bluuebunny/crossref_metadata_2025_split huggingface dataset:
339 Influence of SEEG on Temporal Lobectomy
Authors: Kondylis Efstathios , Hsieh Jason K. , Sundar Swetha J. , Sarmey Nehaw , Schmidt Eric , Rammo Richard , Bulacio Juan , Jehi Lara , Bingaman William E. 
Published: March 2022

INTRODUCTION:
Seizure outcomes after surgical resection in temporal lobe epilepsy (TLE) are historically better in the presence of a discrete MRI lesion, as the surgical hypothesis is better informed by imaging. The role of intracranial monitoring via stereotactic electroencephalography vs. proceeding directly to surgery in this patient population remains under debate.

METHODS:
SEEG usage trends were investigated for 391 consecutive patients who had temporal lobectomy performed from 2015 to 2020. Correlation with Engel scores at 1 year post-op was performed using chi-square for 259 patients in whom this data was available.

RESULTS:
Sparing of mesial structures was more common in patients who had SEEG (35% vs 20%, p < 0.01). There was a nonsignificant trend towards better outcomes in patients who did not have SEEG (63.5% Engel 1 vs 50.5%, p < 0.55). MRI abnormalities were significantly more prevalent in the cohort that underwent SEEG (92% vs. 58%, p < 0.001), and there was no significant association between the presence of MRI abnormality and outcome (p = 0.59).

CONCLUSION:
We found no statistically significant difference in seizure freedom in patients who undergo temporal lobectomy with SEEG in the presurgical workup. This likely results from SEEG being used when the surgical hypothesis is difficult to formulate, reflected by the increased prevalence of distinct imaging abnormalities in the non-SEEG cohort. Thus it seems that the use of SEEG helps close the gap in outcomes for patients with non-lesional temporal lobe epilepsy. There was no difference in outcomes associated with the decision to spare mesial structures, indicating this effect likely stems from patient selection for surgery. Our future work will look into the connection between SEEG and volumes of surgical resection.
340 Simultaneous Preservation of Language and Executive Function in the Dominant Hemisphere
Authors: Aabedi Alexander A. , Grant Lauren , Kaur Jasleen , Kakaizada Sofia , Andrews John P. , Weissman Daniel , Brang David , Hervey-Jumper Shawn L. 
Published: March 2022

INTRODUCTION:
Although awake brain mapping is the gold-standard for the preservation of neurological function in patients with tumors in eloquent regions, it is resource-intensive, costly, and exposes patients to additional perioperative risks. Therefore, the tasks used to map out the brain should be carefully selected and limited to cognitive processes that will be permanently impaired if those brain regions are violated. Impairments in language and executive function are common after tumor resection and are associated with decreased survival. However, mapping of each of those functions separately is often infeasible and antithetical to the delivery of high-value care.

METHODS:
Each participant underwent awake craniotomy with intraoperative mapping using a single lexical retrieval task. Linear mixed-effects modeling was used to assess for a return to preoperative functional levels in language and executive function at preoperative, two days postoperative, and greater than one-month postoperative intervals.

RESULTS:
Participants had lesions in regions that placed them at risk for long-term functional impairments including the perisylvian language network and anterior cingulate gyrus. In the immediate postoperative setting, participants had substantial declines in language and overall executive function performance. However, at longer (i.e., >1 month) testing intervals, performance on both domains returned to baseline levels. Longitudinal changes in picture naming performance were predictive of changes in a measure of executive function that indexes cognitive flexibility.

CONCLUSION:
In patients undergoing resection of brain tissue in the dominant hemisphere, separate mapping of language and executive functions may not be necessary so long as a task that reliably recruits both is implemented during awake brain mapping.
350 Incidence and Long-term Health Care Utilization Associated with Pseudomeningocoele Repair Following Vestibular Schwanomma Resection: A National Database Analysis
Authors: Sharma Mayur , Aljuboori Zaid , Wang Dengzhi , Ugiliweneza Beatrice , Boakye Maxwell , Williams Brian Jeremy , Andaluz Norberto O. 
Published: March 2022

INTRODUCTION:
Long-term health care utilization of patients who developed CSF leak and Pseudomeningocoele (PSM) following Vestibular Schwanomma (VS) surgery is not well defined.

METHODS:
MarketScan database were queried using the International Classification of Diseases, Ninth and Tenth Revisions and Current Procedural Terminology 4, from 2000 to 2018. We included patients 18 years of age with PSM diagnosis with at least 2 years of continuous enrollment. Outcomes analyzed were hospital admissions, outpatient services, medication refills and their associated payments.

