bluuebunny/crossref_metadata_2025_split huggingface dataset:
408 Network Analysis of Neurosurgical Publication Coauthorship: Centrality Ranking of Authors and Institutions with Correlation to Clinical Activity and Industry Payments
Authors: Cole Tyler S. , Lawton Michael T. 
Published: March 2022

INTRODUCTION:
Network analysis has been applied in a number of fields to understand relationships between members of different communities and organizations.

METHODS:
All publications from January 1, 2017, to April 30, 2020, were queried from 4 neurosurgical journals: Neurosurgery, Journal of Neurosurgery, Journal of Neurosurgery: Pediatrics, and Journal of Neurosurgery: Spine. Publication type excluded editorials, letters, and reviews. Authors with at least 7 publications in these journals were included. Measures of network centrality were calculated after conversion of authorship into a nondirected graph with links weighted by frequency of coauthorship. Latent communities in the network were detected with the Walktrap algorithm.

RESULTS:
Based on 811 included authors, network topology broadly demonstrated 4 poles related to subspecialties of vascular, spine, pediatrics, and radiosurgery/tumor. Of the top 100 coauthorship links, 42% of the authors were involved in 2 large study groups. We present rankings of neurosurgical authors based on network measures of centrality and evaluate how centrality metrics correlate to individual author h-index, Medicare utilization, and payments from industry sources. We further evaluate network centrality of institutions and examine institutional connectivity to discovered communities within the network.

CONCLUSION:
While traditional metrics like h-index demonstrate long-term research involvement, network analysis can be applied to understand current relationships between academic authors and evaluate centrality within a publishing network during a given timeframe.
423 Efficacy of an Image-Based Programing Plan in Predicting the Final Stimulation Configuration and Directionality for Subthalamic Nucleus Deep Brain Stimulation
Authors: Restrepo Carlos E. , Weise Lutz , Potvin Christine , MacNeil Peggy 
Published: March 2022

INTRODUCTION:
Subthalamic nucleus stimulation (STN-DBS) is a well stablished therapy for Parkinson’s disease (PD). Initial programing of the DBS electrodes may take up to 2 hours in order to determine the contact(s) with the best and worse therapeutic response and thresholds for side effects. Furthermore novel directional electrodes have additional contacts that increase complexity and time to the selection. New image processing techniques allows reconstruction and visualisation of the DBS electrode and adjacent structures in a tridimensional space as well as modeling of the volume of tissue activation (VTA) which in turns helps to infer which contact(s) could be best for the stimulation.

METHODS:
Forty-four electrodes were evaluated; directional contacts were initially reviewed as a ring. The images were processed using two different methods 1) The spatial position and distance of each electrode contact was assessed in a normalized space with respect to the STN, motor portion of the STN (mSTN) and the corticospinal tract (CST) using the open source toolbox Lead-DBS; 2) The relation of the electrode contacts with the STN was visualized using the Boston Scientific GuideTM XT clinical software which is based on automatic anatomical segmentation. Both methods were independently used to select the best (positive) and worst (negative) stimulation contacts and then compared with the final stimulation plan.

RESULTS:
A chi-square analysis demonstrated a significant association between the IBP and the final therapeutic configuration (p<0.05). The test sensitivity was 95%-97.3%, specificity 85.7%-83.87%, positive predictive value 86.3%-87.8%, negative predictive value 94.7%-96.3%, and accuracy 90.2%-91.2% using the research and clinical methods respectively. In a subsequent analysis the selection of the directional contact(s) was investigated in 5 patients (6 electrodes) using current steering. In 89%-78% of the cases the contact(s) selected based on the IBP was part of the final configuration.

