data not shown).

CONCLUSION:
We have demonstrated the feasibility of performing ex vivo calcium imaging to directly study the aberrant epileptic networks in human MCD tissue resected from children with intractable epilepsy. In future work, we will use this novel technique to uncover network anomalies underlying the epileptic networks in this disorder.
501 Radiomic Phenotypes Distinguish ATRT from Medulloblastoma
Authors: Zhang Michael , Wong Samuel , Lummus Seth , Han Michelle , Radmanesh Alireza , Ahmadian Saman , Prolo Laura M. , Lai Hollie , Eghbal Azam , Oztekin Ozgur , Cheshier Samuel H. , Ho Chang , Vogel Hannes , Vitanza Nick , Lober Robert , Grant Gerald A. , Jaju Alok , Yeom Kristen 
Published: March 2022

INTRODUCTION:
Presurgical distinction of posterior fossa atypical teratoid/rhabdoid tumo (ATRTs) from medulloblastoma (MB) is challenging because of shared, low T1- and T2-weighted intensities, variable enhancement, and reduced diffusion.

METHODS:
The T2- and gadolinium-enhanced T1-weighted images of 48 posterior fossa ATRT and 96 match-paired MB were assembled from seven institutions. 1800 features were extracted from segmented tumor volumes. Feature reduction was performed by LASSO regression and cross-validation. Retained features were inputted to six training models, including support vector machine, logistic regression, k-nearest neighbor, random forest, eXtreme Gradient Boosting, and neural net. The optimal classifier maximized the area under the curve (AUC) on a holdout test set. Finally, two human experts reviewed the MRIs for categorical measurement of enhancement (0%; <50%, and =50% volume).

RESULTS:
The final feature set included one T1-MRI and five T2-MRI variables. Among classifier models, logistic regression produced the highest AUC of 0.858, with sensitivity, specificity, and F1 score of 0.800, 0.818, and 0.851, respectively. The top three predictive features were 90th Percentile Voxel Intensity, Inverse Difference Moment Normalized, and Kurtosis—all from T2-MRI. The last three features included T1-MRI and T2-MRI measurements for Elongation and Flatness. Separate qualitative human assessment identified greater volume enhancement for ATRT versus MB (p = 0.0135).

CONCLUSION:
Overall, T2-MRI-based features were more relevant for distinguishing ATRT from MB, with ATRT identified by brighter and more heterogeneous voxel intensities, consistent with ATRT’s myxoid and broad histologic composition. Additionally, ATRT were with more linear and planar morphology, consistent with ATRT flattening within the cerebellopontine angle and MB expansion within the fourth ventricle. Earlier distinction could aid family counseling and surgical planning.
514 A Data-driven Approach to Predicting 5-ALA-Induced Fluorescence and WHO Grade in Newly Diagnosed Diffuse Gliomas
Authors: Müther Michael , Jaber Mohammed , Johnson Timothy , Orringer Daniel A. , Stummer Walter 
Published: March 2022

INTRODUCTION:
A growing body of evidence has revealed the potential utility of 5-aminolevulinic acid (5-ALA) as a surgical adjunct in select lower-grade gliomas. However, a reliable means of identifying which lower-grade gliomas will fluoresce has not been established.

METHODS:
We investigated a cohort of grades II and III glioma patients who received 5-ALA prior to resection at a single institution. Using a logistic regression-based model, we evaluated 14 clinical and molecular variables considered plausible determinants of fluorescence. We then distilled the most predictive features to develop a model for predicting both fluorescence and tumor grade. We also explored the relationship between intraoperative fluorescence and molecular markers.

RESULTS:
179 subjects were eligible for inclusion. Our logistic regression classifier accurately predicted fluorescence with 91.9% accuracy and revealed enhancement as the singular variable in determining fluorescence. There was a direct relationship between enhancement on MRI and the likelihood of observed fluorescence. Observed fluorescence correlated with MIB-1 index but not with IDH status, 1p19q co-deletion or MGMT promoter methylation.

CONCLUSION:
We demonstrate a strong correlation between enhancement on preoperative MRI and the likelihood of visible fluorescence during surgery in intermediate-grade glioma patients. Our analysis provides a robust method for predicting 5-ALA-induced fluorescence in grade II and grade III glioma patients.
805 Initial Results of Precision Treatment of Postoperative Cerebrospinal Fluid Leak with Ultrasound-Guided Epidural Blood Patch
Authors: De Biase Gaetano , West James Leonard , Abode-Iyamah Kingsley O. , Nottmeier Eric W. , Deen Hugh Gordon , Chen Selby G. , Huynh Thien , Fox W. Christopher , Bydon Mohamad , Miller David , Clendenen Steven R. 
Published: March 2022

INTRODUCTION:
Incidental durotomy, a known complication of spinal surgery, can lead to persistent cerebrospinal fluid (CSF) leak and pseudomeningocele if unrecognized or incompletely repaired.