RESULTS:
Of 1460 patients, 96.6% (n = 1411) had no PSM following surgery for VS, 2.4% (n = 35) were in s-PSM and only 0.95% (n = 14) were in ns-PSM cohorts. Patients in the s-PSM cohort incurred higher hospital readmission rate, outpatient payments compared to those in nd-PSM and ns-PSM cohorts at 6 months, 1-year and 2 –years following the following VS resection. At 1-year following VS resection, median combined payments for s-PSM cohort were $74,683 compared to $42,664 for ns-PSM and $9476 for nd-PSM cohort, p < 0.0001 Similarly, at 2-years, median combined payments median combined payments for s-PSM cohort were $83,351 compared to $63,942 for ns-PSM and $18,839 for nd-PSM cohort, p < 0.0001.

CONCLUSION:
Patients in s-PSM cohort incurred 8 times and 4.4 times the combined payments at 1- and 2-years respectively compared to nd-PSM cohort. Also, patients in ns-PSM cohort incurred 4.5 times and 3.4 times the payments compared to nd-PSM cohort.
362 What Determines the Time Needed for Initial Complete Resolution of Facial Contractions Following Microvascular Decompression for Hemifacial Spasm?
Authors: Al Menabbawy Ahmed , El Refaee Ehab , Elwy Reem , Baldauf Jörg , Schroeder Henry W. S. 
Published: March 2022

INTRODUCTION:
Hemifacial spasm (HFS) causes unilateral intermittent and involuntary contractions of facial muscles attributable to compression at the root exit zone of the facial nerve. Microvascular decompression (MVD) is the most effective treatment option for patients with primary HFS. However, the time needed for initial complete resolution of the symptoms varies between patients undergoing the MVD.

METHODS:
We performed a retrospective review of our prospectively maintained database including all HFS patients who underwent de-novo MVD with a minimum follow-up of six months. We excluded patients with a non-arterial etiology of compression. We assessed postoperative outcome clinically based on patient reported symptom severity as a percentage of preoperative symptoms severity. We performed survival analysis and Cox regression to identify the factors significantly affecting the time needed to initial resolution of the symptoms. Statistical analysis was performed using R software version 3.6.3.

RESULTS:
349 patients were included. The mean (SD) follow-up was 55 (36) months. 308 patients (88.3%) demonstrated initial postoperative recovery which occurred in 50% of the cases at a median of 5 days (95%CI 5-7) after surgery, however 93 of whom reported some recurrent symptoms during their postoperative course. AICA, AICA VA compression, or development of postoperative facial palsy independently showed a statistically significant lower hazard of no initial resolution of symptoms compared to other compression etiologies, and evident peripheral indentation of the facial nerve in contrast showed an increased hazard of no initial resolution of symptoms compared to brainstem or no indentation.

CONCLUSION:
AICA compressions, and development of postoperative facial palsy predict a more favorable outcome. Compared to central brain stem indentation of the facial nerve, peripheral indentation is associated with longer time to initial resolution of symptoms.
365 Sciatica of Non-Disc Origin
Authors: Schmidt Bradley T. , Kanarek Andrew , Blakenbaker Donna , Hanna Amgad S. 
Published: March 2022

INTRODUCTION:
Sciatica resulting from piriformis muscle compression may respond to surgical decompression of the sciatic nerve via piriformis release. The topic has been very controversial. Pre-operative evaluation with MRI is useful to identify potential changes in either the piriformis muscle or the sciatic nerve that may help confirm the diagnosis of piriformis syndrome.

METHODS:
A retrospective analysis of all patients who underwent piriformis release to decompress the sciatic nerve. All surgeries were performed using a transgluteal approach. All patients (15) had preoperative localization of the piriformis muscle via percutaneous wire placement by interventional radiology using either CT or ultrasound guidance. 30 patients, who had MRI scans of their pelvis unrelated to sciatica, served as the control cohort. We also looked for signal changes in the sciatic nerve seen on MRI, piriformis muscle thickness, and pre versus post-operative numeric rating scale (NRS) assessment.

RESULTS:
Between treatment and control cohorts, there was no difference in basic demographics (other than age). In comparing the surgical and control cohorts, we found that a significant number of patients in the surgical cohort had the sciatic nerve riding over the ischial spine. Distance between the midpoint of the sciatic nerve to the ischial spine was also significantly lower in the surgical cohort. Piriformis thickness was essentially identical between the cohorts. In comparing pre and postoperative NRS pain scores, the aggregate of surgically treated patients had a significant improvement in their pain scores by approximately 4 points. Subgroup analysis of the surgical cohort demonstrated trends toward a larger improvement in NRS when the distance between the midpoint of the sciatic nerve to the ischial spine was <9mm, BMI <25, and piriformis thickness <2cm.

