bluuebunny/crossref_metadata_2025_split huggingface dataset:
107 Composition and Gender Distribution of Editorial Boards for Top Neurosurgical Journals
Authors: Kearns Kathryn , Rabinovich Emily , Shabo Leah , Shaffrey Mark E. , Jane John A. , Park Min S. 
Published: March 2022

INTRODUCTION:
Women are underrepresented in academic medicine, most notably in surgical subspecialties. Despite increasing numbers of female neurosurgery residents, female neurosurgeons are not obtaining competitive national positions at comparable rates. Serving as a journal editor is one measure of academic success.

METHODS:
This is a cross-sectional study of editorial boards for the top 10 English-language neurosurgical journals (Journal of Neurosurgery, Neurosurgery, JNS: Spine, World Neurosurgery, Neurosurgical Focus, JNS: Pediatrics, Acta Neurochirurgica, Surgical Neurology International, Neurosurgical Review, and Neurosurgical Clinics). Board members were identified from journal websites. Data was obtained from journal websites, program faculty lists, or physician online profiles. Editors with medical degrees (MD or equivalent) were included. Gender differences were compared using Student’s t-test and chi-squared analysis.

RESULTS:
722 board members were examined (female n=65; male n=650; unidentified n=7). Overall, women had fewer years in practice (p=0.002) while men were more likely to have additional degrees (p=0.009) and to have higher h-indices (p<0.0001). Within the editorial boards of Neurosurgery and Acta Neurochirurgica, men were more likely to have been in practice longer (p=0.014;p=0.023), and to have higher h-indices (p=0.003;p=0.025). Male editors for JNS: Spine and World Neurosurgery were more likely to have higher h-indices (p=0.007;p=0.018).

CONCLUSION:
Women constitute ∼8% of the editorial boards for top neurosurgical journals. While this is comparable to the amount of practicing female academic neurosurgeons, much needs to be done to achieve gender parity in competitive, high-ranking positions. The differences in years in practice and h-index suggest that this discrepancy may improve with time as more women enter practice and produce scientific literature. Efforts to recruit and retain women in neurosurgery should be pursued to rectify this discrepancy.
108 Cost-Effectiveness Analysis on Screening Females Who Smoke Cigarettes for Unruptured Intracranial Aneurysms
Authors: Salih Mira , Salem Mohamed M. , Moore Justin M. , Ogilvy Christopher S. 
Published: March 2022

INTRODUCTION:
Screening for intracranial aneurysms (IA) in asymptomatic patients is recommended for certain high-risk patients with autosomal dominant polycystic kidney and those with a family history of intracranial aneurysm. The prevalence of IAs among smokers and the female population has been studied, yet the cost-effectiveness of screening this risk group has not yet been explored.

METHODS:
A decision analytical study was performed with a Markov model to compare screening with no screening in female smokers. Input data for the model was extracted from Meta-analysis, cohort studies and multi-center studies. A single screening was performed for 30, 35, 40, 45, 50, 55, 60, 65, 70-, or 75-years old female smokers in a lifetime horizon. Costs, effects, and incremental cost-effectiveness ratios were analyzed. Probabilistic, one-way, and two-way sensitivity analyses were performed to evaluate the robustness of the Model.

RESULTS:
A single screening at any age yields extra QALYs and screening always cost more than not screening. A single screening at age 30, 35, 40, 45, 50, 55, 60, 65-, or 70-years old is cost-effective. The finding is robust in probabilistic, one- and two-way sensitivity analyses. One-way and Two-way sensitivity analyses show that the upper age limit for a single screening is 72.

CONCLUSION:
Given the current literature and our model, a single screening of female smokers at any age up to 72 years is justifiable and gains extra QALYs. Screening at a younger age brings more health benefit.
115 Minimally Invasive Versus Open Lumbar Spinal Fusion: A Matched Study Investigating Patient-Reported and Surgical Outcomes
Authors: Mooney James Henry , Michalopoulos Giorgos , Alvi Mohammed , Zeitouni David , Chan Andrew K. , Mummaneni Praveen V. , Bisson Erica F. , Haid Regis W. , Knightly John J. , Devin Clinton J. , Pennicooke Brenton H. , Asher Anthony L. , Bydon Mohamad 
Published: March 2022

INTRODUCTION:
With the expanding indications for and increasing popularity of minimally invasive spine surgery (MIS) for lumbar spinal fusion, large-scale analysis of patient outcomes after MIS approaches compared to traditional open procedures is warranted.

METHODS:
Patients undergoing MIS and open lumbar fusion were matched at a 1:2 ratio on 33 baseline variables to create two highly homogeneous groups. Primary endpoints of interest were overall satisfaction and a decrease in Oswestry Disability Index (ODI) at 3 months postoperatively. Satisfaction was defined as score 1-2 in the North American Spine Association index; minimal clinically important disease (MCID) for ODI was defined as = 30% decrease from baseline. Secondary endpoints were satisfaction and decrease in ODI at 12 months, length of stay (LOS), operative time, and incidental durotomy rate.

