bluuebunny/crossref_metadata_2025_split huggingface dataset:
517 Metastasis in High-Grade Meningioma: A Systematic Review of Incidence and Risk Factors
Authors: Montgomery Eric , Sundarrajan Chandrasekhar , Pernik Mark N. , Caruso James , Garzon-Muvdi Tomas 
Published: March 2022

INTRODUCTION:
Meningioma is the most common primary tumor of the central nervous system and has relatively good outcomes. Rarely, meningiomas metastasize and greatly reduce the likelihood of survival. Due to its infrequency, there is little information available to inform physicians whether a meningioma patient is at-risk for experiencing metastasis.

METHODS:
We searched PubMed, Scopus, Embase, and Ovid for studies with intracranial meningiomas metastasizing to non-CNS locations. Case reports and studies with metastasis to the spinal cord were excluded. Primary tumors were characterized based on location, recurrence, histological grade, patient sex, and overall survival.

RESULTS:
Our database search yielded 1,002 unique articles, of which 5 were included in the final review. The studies yielded a total of 480 patients with high-grade meningioma. Overall, there were 21 patients from this cohort that suffered metastasis of their primary tumor (4.38%). The majority of metastatic patients were female (61.1%), and 18 of the 21 patients experienced recurrence of their primary tumor, along with metastasis (85.7%). Multiple risk factors were individually analyzed by studies, including skull base location, sinus invasion, and molecular characteristics.

CONCLUSION:
Metastatic meningioma is a rare occurrence but greatly reduces the survival of meningioma patients. Due to its infrequent incidence, there is a paucity of literature comparing risk factors for metastasis to guide clinical decision-making. Our study summarizes the current literature available on the overall incidence of metastasis in high-grade meningiomas and highlights multiple risk factors that future studies should characterize to provide a more comprehensive understanding of this rare pathology.
518 Bavituximab Effectively Targets Suppressive Myeloid Cells in Patients with Glioblastoma
Authors: Choi Bryan D. , Richardson Leland G. , Ly K. Ina , Gerstner Elizabeth , Curry William T. 
Published: March 2022

INTRODUCTION:
Glioblastoma and tumor endothelial cells express phosphatidylserine, an immunosuppressive membrane phospholipid. Bavituximab – a chimeric monoclonal antibody – competitively binds to the β2-glycoprotein 1-phosphatidylserine complex, resulting in anti-tumor immune activation and anti-angiogenesis. Bavituximab may act in the tumor immune microenvironment (TIME) through myeloid cells.

METHODS:
33 adults with newly diagnosed glioblastoma were enrolled in this phase II trial (NCT03139916). Bavituximab was given weekly, starting week 1 of Stupp. The primary objective was % overall survival at 12 months. We collected peripheral blood mononuclear cells (PBMCs) at enrollment and at regular intervals thereafter. Tumor tissue was banked and analyzed retrospectively. The nCounter Myeloid Innate Immunity Panel, which includes 770 myeloid-associated genes, was used to profile the myeloid transcriptome in both PBMCs and tumor tissue. Multispectral immunofluorescence was used to characterize the intratumoral immune environment.

RESULTS:
In the TIME, bavituximab-treated patients saw a reduction in the number of MDSCs. While the pretreatment RNA profile in PBMCs was not associated with outcome, above-median progression-free and overall survival were associated with significantly enriched expression of myeloid-associated genes in pretreatment tumor tissue.

CONCLUSION:
Bavituximab reduces MDSCs in the glioblastoma microenvironment. Elevated tumor expression of myeloid-associated genes may be a predictive biomarker for response to bavituximab.
810 Aberrant Immune Activation Drives Chronic White Matter Loss After Experimental Traumatic Brain Injury
Authors: Jarrahi Abbas , Braun Molly , Ahluwalia Meenakshi , Ahluwalia Pankaj , Lu Yujiao , Khodadadi Hesam , Salles Evila Lopes , Vaibhav Kumar , Vender John R. , Baban Babak , Vale Fernando L. , Dhandapani Krishnan 
Published: March 2022

INTRODUCTION:
Epidemiological studies suggest a single traumatic brain injury (TBI) initiates progressive neurodegeneration, including extensive white matter (WM) injury; yet, the majority of demyelination and WM atrophy occurs in the years following TBI in both rodents and humans. Chronic immune activation correlates with neurological dysfunction after TBI, but the underlying mechanisms remain undefined.