CONCLUSION:
Identifying clear MRI findings related to the sciatic nerve and its trajectory through the pelvis can potentially help identify patients who will better respond to surgery.
368 Intravenous Lidocaine for Analgesia in Spine Surgery: A Meta-Analysis of Randomized Controlled Trials
Authors: Musa Arif , Haratian Aryan , Field Ryan , Farhan Saif , Bennett Collin , Rajalingam Karan , Cooke Christopher , Patel Rakesh , Aleem Ilyas , Eichler Martin , Lee Carlin , Bederman S. Samuel 
Published: March 2022

INTRODUCTION:
Spine surgeons face numerous challenges when managing postoperative pain. Although opioid-based management remains the gold standard for the treatment of postoperative pain, opioid consumption is associated with respiratory depression, sedation, pruritus, ileus, nausea, vomiting, and other complications. Lidocaine, a commonly used local anesthetic, also has documented anti-inflammatory, analgesic, and anti-emetic properties. However, its potential as an adjunctive analgesic to minimize reliance on opioid-based therapy remains controversial.

METHODS:
We conducted a meta-analysis of randomized controlled trials (RCTs) comparing adjunctive intravenous lidocaine to placebo control for pain management after spine surgery. The following databases were searched: PubMed, Clinicaltrials.gov, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Clarivate Analytics Web of Science, and World Health Organization International Clinical Trial Register Platform. Postoperative morphine equivalent consumption was compared using standardized mean difference (SMD) and 95% confidence interval (CI). Complications such as nausea, vomiting, pneumonia, delirium, and wound infection were compared using odds ratios (OR) and 95% CI. A p-value < 0.05 was considered statistically significant.

RESULTS:
A total of three RCTs were included in quantitative synthesis, comprising 235 patients. Cumulative morphine equivalent consumption was not significantly different between lidocaine and control groups (SMD = -1.69, 95% CI: -3.65 to 0.27, p = 0.09) at 48 hours postoperatively. There was no statistical significance between groups in terms of the following adverse events: nausea (OR = 1.40, 95% CI: 0.73 to 2.71, p = 0.31), vomiting (OR = 1.59, 95% CI: 0.76 to 3.34, p = 0.22), pneumonia (OR = 0.31, 95% CI: 0.76 to 3.34, p = 0.48), delirium (OR = 3.00, 95% CI: 0.12 to 76.24, p = 0.51), or surgical site infection (OR = 3.05, 95% CI: 0.12 to 76.54, p = 0.50).

CONCLUSION:
There was no significant difference between the average cumulative morphine equivalent consumption of patients in the lidocaine and control groups at 48 hours after surgery. The addition of lidocaine did not significantly increase the rates of postoperative complications such as nausea, vomiting, pneumonia, delirium, or surgical site infections.
400 Safety and Efficacy of the Off-label Use of Pipeline Embolization Device Based on the 2018 FDA Approved Indications for Intracranial Aneurysms: A Single Center Retrospective Cohort Study
Authors: Enriquez-Marulanda Alejandro , Penumaka Anirudh , Ogilvy Christopher S. , Thomas Ajith J. , Moore Justin M. 
Published: March 2022

INTRODUCTION:
The Pipeline embolization device (PED) has proven to be safe and effective for treating selected intracranial aneurysms. The versatility and the popularity of this device have driven increased interest in expanding the latest 2018 FDA-approved indications.

METHODS:
Retrospective analysis of aneurysms treated with PED at a single center from 2013-2019 was performed. Comparisons were made based on the compliance to the 2018 FDA-approved indications. Univariate comparisons and longitudinal analysis were performed.

RESULTS:
A total of 492 treated aneurysms were included, from which 65.2% were considered on-label and 34.8% off-label. Aneurysm complete and near-complete occlusion rate was non-significantly lower in the off-label group (80.9% vs 85.7%; p=0.19). Off-label treatment had higher rate of poor functional outcomes defined as modified Rankin scale > 2 (10.3% vs 3.5%; p=0.002). Although baseline pre-treatment mRS was already higher in the off-label group (10.3% vs 3.5%; p<0.001). There were no differences in retreatment, thromboembolic complications, intracranial hemorrhagic complications, and mortality rates.