RESULTS:
The MIS and open groups consisted of 1,483 and 2,966 patients, respectively. MIS fusion patients had a higher odds of satisfaction compared to open surgery at 3 months (OR = 1.4, p = 0.004), while maintaining non-inferior odds of satisfaction at 12 months (OR = 1.04, p = 0.67). Lumbar stenosis, single-level fusion, predominant back pain, higher ASA grade, and absence of spondylolisthesis were associated with higher odds of satisfaction with MIS compared to open surgery. Patients in the MIS group had slightly lower ODI scores at 3 months (mean difference=1.61, p = 0.006; MCID OR = 1.14, p = 0.0495), and 12 months (mean difference=2.35, p < 0.001; MCID OR = 1.29, p < 0.001). The groups did not differ in terms of operative time and incidental durotomy rate; however, LOS was shorter for the MIS group.

CONCLUSION:
These results demonstrate that MIS fusion is associated with higher odds of satisfaction and, possibly, a greater decrease in ODI than open fusion at 3 months postoperatively while maintaining a greater ODI improvement and performing non-inferiorly to open in regards to satisfaction at 12 months.
116 OpEyes-Augmented Reality Surgical Navigation and Advanced Minimally Invasive Pedicle Screw Navigation
Authors: Parr Ryan , Felix Brent , Cvetko Steve , Gibby Wendell 
Published: March 2022

INTRODUCTION:
The spine surgery market is moving away from open dissection to minimally invasive spine surgery (MISS). Precise operative navigation is imperative for MISS to achieve its potential. Guidance systems have been available for years, but adoption is limited by laborious set-up, costs and intraoperative imaging requirements. Herein is described the use of OpEyes-Augmented Reality (Novarad, American Fork, UT) for navigation and guidance of MISS for highly accurate insertion of pedicle screws.

METHODS:
A Microsoft HoloLens 2 (Microsoft, Redmond, WA) was used as the hardware platform for OpEyes-AR software. AprilTags, printed with CT visible ink, were either adhered to the skin, anchored to the iliac crests, or a vertebra. Following CT, the radiologist identified virtual pathways for ideal placement of pedicle screws for each vertebra.The annotated studies were wirelessly uploaded to the software/visor combination by viewing an encrypted QR code assigned by the pre-op system. The studies were registered to the AprilTags captured during CT. The virtual pathways were called by voice command for each vertebra and were used to establish skin entry point, trajectory, and depth with target bullseyes. Fluoroscopy was not required for navigation. Excella MIS hardware was used for placement of the screws into the pedicles of a donor torso (Innovasis, Salt Lake City, UT).

RESULTS:
Pedicle screws were instrumented through levels L5-T9 for a total of 15 screws. There were no breaches. Many of the thoracic pedicles were narrow with little or no tolerance. Guidance and navigation were performed solely with OpEyes-AR.

CONCLUSION:
OpEyes-AR is a tether-less, holographic visor and software combination offering the potential for precise navigation of MISS percutaneous insertion of pedicle screws with a nominal OR footprint and elimination of OR imaging.
119 Impact of an Early Mobilization Protocol on the Reduction of Medical Complications After Surgery for Chronic Subdural Hematoma – GET-UP Trial Interim 1 Year Overview
Authors: Sousa Sérgio , Pinto Vasco S. , Vaz da Silva Filipe , Costa Tiago , Fernandes Armindo Picão , Rangel Rui , Calheiros Alfredo 
Published: March 2022

INTRODUCTION:
Timing for mobilization after chronic subdural hematoma (CSDH) surgery is highly heterogeneous among neurosurgical centers. No high-quality evidence addresses this question.

METHODS:
Our aim is to recruit a total of 208 patients. Patients are randomized to either an early mobilization group (EMG) where mobilization is required within the first 12 hours post-surgery; or to a bed rest group (BRG) where they remain recumbent for 48 hours after surgery. The primary outcome is medical complications after surgery and until discharge. Secondary outcomes include evaluation of the functional status at 1 year post-op, using Glasgow Outcome Scale Extended (GOS-E) and Short Form 36 Health Survey (SF-36).

RESULTS:
We present results of the interim analysis at one year post-op referring to the first 104 randomized patients. A total of 52 patients were randomized to each group. Two patients were lost to follow up at one year. No significant baseline demographic differences were observed. A good outcome was considered when patients achieved GOS-E 5 or higher. At one year we observed a tendency towards better outcome in the EMG group with 71% of the patients having a GOS E = 5 against 54% in the BRG group (p = 0.073). Mortality at 1 year demonstrated a tendency to be lower in the EMG group (21% against 30% in the BRG group, p = 0.305). When we analyze our results based on the SF-36 questionnaire, a tendency toward better performance in the EMG is apparent, especially in the physical performance (p = 0.048), mental health (p = 0.037), vitality (p = 0.043) and general health (p = 0.002) subdivisions.