METHODS:
To define the molecular changes associated with focal TBI, unbiased Nanostring arrays were utilized after controlled cortical impact, a pre-clinical model of focal TBI, in adult mice. Immune activation was monitored using flow cytometry and neurodegeneration was assessed at 8 weeks post-TBI, by histology, electron microscopy, and magnetic resonance imaging.

RESULTS:
Genomic profiling revealed acute upregulation of gene classes associated with leukocyte activation, phagocytosis, antigen presentation, lymphocyte activation, and metabolism whereas genes associated with axon/dendrite structure and neural connectivity were downregulated. Infiltrating macrophages, which phagocytosed myelin debris, represented the predominant antigen presenting cells (APCs) within the CNS after TBI. Similarly, a time dependent increase in the number of myelin containing macrophages was observed within cerebrospinal fluid of severe TBI patients. Functionally, APCs stimulated with myelin ex vivo or isolated after TBI increased T-helper (TH) cell proliferation and enhanced pro-inflammatory TH1/TH17 polarization. Myeloid-selective activation of the key metabolic regulator, 5’-adenosine monophosphate-activated protein kinase (AMPK), suppressed myelin reactive T-cells, and reduced neurodegeneration after TBI.

CONCLUSIONS:
The infiltrating myeloid cells after TBI undergo metabolic dysfunction following phagocytosis of myelin debris and orchestrate the generation of myelin autoreactive T-cells resulting in progressive neurodegeneration.
818 Association Between Intraoperative LFP, Lead Location, and Outcomes in Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease
Authors: Katlowitz Kalman , Ince Nuri Firat , Tarakad Arjun , Sheth Sameer A. , Viswanathan Ashwin 
Published: March 2022

INTRODUCTION:
Imaging-based, LFP-based and empirical programming strategies can be used to determine the optimal therapeutic contact for deep brain stimulation, but the most efficient strategy is unclear.

METHODS:
In this prospective, IRB-approved study, 10 awake patients were implanted with bilateral STN DBS using both an electrophysiologically- and imaged-confirmed technique. Once the DBS lead had been secured, LFP signals were recorded with a Grapevine Neural Amplifier (Ripple Neuro, UT) at 30 KHz and 16-bit A/D resolution, and LFPs were down-sampled to 2 KHz before further processing. Stereotactic CTs acquired two weeks postoperatively were fused to the pre-operative 3T, T2 weighted MRI and processed using the SureTune platform (Medtronic, MN). Therapeutic DBS programming parameters were obtained 6 months post-implantation, along with pre- and post-operative UPDRS Part III scores.

RESULTS:
There was a 54% reduction in the UPDRS score when comparing the preoperative OFF score, to the 6 month postoperative OFF Meds/ON Stimulation Score. 50% of the chosen contacts were in the STN only, 10% in the ZI only, and 35% in both. One lead was found to be outside the segmented STN and ZI; this patient did not experience clinical improvement based on their Part III UPDRS score. Beta (8-30Hz) power was 4.1 times higher for electrodes within the STN versus out, 1.4 times for ZI versus out, and 5.9 times higher for both versus neither. The average beta power was 15% higher in the chosen therapeutic contacts over those contacts not used. Lastly, we found that the number of electrodes within the STN correlated with the decrease in the UPDRS score (r=0.27).

CONCLUSIONS:
There is a strong correlation between image-based electrode localization, LFP characteristics, and clinical outcomes in patients undergoing STN DBS for Parkinson Disease. Focused programming strategies based on either imaging or LFP data can facilitate identification of the optimal therapeutic contact.
819 White Matter Activation Pathways in STN and GPi DBS for Parkinson’s Disease
Authors: DiRisio Aislyn , Avecillas-Chasin Josue Moises , Platt Samantha , Figee Martijn , Jimenez-Shahed Joohi , Mayber,g Helen S. , Choi Ki Sueng , Kopell Brian H. 
Published: March 2022

INTRODUCTION:
The subthalamic nucleus (STN) and globus pallidus interna (GPi) are common deep brain stimulation (DBS) targets for Parkinson’s disease (PD). DBS is thought to function by modulating downstream circuits, yet targeting is based on anatomy rather than structural connectivity. While tractography using normative connectomes has been used to study the impact of the hyperdirect pathway, cortical connectivity patterns only account for 20% of the variance in DBS response. Less is known about subcortical and cerebellar connectivity, and patient-specific tractography in DBS for PD.