CONCLUSION:
Off-label treatment with PED may be considered for select aneurysms, which are challenging to treat with other techniques (clipping, coiling, etc.). These cases have similar complete and near-complete occlusion rates compared to on-label cases. There are, however, potential higher risks of poor functional outcomes.
403 Saccular Aneurysms in the Post–Barrow Ruptured Aneurysm Trial Era
Authors: Catapano Joshua , Labib Mohamed , Srinivasan Visish M. , Nguyen Candice , Rumalla Kavelin , Rahmani Redi , Cole Tyler S. , Baranoski Jacob F. , Rutledge Caleb , Chapple Kristina , Ducruet Andrew F. , Albuquerque Felipe , Zabramski Joseph M. , Lawton Michael T. 
Published: March 2022

INTRODUCTION:
The Barrow Ruptured Aneurysm Trial (BRAT) was a single-center trial that compared endovascular coiling to microsurgical clipping in patients treated for aneurysmal subarachnoid hemorrhage (aSAH). However, because patients in the BRAT were treated more than 15 years ago, and because there have been advances since then—particularly in endovascular techniques—the relevance of the BRAT remains controversial.

METHODS:
All patients with a confirmed saccular aSAH treated at a single quaternary center from August 1, 2007, to July 31, 2019, were retrospectively reviewed. Patients were separated into two groups for analyses: microsurgery or endovascular intervention. The primary outcome analyzed for comparison was a poor neurological outcome, defined as a modified Rankin Scale (mRS) score >2. The secondary outcomes that were compared included retreatment rates for both therapies.

RESULTS:
Of the 1014 patients with aSAH during the study period, 798 (79%) were confirmed to have saccular aneurysms. Neurologic outcomes at =1-year follow-up did not differ between patients treated with microsurgery and those who received endovascular treatment (P=0.51). The number of retreatments was significantly higher among patients treated endovascularly (32/347, 9%) than among patients treated microsurgically (6/451, 1%) (P<0.001). The retreatment rate after endovascular treatment was lower in the PBRAT (9%) than in the BRAT (18%).

CONCLUSION:
Similar to results from the BRAT, results from the PBRAT era showed equivalent neurologic outcomes and increased rates of retreatment among patients undergoing endovascular embolization compared with microsurgery. However, the rate of retreatment after endovascular intervention was much lower in the PBRAT than in the BRAT.
411 Treatment Results of Arteriovenous Fistulas at the Craniocervical Junction: A Multicenter Cohort Study of 108 Patients
Authors: Endo Toshiki , Takai Keisuke , Inoue Tomoo , Seki Toshitaka 
Published: March 2022

INTRODUCTION:
No standard treatment has been established for the arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ).

METHODS:
A total of 103 consecutive patients with the CCJ AVFs were collected from 29 centers that are members of Neurospinal society of Japan. Angiographic findings and the clinical characteristics of the CCJ AVFs were evaluated.

RESULTS:
Among 103 cases, dural AVF (59 cases), radicular AVF (12 cases), epidural AVF (16 cases), and perimedullary AVF (5 cases) were included. There were 11 cases in which combinations of the pathologies occurred in one case. 51 and 7 patients presented with subarachnoid hemorrhage (SAH) and intramedullary hemorrhage, respectively. 28 cases presented with congestive myelopathy, while there were 17 asymptomatic cases. Overall, 78 cases (76%) and 19 cases (18 %) underwent primary surgical or endovascular treatments, respectively. 4 cases (4%) underwent combined treatments. 14 cases (14%) required second treatments. The rate of initial treatment failure or recurrence was 2.6% after the surgical treatments (Surgery Group), while it was 63% of the endovascular treatment group (Endovascular Group). In multivariate analysis, endovascular treatment was the independent risk factor with significantly higher odds of initial treatment failure or recurrence (odds ratio [OR], 59; 95% confidence interval [CI], 11-324). Treatments related complications occurred in 28 cases (27 %). The rates of complications were 21% in the Surgery Group. While, it was 42% in the Endovascular Group. Complications included medulla/spinal/cerebellar infarction (12 cases), the cerebrospinal fluid leak (3 cases), and postoperative hematomas (3 cases).Post-operatively, an improvement of 1 or more in modified Rankin Scale (mRS), was observed in 60% and 37% of Surgery and Endovascular Groups, respectively with a median follow-up of 23.0 months.