METHODS:
A retrospective review was performed to determine demographic, procedural, and outcome characteristics for patients who underwent US-EBP for symptomatic postoperative pseudomeningocele.

RESULTS:
Overall, 48 patients who underwent 49 unique episodes of care were included. The average age and BMI were 60.5±12.6 years and 27.8±4.50 kg/m2, respectively. The most frequent index operation was laminectomy (24.5%) and 36.7% of surgeries were revision operations. Durotomy was intended or recognized in 73.4% of cases, and the median time from surgery to symptom development was 7 (IQR 4-16) days. A total of 61 US-EBPs were performed, with 51.0% of patients experiencing resolution of their symptoms after the first US-EBP. An additional 20.4% were successful with multiple US-EBP attempts. Complications occurred in 14.3% of cases and the median clinical follow-up was 4.3 (IQR 2.4-14.5) months.

CONCLUSIONS:
This manuscript represents the largest series in the literature describing US-EBP for the treatment of postoperative pseudomeningocele.
812 Outcomes of Tranexamic Acid in Patients with Traumatic Brain Injury: A Meta-analysis of 36,692 Patients
Authors: Diaa Mohamed , Ghaith Hazem , Hanbal Ahmed , Azam Ahmed , Kanmounye Ulrick Sidney , Negida Ahmed , Elfil Mohamed 
Published: March 2022

INTRODUCTION:
Tranexamic acid (TXA) is an antifibrinolytic agent that can help to treat and control bleeding. Recently, many studies have discussed TXA as an effective medication for traumatic brain injury (TBI). However, there is a current controversy and debate for the benefit of TXA using in TBI patients.

METHODS:
A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until July 2021. Studies comparing TXA versus no TXA in TBI patients were selected for the analysis, and all relevant outcomes were pooled in the meta-analysis using Review Manager Software.

RESULTS:
Ten studies with a total of 36692 patients were included in the meta-analysis. TXA could significantly cut the risk of mortality (RR 0.93, 95% CI 0.88-0.99, P=0.02) and growth of hemorrhagic mass (RR 0.87, 95% CI 0.77 to 1.00, P=0.05). No significant difference were found between TXA and placebo groups in terms of “need for neurosurgery” (RR 0.99, 95% CI 0.91-1.07, P=0.76), “deep venous thrombosis” (RR 1.01, 95% CI 0.74-1.36, P=0.97), “pulmonary embolism” (RR 0.96, 95% CI 0.76-1.22, P=0.76), “myocardial infarction” (RR 0.82, 95% CI 0.59-1.13, P=0.22), “stroke” (RR 0.92, 95% CI 0.72-1.18, P=0.52), “seizure” (RR 1.04, 95% CI 0.88-1.22, P=0.66), and “length of ICU stay” (MD 0.68, 95% CI -4.04 to 5.40, P=0.78).

CONCLUSIONS:
TXA significantly reduces the incidence of mortality and growth of hemorrhagic mass in TBI patients. However, current evidence does not support any benefits in deep venous thrombosis, pulmonary embolism, myocardial infarction, stroke, or seizure.
828 The Impact of a Night Float System on Neurosurgery Resident Operative Experience
Authors: Lazaro Tyler , Katlowitz Kalman , Karas Patrick Jacob , Srinivasan Visish M. , Rao Ganesh , Patel Akash J. 
Published: March 2022

INTRODUCTION:
Traditionally, resident call had been based on alternating call between residents in the call pool, requiring residents to work 24-hour shifts multiple times per week. However, to comply with an 80-hour work week, many programs moved toward different “float” systems, dedicating one resident to be on call for a given period of time. For surgical subspecialities, however, there has been some reticence to adopt night float due to concern for the loss of operative experience. In this study, we describe our training program’s transition to the night float system and its impact on the resident operative experience.

METHODS:
We conducted a single program study of resident surgical case volume before and after the implementation of night float 3 of the 5 hospitals at our program over a 6-year period from 2014 to 2020. Surgical cases were obtained from the ACGME case log database. Overall surgical cases were collected from individual hospital databases.

RESULTS:
After the implementation of night float, there was a significant decrease in overnight call burden, specifically for senior residents who saw a decrease in call from 112 calls a year to 16. Across the three hospitals involved in the night float rotation, an average of 33 pages and 5 consults occurred each night, with a case occurring once every once every 2.75 days. Logged procedures significantly increased after the initiation of night float for participating hospitals (p<0.05, t-test), while cases at non-night float hospitals remained the same. This rise was commiserate with a global increase in hospital cases, suggesting that residents were able to take advantage of increasing opportunities. This difference was mainly driven by senior resident cases (p=0.010, t-test), as juniors and chiefs did not show significant differences in case logs (p>0.40, t-test).