METHODS:
Preoperative T1-weighted and diffusion-weighted MRI, postoperative CT, and clinical data were acquired for 49 patients (24 STN, 25 GPi) who underwent DBS for PD. After initial programming, the Lead DBS toolbox was used to model VAT based on the individual subject electrode and stimulation parameters. Whole-brain probabilistic tractography was performed from VAT using FSL (FMRIB's Software Library) to estimate activation pathways. Average activation pathways were generated for each target by weighting each subject’s pathways by unilateral MDS-UPDRS-III response to stimulation at initial programming. Comparison tractography was performed using 85-subject PD normative connectome.

RESULTS:
Analysis of weighted activation pathways reveals that STN-DBS strongly activates pathways to the caudate nucleus and bilateral cerebellum. In contrast, GPi-DBS activates pathways to the putamen and the ansa lenticularis. Furthermore, normative connectome tractography shows that the subcortical and cerebellar structural connectivity is not as well appreciated. Lastly,cortical pathways show that GPi DBS has increased premotor connectivity while STN DBS has robust motor connectivity, and confining the seeds to the STN and GPi does not diminish cortical connectivity.

CONCLUSIONS:
Activation pathways from STN and GPi therapeutic contacts have unique subcortical and cerebellar connectivity. White matter connections within the basal ganglia and cerebellum, including ansa lenticularis and regions associated with the DRTT, are connected to the therapeutic contacts, and this connectivity is not as well appreciated using normative connectome data. Activation pathways via the internal capsule alone cannot explain cortical connectivity. Further research to test the utility of defined connections using patient-specific tractography may help better predict DBS response or prospectively inform targeting.
821 Association Between Tumor Mutations and Meningioma Recurrence in Grade I/II Disease
Authors: Dullea Jonathan , Rutland John , Gill Corey M. , Ranti Daniel , Arrighi-Allisan Annie E. , Kinoshita Yayoi , McBride Russell , Bederson Joshua B. , Donovan Michael , Sebra Robert , Fowkes Mary , Umphlett Melissa , Shrivastava Raj K 
Published: March 2022

INTRODUCTION:
A subset of grade I and II meningiomas, in contrast to their predicted favorable oncologic course, recur. Recent interest has been paid to the development of predictive measures to identify which tumors may necessitate more aggressive initial management or more frequent post-resection surveillance.

METHODS:
Using our tissue bank of 255 meningiomas with linked targeted next-generation sequencing, we identified 173 with at >90 days of post-surgical follow-up. We computed progression free survival cox-regression models for each of the 5% most prevalent tumor mutations corrected for tumor grade, recurrence status, and resection status. Grade III tumors were excluded due to issues with the proportional hazards assumption. We then built a multi-gene model by including all individual gene predictors with a p-value of less than 0.20. Starting with that model, we performed automated backwards selection.

RESULTS:
In the single gene analysis, ATM (HR = 5.22; 95%CI: 1.81 – 15.08), CREBBP (HR = 2.71; 95% CI = 1.15 – 6.38), and POLE (HR = 0.56; (95%CI = 0.32 – 0.97) were significantly associated with alterations in disease progression. In the multi-gene model, only POLE remained a significant predictor of recurrence after adjusting for the same clinical covariates and the genes ATM, ATR, CREBBP, RNF43, and SETD2. Backwards selection identified recurrence status, resection status, and mutations in ATM (HR = 8.14; 95%CI = 2.65 – 24.99) and POLE (HR = 0.45; 95% CI = 0.25 – 0.78) as predictive of recurrence.

CONCLUSIONS:
There is an association between ATM, CREBBP and POLE with progression free survival after accounting for tumor grade, resection extent, and recurrence status. In a muiti-gene model, POLE was the only gene found to alter survival. Backwards variable selection identified ATM as deleterious and POLE as protective.
822 Awake Craniotomy Within Glioblastoma Subgroups (GLIOMAP study)
Authors: Gerritsen Jasper , Zwarthoed Rosa , Versyck Georges , Jessurun Charissa , Pruijn Koen , Fisher Fleur , Kilgallon John , Nawabi Noah , Lien Solie Emma Larivière; , de Jong Sil , Satoer Djaina , Schouten Joost , Bos Eelke , Kloet Alfred , Tewarie Rishi Nandoe , Smith Timothy R. , Dirven Clemens M.F. , De Vleeschouwer Steven , Broekman Marike , Vincent Arnaud 
Published: March 2022

INTRODUCTION:
Awake mapping has been associated with decreased neurological deficits and increased extent of resection in eloquent glioma resections. However, its impact within clinically relevant glioblastoma subgroups remains poorly understood.