CONCLUSION:
Based on the largest and latest multicenter cohort, this study showed that primary microsurgery was superior to endovascular treatment to achieve complete obliteration of the CCJ AVF in a single procedure.
413 ABO Blood Type and Thromboembolic Complications After Intracerebral Hemorrhage
Authors: Ironside Natasha , Chen Ching-Jen , Connolly E. Sander , Roh David 
Published: March 2022

INTRODUCTION:
Thromboembolic complications (TECs) are preventable causes of morbidity and mortality in patients with intracerebral hemorrhage (ICH).

METHODS:
Consecutive adult ICH patients enrolled in the Intracerebral Hemorrhage Outcomes Project with available ABO blood type data were included. The primary analysis dichotomized patients by O blood type status (O versus non-O cohorts). The primary outcome was TEC, comprising pulmonary embolism, deep venous thrombosis, ischemic stroke, and myocardial infarction, during the hospital stay. Outcomes were compared between cohorts using multivariable regression and propensity score-matched analyses. A secondary analysis compared outcomes between individual non-type O (i.e., A, B, and AB) and type O blood phenotypes.

RESULTS:
Type O and non-type O cohorts comprised 269 and 244 patients, respectively. TECs were more common in the type O cohort compared to non-type O cohort (15.2% vs. 9.4%; OR = 1.728 [1.004-2.974], p = 0.048). In the propensity score-matched analysis, comprising 126 patients in each cohort, TEC rates were comparable between the two matched cohorts (13.5% vs. 11.1%; OR = 1.248 [0.586-2.654], p = 0.566). TEC rates were also comparable between individual non-type O and type O blood phenotypes in the secondary analysis. Type A blood phenotype was associated with a lower modified Rankin Scale score at 90 days in shift analysis (OR = 0.654 [0.434-0.985], p = 0.042).

CONCLUSION:
ABO blood phenotype does not appear to be associated with TECs after spontaneous ICH. Type A blood phenotype may be associated with a better 90-day functional outcomes after ICH. A multicenter, multiethnic ICH study capturing genetic and molecular patient data may help elucidate the potential role of blood phenotype in ICH pathophysiology.
416 Low Allele Frequency Somatic Variants in Sporadic Saccular “Berry” Cerebral Aneurysms
Authors: McAvoy Malia , Karasozen Yigit , Parada Carolina , Busald Tina , Osbun Joshua W. , Ruzevick Jacob J. , Emerson Samuel , Nistal Dominic A. , Tyrtova Evgeniya , Eaton Jessica C. , Swaminathan Shreya , Levitt Michael R. , Gonzalez-Cuyar Luis , Hale Christopher , Byers Peter , Kim Louis J. , Dorschner Michael , Ferreira Manuel 
Published: March 2022

INTRODUCTION:
The pathogenesis of intracranial aneurysms (IAs) is complex, with both genetic and environmental risk factors. Much effort has been devoted to identifying the molecular mechanisms of IAs to develop new therapies halting the progression of IAs.

METHODS:
Deep whole exome sequencing was performed for 11 anterior circulation, sporadic saccular IAs from 10 unrelated patients. Paired aneurysm-peripheral blood DNA samples were compared to evaluate the somatic saccular aneurysm exome alterations. Variants were validated with deep next generation sequencing methods. The genetic landscape of a validation cohort of 60 aneurysms was analyzed by targeted deep sequencing of a vascular panel of genes.

RESULTS:
Whole exome sequencing revealed somatic variants in 7 of 11 saccular aneurysms. Most coding somatic variants found were missense (68%). Somatic variants in multiple genes were common, all falling into similar allele frequencies (3-18%). Two aneurysms from one patient underwent exome sequencing with differing alterations (Acom with no alterations and MCA with 20 variants with about 8% allele frequencies). Targeted sequencing validation of these in a larger cohort revealed alterations in similar allele fractions. Saccular aneurysms harbored variants in genes falling into several functional categories including angiogenesis (PKD1), DNA repair (SFB3, DCC, MLH1), ECM (COL4A5, MMP8) and cancer genes (ERBb4 and PTCH1). Double variants, predicted to be protein/function altering were found in the following genes: DCC, ATXN1L, CCDC178, GAD2, IARS2, ERBb4, COL4A5, FAM122C, ANK2, SF3B3, ADCY7, ABCB4 and RAB11FIP1.

CONCLUSION:
Anterior circulation saccular IAs harbor somatic low allele fraction variants in coding genes predicted to alter protein function. Allele fractions occurred in a similar range within and between samples suggesting a cell-based population driving the pathogenesis of saccular IAs. Recurrent variants in genes known to be involved in IAs (PKD1 and COL4A5) and novel genes (ERBb4 and FAM122C) are new frontiers for further research.