CONCLUSIONS:
The transition to a night float call system improved our residents’ operative experience by increasing their opportunities to participate in cases. In particular, senior residents had fewer night time call requirements and showed a significant increase in logged case volume.
833 Potential Palliative Role for Neoadjuvant Arterial Embolization in Patients with Spine Metastases
Authors: Gibbs David Charles , Damante Mark A. , Dibs Khaled , Blakaj Dukagjin , Elder James Bradley 
Published: March 2022

INTRODUCTION:
Approximately two-thirds of all cancer patients will develop bone metastasis, and the spine is the most common site.1 Spine metastases may lead to significant pain, instability, and/or neurological morbidity. A high rate of local control can be achieved with local therapies such as radiation and surgery, but persistent pain is described among some patients. Prior clinical research demonstrated that arterial embolization without surgery may improve pain associated with spine metastases.2 This study aimed to determine the effects of embolization on pain in patients undergoing surgical decompression and stabilization.

METHODS:
A retrospective single-center review between 2012 and 2020 identified 117 patients receiving adjuvant SRS or SBRT following surgical intervention for spine metastases. The study group included various primary tumor types and patients treated with laminectomy and/or varying degrees of vertebrectomy. Data analyzed included demographic information, embolization and surgical details, KPS, defensive veterans pain rating scale (DVPRS), dose of radiotherapy, and daily doses of analgesic medications.

RESULTS:
Of 117 patients, 47 (40.2%) underwent preoperative embolization. Forty-nine (70%) and 24 (51.1%) patients underwent laminectomy/partial vertebrectomy in the non-embolization and embolization cohorts, respectively. Demographics were similar between groups at baseline. DVPRS scores did not differ by primary tumor histopathology (p = 0.63). DVPRS daily average and maximum rest scores decreased from 5.6 to 3.7, p < 0.001, and 5.7 to 3.8, p < 0.001, respectively following embolization. Throughout postoperative days 1-14, pain scores and daily doses of analgesic medications were largely similar between cohorts.

CONCLUSIONS:
Preoperative arterial embolization decreases pain scores immediately after the procedure, consistent with prior literature. This palliative effect largely disappears in the postoperative period, likely due to surgical pain. Future prospective studies identifying long-term palliative effects of embolization for spine metastasis are needed.
Portal vein embolization via the ipsilateral percutaneous transhepatic approach versus laparotomic transileocecal approach: complications, profile and changes in future liver remnant volume
Authors: Okada Munemasa , Ihara Kenichiro , Miyoshi Keisuke , Nakao Sei , Tanabe Masahiro , Tokumitsu Yukio , Harada Eijiro , Sakamoto Kazuhiko , Nagano Hiroaki , Ito Katsuyoshi 
Published: March 2022

Objective: Major liver resection is an effective treatment option for patients with liver malignancy. The future liver remnant (FLR) volume and complications after portal vein embolization (PVE) were compared between the ipsilateral right portal vein (PTPE) and transileocolic (TIPE) approaches. Methods: A total of 42 patients (TIPE, n = 22; PTPE, n = 20) underwent right lobectomy after PVE. CT and hepatobiliary scintigraphy were repeated before and after PVE. The blood examination findings and the FLR values (FLRCT: calculated from CT, %FLRCT: FLRCT ratio, %FLRSPECT: FLR ratio using single photon emission CT, FLRCT/BS: FLRCT to body surface ratio) were compared between two approach sites. The complications and mortality were also analyzed after PVE and major right hepatectomy. Results: There were no significant differences in the patient characteristics, blood examination findings or FLR values between two groups. Adequate liver regeneration was observed without significant differences between PTPE and TIPE (increased ratio of FLRCT: 8.7% vs 19.2%, p = 0.15 [25–75 percentile: 17.1–60.4], %FLRCT: 11.2% vs 8.3%, p = 0.25 [6.3–13.3], %FLRSPECT: 15.4% vs 19.2%, p = 0.09 [16.0–22.4], FLRCT/BS: 33.6% vs 47.1%, p = 0.19 [17.2–60.4], respectively), but TIPE required a significantly longer procedure time than PTPE [181.4 min vs 108.7 min, p < 0.01 (103.3–193.5)]. However, one patient was converted to TIPE due to bleeding during PTPE. After right lobectomy, portal vein stenosis or thrombosis was noted in three patients [two with TIPE (9.1%) and one with PTPE (5%)] and three TIPE patients died within 90 days (13.6%) after right hepatectomy. Conclusion: FLR volume significantly increased after PVE, regardless of the approach sites; however, PTPE is a useful technique with a shorter procedure time.
The impact of altering participant MRI scanning position on back muscle volume measurements
Authors: Alharthi Salman , Meakin Jude , Wright Chris , Fulford Jonathan 
Published: March 2022