METHODS:
918 patients with tumor resection for primary eloquent glioblastoma between 2010 and 2020 at four tertiary centers from Europe and the United States were included from an initial cohort of 4075 patients. Awake patients were matched with asleep patients for the overall cohort and subgroups.

RESULTS:
Overall, awake mapping led to less neurological deficits at 6 weeks (18.4% vs. 27.8%, p = 0.036) and 6 months postoperatively (26.5% vs. 41.9%, p = 0.0039), lower residual volume (mean: 1.9 vs. 6.4 ml, p = 0.0076), a higher extent of resection (mean: 95.5% vs. 85.3%; median: 99.8% vs. 94.0%, p < 0.001), and longer overall survival (median: 20.0 vs. 18.5 months, p = 0.042). Awake mapping led in the subgroups of age < 70, age = 70, preoperative NIHSS score 0-1 and preoperative KPS 90-100 to less postoperative neurological deficits at 6 weeks and 6 months. For patients in the KPS = 80 subgroup, awake mapping led to less postoperative neurological deficits at 6 months (22.0% vs. 45.9%, p = 0.026). Patients aged < 70 years undergoing awake craniotomy had on average a longer overall survival than the asleep resection group (median: 24 months vs. 20.5 months, p= 0.031). Awake mapping was an independent predictor for receiving adjuvant chemotherapy and radiotherapy (OR for no receival: 0.40, p = 0.025), gross-total resection based on residual volume (OR 2.79, p = 0.041), and gross-total resection based on extent of resection (OR 2.24, p = 0.002). Moreover, it had a positive impact on overall survival in the = 70 subgroup (HR 0.08, p = 0.033), but a negative impact on overall survival in the NIHSS = 2 subgroup (HR 3.07, p = 0.014).

CONCLUSIONS:
Awake mapping prevents postoperative neurological deterioration in eloquent glioblastoma resections for patients aged <70, aged = 70, with a preoperative NIHSS score of 0-1 or preoperative KPS of 90-100 and increases the rate of gross-total resections in all patients.
824 Development of a Preclinical Glioblastoma Platform in a Murine Model in order to optimize Diffusion Kurtosis Imaging Protocol to be able to accurately differentiate Acute and Chronic Radiation Necrosis from Tumor Recurrence
Authors: Gunasekaran Arunprasad , Lindhorst Scott , Yazdani Milad , McDonald Daniel , Kosnik Infinger Libby M. , Varma Abhay K. , Vandergrift William A. , Patel Sunil J. , Cachia David , Das Arabinda 
Published: March 2022

INTRODUCTION:
Radiation induced damage in glioblastoma (GB) patients can present in a late-delayed fashion as radiation necrosis (RN) or tumor recurrence (TR). The radiographic differentiation of these entities is particularly challenging as they appear similar on magnetic resonance imaging (MRI.) Failure to differentiate these can ultimately lead to unnecessary surgery and early cessation radiation therapy. There is a need for developing novel non-invasive techniques that can reliably distinguish between radiation necrosis and tumor recurrence.

METHODS:
We orthotopically transplanted GL261 mouse glioblastoma cells into C57BL/6 mice, with successful tumor induction verified by MRI after two weeks. To consistently induce RN/TR, an aggressive radiation dose fractionation (12 Gy/60 Gy) on alternating days was used. This was completed such that one portion of the tumor received 100% dose of radiation fraction, sufficient to cause RN, whereas the tumor edge received only 50% of the dose, allowing for tumor recurrence. At four time points, MRI and diffusion kurtosis imaging (DKI) were obtained, and objective metrics such as mean, axial, and radial kurtosis and diffusivity were calculated.

RESULTS:
Our data demonstrated mice tumor recurrence and radiation necrosis on MR imaging. MRI and DKI at 2 weeks following orthotopic glioblastoma implantation demonstrated edema and gyral edema compatible with tumor recurrence. One week later, imaging sequences demonstrated continued tumor progression. This demonstrated that our proposed model for radiation induction was effective at achieving its goal of creating some areas of RN and some of TR.