CONCLUSION:
An Imaged-based programing plan could be used as an initial guide to predict the best electrode configuration in order to reduce the programing time, this may translate in better use of hospital resources, improve the patient comfort and may avoid further adjustments in programing.
437 The Leptomeninges as a New and Critical Organ: 1st ScR of “Arachnoiditis,” With 62 Other Names for the Same Pathology
Authors: Wottrich Stephanie , Palackdharry Carol , Witiw Christopher D. , Dienes Erin , Bydon Mohamad , Steinmetz Michael P. , Traynelis Vincent C. 
Published: March 2022

INTRODUCTION:
The goal of this prospective PRISMA-based Systematic Scoping Review with modified e-Delphi [ScR] is to synthesize all available information about a reportedly iatrogenic disease typically called “arachnoiditis” [arcs]. Past literature describes a rare, iatrogenic disease of the arachnoid membrane, with no known treatment. By 2021, nothing materially new had been added to the literature. The present ScR aims to clarify the clinical view of arcs. Grey data from legal documents, government proceedings, government and manufacturer device adverse events [AE] tracking, and investigative reporting was included. Although excluded from the data charting, we were surprised by multiple articles about the biology of the subarachnoid space [SAS] and the critical role it plays in protecting and maintaining the central nervous system [CNS].

METHODS:
The entire ScR is published at https://arcsology.org/about-arcsology/scoping-systematic-review-of-arachnoiditis-official-protocol/. Data charting was standardized through an iterative process involving = 2 independent clinicians. Data synthesis was performed in R.

RESULTS:
A total of 46,646 sources were screened. Data from 887 sources are synthesized, finding 63 names used for pathology of the leptomeninges [LM]. “Arachnoiditis” is a misnomer. Leptomeningeal diseases are not rare and can cause a range of neurologic symptoms. Spinal versus brain presentations are similar, although the two categories differ substantially. Many causes were identified. In high-income countries, >50% of cases are caused by non-communicable diseases, with spinal surgery as the largest single contributor. In underdeveloped countries, communicable diseases and trauma predominate. In sum: irritants in or around the LM can trigger an inflammatory and/or fibrotic cascade within the subarachnoid space. Prognosis is variable and continuous progression does not occur in most patients.

CONCLUSION:
These results impact all health care practitioners. Consistent and correct terminology is critical going forward. The WHO-ICD11 team is currently reviewing our proposal for name and hierarchical changes. The LM meet criteria for a newly recognized organ with a unique and critical structure, function, and cellular components. Integration of in vitro and animal models will be helpful for future directions.
444 Partial Transpedicular Thoracic Discectomy With Ultrasonic Aspiration and Ultrasound Guidance for Every Thoracic Disc Herniation: A 43-Patient Case Series and Technical Note Demonstrating Safety and Efficacy
Authors: Saway Brian F. , Alshareef Mohammed A. , Lajthia Orgest , Santos Jaime M. , Cunningham Coby , Shope Chelsea , Kalhorn Stephen P. 
Published: March 2022

INTRODUCTION:
Thoracic disc herniations (TDHs) are a challenging pathology. A variety of surgical techniques have been used to achieve spinal cord decompression.

METHODS:
A retrospective review was performed of patients who underwent a thoracic discectomy through the partial transpedicular approach between January 2014 and 2020 by a single surgeon. Variables reviewed included demographics, peri-operative imaging, and functional outcome scores.

RESULTS:
43 patients (53% female) underwent 54 discectomies. The most common presenting symptoms were myelopathy (86%), motor weakness (72%), and sensory deficit (65%) with a symptom duration of 9 ± 8.86 months. 23 (42.5%) of discs were fully calcified on imaging and 18 (33.3%) were partially calcified. 33 (61.1%) were giant TDH (>40% canal compromise). Average operative time was 197 ± 77.1 minutes with an average blood loss of 238 ± 250 cc. 6 patients required ICU stays. Hospital length of stay was 4.37± 3.42 days. Of patients with follow-up MRI, 38 of 40 disc-levels (95%) demonstrated <20% residual disc. Post-operative Frankel scores (>3 months) were maintained or improved for all patients with 28 (65.1%) patients having an increase of 1 or greater on their Frankel score. 6 (14%) patients required repeat surgery, 2 of which were due to re-herniation, 2 were from adjacent level herniation and 2 others from wound problems. Patients with calcified TDHs had similar improvement in Frankel grade compared to patients without calcified TDH. Additionally, improvement in intra-operative neuromonitoring was associated with a greater improvement in Frankel grade.