Objectives: Muscle volume may reflect both strength and functional capability and hence is a parameter often measured to assess the effect of various interventions. The aim of the current study was to determine the sensitivity of muscle volume calculations on participant postural position and hence gauge possible errors that may arise in longitudinal studies, especially those where an intervention leads to large muscle changes and potentially the degree of spinal curvature. Methods: Twenty healthy participants (22–49 years, 10 male and 10 female), were recruited and MRI images acquired with them lying in four different positions; neutral spine (P1), decreased lordosis (P2), increased lordosis (P3) and neutral spine repeated (P4). Images were analysed in Simpleware ScanIP, and lumbar muscle volume and Cobb’s angle, as an indicator of spine curvature, determined. Results: After comparing volume determinations, no statistically significant differences were found for P1 - P2 and P1 - P4, whereas significant changes were determined for P2 - P3 and P1 - P3. P2 and P3 represent the two extremes of spinal curvature with a difference in Cobb’s angle of 17°. However, the mean difference between volume determinations was only 29 cm3. These results suggest the differences in muscle volume determinations are generally greater with increasing differences in curvature between measurements, but that overall the effects are small. Conclusions: Thus, generally, spinal muscle volume determinations are robust in terms of participant positioning. Advances in knowledge: Differences in muscle volume calculations appear to become larger the greater the difference in spinal curvature between positions. Thus, spinal curvature should not have a major impact on the results of spinal muscle volume determinations following interventions in longitudinal studies.
The outcome of an automated assessment of trabecular pattern in intraoral radiographs as a fracture risk predictor
Authors: Gullberg Joanna , Sundh Daniel , Johansson Lisa , Isberg Per-Erik , Lorentzon Mattias , Lindh Christina 
Published: March 2022

Objectives: This study aims to investigate if automated analyses of the trabecular pattern in intraoral radiographs independently contribute to fracture risk assessment when other risk factors incorporated in the Fracture Risk Assessment Tool (FRAX) are taken into account. A secondary aim is to explore the correlation between the automated trabecular pattern assessment in intraoral radiographs and Trabecular Bone Score (TBS). Methods: A total of 567 intraoral radiographs from older females participating in a large population-based study (SUPERB) based in Gothenburg, Sweden, were selected to analyse trabecular pattern using semi-automated and fully automated software. Associations between trabecular pattern analysis and incident fractures were studied using Cox proportional hazard model, unadjusted and adjusted for FRAX risk factors (previous fracture, family history of hip fracture, smoking, corticosteroids, rheumatoid arthritis, without and with bone mineral density (BMD) of the femoral neck). In addition, the correlation between trabecular pattern analysis and TBS of the lumbar spine was investigated using Pearson correlation analysis. Results: Neither the unadjusted nor the adjusted trabecular pattern analysis in intraoral radiographs was significantly associated with any fracture or major osteoporotic fracture (MOF). A weak correlation was found between semi-automated trabecular pattern analysis and TBS. No correlation was found between the fully automated trabecular pattern analysis and TBS. Conclusions: The present study shows that semi-automated and fully automated digital analyses of the trabecular pattern in intraoral radiographs do not contribute to fracture risk prediction. Furthermore, the study shows a weak correlation between semi-automated trabecular pattern analysis and TBS.
O FEDERALISMO NA CONSTITUIÇÃO DE 1988 E OS IMPACTOS NA RECEITA DOS MUNICÍPIOS DO ESTADO DO RIO GRANDE DO SUL
Authors: Zanotta Calçada Luís Antonio , Rodrigues Reck Janriê 
Published: March 2022

Contextualização do tema: o presente artigo parte da premissa de que a arrecadação de recursos pelo Estado é necessária para o custeio das atividades públicas e, em seguimento, faz-se um cotejo com as disposições constitucionais a respeito da forma federativa do Estado e da distribuição das competências tributárias realizada pela Carta.Objetivos: busca avaliar se o modelo de federalismo concebido pela Constituição de 1988 prejudica os municípios do Rio Grande do Sul acerca da realização de receitas públicas e, consequentemente, quanto à autonomia do ente federativo. Metodologia:Tal análise foi realizada a partir da revisão bibliográfica e documental, utilizando o método indutivo.Resultados: ao final, apresentam-se dados extraídos do sítio Dados Abertos, do Tribunal de Contas do Estado do Rio Grande do Sul. Tais subsídios permitiram concluir que o federalismo brasileiro transformou os munícipios em recebedores de recursos dos outros entes, prejudicando a autonomia desses. Assim, infere-se a necessidade de se estabelecer um novo federalismo.