CONCLUSIONS:
Our results provides an invaluable platform for the mechanistic study of acute radiation necrosis, chronic radiation necrosis, and tumor recurrence, and management of these conditions.
825 Can Applying Machine Learning on Perioperative Team Communication Data Change the Way we Predict Case-time Duration?
Authors: Ber Roee , Valliani Aly , Liu Albert , Kurland David B. , Pacione Donato R. , Oermann Eric Karl 
Published: March 2022

INTRODUCTION:
Accurate case-time prediction is a critical component in improving operating room efficiency. Applying machine learning on patient and booking parameters has been shown to improve accuracy. However, the details of the actual surgical plan as determined by the surgeon pre-operatively have not been included in these predictions. In this study, we applied machine learning methods on data from perioperative team communication platform to predict case time duration.

METHODS:
The objective data collected from 535 neurosurgical cases by a perioperative team communication platform were divided to training and testing datasets (431 and 104 cases respectively). We developed a machine learning algorithm based on historical case-duration data (last 10 similar cases by the same surgeon) and compared to planning data collected from a perioperative team communication platform. We used the real case-time duration of the cases in the training dataset to train the algorithm. We then tested our model on the testing dataset and compared the accuracy of case-time prediction to the historical data alone prediction model, which is the common method used in our institution.

RESULTS:
The machine learning model combining historical and team communication data provided better accuracy in case-time prediction than historical data alone. The historical data method averaged 90.6 minutes difference in case-time from real time, and the machine learning model averaged 80.04 minutes (p=0.029). For cases longer than the case-time 50th percentile (183 minutes), the historical data method averaged 126.02 minutes difference from real time, and the machine learning model averaged 104.52 minutes (p=0.014).

CONCLUSIONS:
The actual case plan as discussed amongst the surgical team in the perioperative period provides information that is not often available otherwise. Applying a machine learning algorithm on the data captured through a team communication platform improved case time prediction compared to common methods.
829 Surgical Outcome of Rhinocerebral Mucormycosis in Corona Virus Associated Patient: A Prospective Study from a Tertiary Care Center in Eastern India
Authors: Jha Keashav Mohan , Kumar Brajesh , Kumar Dhanajay , Singh Samrendra Kumar 
Published: March 2022

INTRODUCTION:
Second wave of covid19 affected India significantly with total numbers of cases 31,440,950 and total death 4,21,224. As India acheived stablity in fight against covid, another challenge emerged in the form of Mucormycosis. Mucormycosis is a serious angioinvasive infection caused by the order Mucorales and class of Mucormycetes. It is associated with high mortality in immunocompromised mainly diabetic patients if not treated agressively.

METHODS:
Our Hospital, IGIMS was declared exclusive covid facility in April 2021 and subsequently was declared dedicated hospital for Mucormycosis.During this two month period demographic, Clinical details and outcome were collected prospectively.

RESULTS:
During two month period, 500 cases were seen in OPD, 300 patients were admitted and 120 patients were operated. 47 patients have cerebral involvement. 11 patients with extensive involvement of brain including cavernous sinus were not offered surgery, because of poor pronosis. 4 patients of this group improved 5 patients died and 2 patients were discharged in moribund condition. Another 26 patients with only meningeal involvement and small lesion, with no mass effect and was treated conservatively. 16 of this group improved, Four (with poor coma score expired. Another 4 patients were transferred to other medical facilities and details of these patients are not available. 10 patients having large fungal lesion in non eloquent area along with mass effect were operated. six patients were operated with microscopic technique and 4 patients with endoscopic technique. eight patients were earlier, Covid RT-PCR positive and was treated with steroid and oxygen inhalation. Another two patient had fever , but Covid RT-PCR was negative and was treated at home with oxygen cylinder.All of them were treated with liposomal amphotrecin B. Sinus surgery was performed in all patients. Eight patient did well and was discharged from hospital in good condition. One patient, in which endoscopic cerebral exploration was done expired. Another patient was discharged with severe neurological sequlae.

CONCLUSIONS:
Patients with Rhincerebral Mucormycosis spreading outside sinonasal cavity to the base of the brain can be treated by neurosurgical intervention.