CONCLUSION:
Here we demonstrate a minimally invasive, posterior approach that utilizes intraoperative ultrasound and ultrasonic aspiration with great outcomes and a complication profile similar or better than other reported case series. This posterior approach is a great complement to the spine surgeon’s arsenal for the confident tackling of all TDHs.
446 Utility of Intraoperative Motor-Evoked Potential in L4-5 Lateral Lumbar Interbody Fusion: 3-Year Prospective Study
Authors: Alan Nima , Adams Gregory , Agarwal Nitin , Hamilton David , Miele Vincent J. , Okonkwo David O. , Kanter Adam S. 
Published: March 2022

INTRODUCTION:
Nerve injury has been reported as high as 23% in direct transpsoas lateral interbody fusion (LLIF), particularly at L4-5.

METHODS:
This is a prospective, observational, cohort study of consecutive patients who underwent L4-5 LLIF in a 3-year interval from 2018 to 2020. Spontaneous and triggered EMG, somatosensory evoked potentials (SSEP) were routinely recorded. In addition MEPs from quadriceps and anterior tibialis muscle groups were also recorded bilaterally. Transcranial MEP were recorded every 5 minutes from the time of incision. A decrease in amplitude of 50% or more from baseline was considered a positive result, and the surgeon was alerted accordingly. Patient’s neurological exam and health related quality of life measures were collected preoperatively, immediately postoperatively, and at the time of follow up at 6 weeks, 3 months, 6 months, 1 and 2 years.

RESULTS:
72 patients were included. Transient quadriceps weakness occurred in 13 patients but resolved by 6 weeks. 30 patients had a significant decrease in MEP amplitude without changes in spontaneous or triggered EMG and SSEP. Two patients had persistent dorsiflexion weakness (3/5 and 1/5) at 2 year follow up. One patient had persistent quadriceps (4-/5) and dorsiflexion (4/5) weakness at 1 year follow up. One patient the surgery was aborted at the time of introduction of retractor due to 69% reduction in MEP and inability to mitigate the changes. All instances of MEP changes were noted during retraction phase. No patient with a negative MEP developed weakness postoperatively. At predetermined level of 50% decrease of amplitude, MEP was 100% sensistive and 65% specific in detecting neural injury.

CONCLUSION:
MEP monitoring provides additional value to sEMG, tEMG, and SSEP during LLIF at L4-5 to avoid injury. The value of MEP is primarily during maintenance of retraction and not during traversing the psoas muscle where EMG is most valuable.
457 Surgeon Specialty Effect on Early Outcomes of Elective Posterior/Transforaminal Lumbar Interbody Fusions: An Updated Propensity-Matched and Subgroup Analysis of 13,072 Patients
Authors: Alomari Safwan , Planchard Ryan F. , Belzberg Allan J. , Lo Sheng F. L. , Sciubba Daniel M. , Theodore Nicholas , Witham Timothy F. , Bydon Ali 
Published: March 2022

INTRODUCTION:
Comparative effectiveness research has a vital role in recent health reform and policies. Specialty training is one of these provider-side variables, and surgeons who were trained in different specialties may have different outcomes upon performing the same procedure. Posterior/transforaminal lateral interbody fusion is one of the common spinal procedures that are being performed by both neurosurgeons and orthopedic surgeons for patients with degenerative diseases.

METHODS:
Patients who underwent PLIF/TLIF between 2015-2018 were reviewed from ACS-NSQIP database. Propensity score matching and subgroup (single/multi-level) analysis were used.

RESULTS:
15,216 cases underwent single-level PLIF/TLIF, and 6,960 cases underwent multilevel PLIF/TLIF. In the single-level group, neurosurgeons performed 10,043 cases (66%) while orthopedic surgeons performed 5,173 cases (34%). In the multi-level group, neurosurgeons performed 4,315 cases (62%) while orthopedic surgeons performed 2,645 cases (38%). Patients in the neurosurgery cohort were more likely to be male, older, have higher BMI, be of white race, have an ASA class 3 or more, be a smoker, have hypertension, have diabetes mellitus and be functionally dependent. In both groups (single/multi-level PLIF/TLIF), patients in the orthopedic surgery cohort were more likely to have shorter operation time (205 vs 239 minutes/254 vs 276 minutes), longer total hospital stay (96 vs 75 hours/103 vs 85 hours), higher return to operating room rates within the same admission (4.2% vs 2.2%/4.3% vs 2.5%), be discharged to destination other than home (12.7% vs 8.8 %/18.2% vs 101.8%), be discharged after postoperative day 3 (31.8% vs 28%/43.9% vs 38.1%), higher readmission rates (6.5% vs 4.4%/7.5% vs 4.5%) and higher perioperative blood transfusion rate (6.0% vs 2.7%/14.1% vs 11.0%), (p < 0.05). Other outcome measures and mortality rates were similar among the 2 cohorts in both groups.

CONCLUSION:
There are significant differences in baseline characteristics and outcomes of PLIF/TLIF cases performed by neurosurgeons and orthopedic surgeons. These outcome measures have significant clinical and cost implications for patients, physicians, program directors, payors and hospitals.
462 Is Transfer Status Associated With Inpatient Mortality in Patients Transferred for Non-Elective Neurosurgical Diagnoses?
Authors: Khan Imad S. , Pomponio Maria , Hong Jennifer 
Published: March 2022

INTRODUCTION:
Inter-hospital transfer plays an important role in providing patients appropriate care in a timely fashion. There is a concern, however, that patients who are transferred fare worse than those who are not. While some work has been done looking at specific diagnoses, a more general overview of the impact of transfer status on neurosurgical patient outcomes is lacking.

METHODS:
We analyzed data from the Nationwide Inpatient Sample (NIS) from 2009 to 2018 to determine if the likelihood of mortality was associated with being transferred with non-elective neurosurgical diagnoses. We used multivariate regression analysis with the transfer status as our main exposure and inpatient mortality as the primary outcome. Our model controlled for patient demographics, hospital characteristics, and severity of illness.

RESULTS:
Out of a total of 2,080,460 patient weighted discharges with neurosurgical diagnoses, 387,321 (18.7%) were transferred. After controlling for patient- and hospital-related confounders, patients transferred for ventricular shunt procedure had a higher likelihood of inpatient mortality - OR 1.55, 95% CI 1.23, 2.14, p = 0.001. However, intracranial vascular disease (OR 0.72, 95% CI 0.64, 0.82, p < 0.001), craniotomy with device diagnoses (OR 0.87, 95% CI 0.81, 0.92, p < 0.001), craniotomy and intravascular procedures (OR 0.77, 95% CI 0.70, 0.84, p < 0.001), and trauma (OR 0.80, 95% CI 0.75, 0.89, p < 0.001), were all associated with a statistically significantly lower odds of inpatient mortality. The diagnosis of peripheral and cranial nerve disorders was not associated with inpatient mortality (OR 1.07, 95% CI 0.88, 1.30, p = 0.05).

CONCLUSION:
For most non-elective neurosurgical diagnoses, patients who are transferred have no difference or a lower likelihood of inpatient mortality. However, patients transferred for ventricular shunt procedures have significantly higher odds of inpatient mortality. Further work in understanding how the transfer status affects outcomes may help identify areas for improvement.
471 Prospective Comparison of CT and Digital Subtraction Angiography to Diagnose Penetrating Cerebrovascular Injuries: Preliminary Data
Authors: Meyer R. Michael , McAvoy Malia , Lim Do , Prijoles Keiko , Walker Melanie , Bonow Robert Hitchens , Kim Louis J. , Levitt Michael R. 
Published: March 2022

INTRODUCTION:
Digital subtraction angiography (DSA) is the gold standard for detecting penetrating cerebrovascular injuries, but CT angiography (CTA) is often used. Few studies compare CTA and DSA for this indication and are retrospective, which indicate sensitivity of CTA is about 70%.

METHODS:
Prospective observational cohort study of all patients with penetrating head injuries at Harborview Medical Center, excluding patients with unsalvageable injuries. CTA of the head was performed immediately after presentation, followed by 6 vessel DSA within 48 hours. Sensitivity and specificity of CTA compared to DSA were then calculated.

RESULTS:
Enrollment is ongoing. 14 patients have undergone CTA and DSA of whom 7 have cerebrovascular injury. Of these CTA missed pathology seen on DSA in 4 cases, yielding sensitivity of 43%, all cases missing dural-arteriovenous or carotid-cavernous fistulae. In one case a small pseudoaneurysm was called on CTA that was not seen on DSA, yielding specificity of 86%.

CONCLUSION:
Early findings suggest that CTA is at least as insensitive for penetrating cerebrovascular injury as suggested by retrospective studies. This insensitvity is particularly relevant in cases of traumatic fistulae. More data are needed, and enrollment of subjects is ongoing at our center and at collaborating institutions.
484 The Role of Plasma Derived Purified Exosome Product (PEP) for Improved Locomotor Recovery in Spinal Cord Injured Rats
Authors: Onyedimma Chiduziem , Moinuddin F.M. , Ghaith Abdul K. , Zamanian Cameron , Yolcu Yagiz , Bydon Mohamad 
Published: March 2022

INTRODUCTION:
Preclinical studies indicate that mesenchymal stem cell-derived secretomes exert immunomodulatory and neuroprotective effects in various spinal cord injury models. Exosomes as one of the secretomes, have been shown to successfully aid wound healing for the skin and following myocardial infarction. However, the effects of human plasma-derived purified exosomal products (PEP) on spinal cord injury (SCI) have not been explored to this date.

METHODS:
Twenty-four female rats were randomly divided into five groups. These included 2 control groups for the I.V or I.T injected PEP groups and a sham group. Groups were subject to a T9 laminectomy, followed by a moderate contusion SCI. After 24 hours, lactated ringer solution or PEP was injected through I.V or IT routes. Rats were assessed weekly for a total period of 10 weeks by an open field Basso, Beattie, and Bresnahan (BBB) motor score and a postmortem quantification of external scaring, neuronal regeneration, cavity volume, and glial scarring was carried out at the end of the follow-up period.

RESULTS:
Animals treated with I.V PEP or IT PEP had significant improvement within the first-week post-injury (1.05±1.2 vs. 2.16±3.15) and (1.08±3.5 vs. 4.5±0.083) respectively, with sustained improvement in BBB score at 10 weeks (11±1.16 vs. 13.8±1.90), (11.3±1.4 vs. 14±1.16).

CONCLUSION:
Our preliminary results suggest that I.V or IT PEP injection without immunosuppression might provide beneficial effects initially following traumatic SCI.
497 Developing Predictive Models to Anticipate Shunt Complications in 33,248 Pediatric Patients with Shunted Hydrocephalus Utilizing Machine Learning
Authors: Shahrestani Shane , Shlobin Nathan A. , Brown Nolan J. , Himstead Alexander , Ransom Seth C. , Ton Emily , Lee Darrin J. , Chiarelli Peter , Bullis Carli , Chu Jason 
Published: March 2022

INTRODUCTION:
Hydrocephalus is a common pediatric neurosurgical pathology and is typically treated with a ventricular shunt. Shunt complications are common in pediatric hydrocephalus, and ∼30% of patients experience shunt failure during the first year after shunt placement.

METHODS:
We queried the Healthcare Cost and Utilization Project (HCUP) National Readmissions Database (NRD) from 2016 to 2017 using ICD-10 codes and found 33,248 pediatric patients who underwent shunt placement. Elixhauser comorbidity index (ECI) scores, Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining criteria, and Major Diagnostic Category (MDC) classifications were obtained. To determine predictors of shunt complication, the database was divided into a training dataset (n=19,948), a validation dataset (n=6,650), and a testing dataset (n=6,650). Multivariable analysis was performed using the training dataset to identify significant independent predictors of shunt complications in the other datasets. Statistically significant variables were used to develop logistic regression models, and post-hoc receiver operating characteristic (ROC) curves were created.

RESULTS:
Average age of the 33,248 pediatric patients was 6.9±5.7 years. Variables found to be positively correlated with shunt complications included: number of diagnoses during primary admission (OR: 1.05, 95% CI: 1.04-1.07) and neurological MDCs (OR: 3.83, 95% CI: 3.33-4.42). Variables found to be negatively correlated with shunt complications included: ECI (OR: 0.82, 95%CI: 0.77-0.86), Female sex (OR: 0.87, 95%CI: 0.76-0.99), and elective admissions (OR: 0.62, 95%CI: 0.53-0.72). The ROC curve for the regression model utilizing all significant predictors of readmission in multivariate analysis demonstrated an area under the curve (AUC) of 0.733.

CONCLUSION:
Expeditious and safe treatment of pediatric hydrocephalus is of paramount importance. Our machine learning algorithm established numerous variables predictive of shunt complications in the pediatric population. Our AUC is suggestive of excellent predictive value. These risk factors may be of clinical importance when evaluating pediatric patients with hydrocephalus.