CONCLUSION:
GET-UP Trial is performing in accordance with the established protocol. This interim analysis’ results validate the methodology and do not pose security concerns even after 1 year follow-up. Active recruitment is ongoing.
121 Analysis of Post-traumatic Epilepsy After Severe Traumatic Brain Injury in a Modern Series Identifies an Increasing Incidence and Novel Risk Factors
Authors: Pease Matthew , Elmer Jonathan , Nwachuku Enyinna L. , González-Martínez Jorge A. , Puccio Ava , Castellano James , Okonkwo David O. 
Published: March 2022

INTRODUCTION:
Post-traumatic epilepsy (PTE) accounts for 20% of symptomatic epilepsy with rates highest after severe Traumatic Brain Injury (TBI). PTE has not been well studied in modern cohorts and its risk factors are poorly understood.

METHODS:
We retrospectively reviewed severe TBI patients from a prospective database treated from 2002 through 2018 at a single level 1 trauma center, excluding those with alcohol withdrawal seizures, prior epilepsy, or death at discharge. Using definitions from the International League Against Epilepsy, a seizure was defined as a witnessed clinical event confirmed to be a seizure by the treating healthcare team or electroencephalography, and PTE as two or more seizures. We collected timing of seizures, follow up, demographic, clinical information, and Glasgow Outcomes Scale (GOS). Because more severe injury predisposes to both death and PTE, we developed a competing hazards model to identify independent predictors of PTE.

RESULTS:
We identified 393 patients after exclusions. The rate of early seizures within 7 days was 2.8% (11). The cumulative incidence of PTE was 11% by one year and 25% overall, with 29% of PTE patients requiring multiple anti-seizure medications.Patients with PTE had more severe injuries with higher rates of unreactive pupils, subdural hematomas, obliteration of the basal cisterns, skull fractures, Marshall CT classification, decompressive hemicraniectomies (DHC), lobectomies, and shunting, as well as increased length of stay (LOS), younger age, and intracranial infections (all p < 0.01). Our adjusted model identified age (subdistribution hazard 0.75; 95% confidence interval [95% CI]: 0.62 – 0.93]), DHC (3.3; 95% CI: 2.0-5.5), lobectomy (2.2; 95% CI: 2.6 – 4.2), and infection (1.9; 95% CI: 1.1 – 3.3) as predictors of PTE. Patients with PTE had worse functional outcomes (GOS 1-3 versus 4-5) at 6, 12, and 24 months (p < 0.03).

CONCLUSION:
The incidence of PTE after severe TBI is higher than historical cohorts suggest and continues to increase though fifteen years post-trauma. Patients with PTE have more severe injuries with worse functional outcomes.
124 Feasibility of Spinal Motor Mapping Using High-resolution Spinal Cord Stimulation Paddles in Patients with Chronic Pain
Authors: Telkes Ilknur , Hadanny Amir , DiMarzio Marisa D. , Chitnis Girish , Staudt Michael D. , Paniccioli Steven , O'Connor; Rachael Grey Katherine , Gillogly Michael , Khazen Olga , McLaughlin Bryan , Pilitsis Julie G. 
Published: March 2022

INTRODUCTION:
High-resolution spinal cord stimulation (HR-SCS) paddles, which have the ability to target both medially and laterally oriented spinal targets (dorsal columns and dorsal horns respectively), may provide improved options for treating chronic pain. The physical rigidity of existing technologies often either precludes lateral placement due to compression of nerve roots or lacks the ability to concurrently stimulate the medial targets.

METHODS:
During standard of care SCS placement, intraoperative neuromonitoring (IONM) recordings were performed with the HR-SCS paddle. Spinal motor mapping was performed at 18 muscle groups at 60 Hz/300 µs at increasing amplitudes from 0-to-10 mA. EMGs were acquired by Cadwell CascadePro IONM system and analyzed in MATLAB. For feature extraction, root-mean-square values of denoised EMGs were computed and normalized to baseline (stimulationOFF). Data from left and right sided data were not significantly different (p > 0.05) and combined for analysis.

RESULTS:
Electrophysiological signals were recorded in twelve subjects (7 women) with chronic pain. The testing was performed between T9-12 depending on the patients’ trial response. Based on overlayed images of HR-SCS paddles, all contacts were aligned with respect to anatomical midline (in one case, to electrophysiological middle). Distribution of EMGs above 50% change revealed stronger responses in adductor magnus, medial gastrocnemius (MG), and tibialis anterior (TA) when stimulation was delivered from the lateral contacts. Responses were higher in gluteus maximus when stimulation was delivered from the medial contacts. Statistical analysis showed significance difference between contacts in MG (p = 0.041) while it was marginal in TA (p = 0.072). Laterality was not observed in the abdominal muscles in either condition.

CONCLUSION:
By using our routine IONM setup and offline signal processing techniques, we showed that the HR-SCS paddle with 8-columns was able to trigger distinct motor responses at thoracic levels of T9-12 in 12 subjects in accordance with the dorsal column fibers spatial organization.
130 Development of an Integrated Risk Scale for Prediction of Shunt Placement After Neonatal Intraventricular Hemorrhage
Authors: Jin Michael C. , Parker Jonathon J. , Rodrigues Adrian , Colon Gabriela R. , Garcia Cesar A. , Mahaney Kelly B. , Grant Gerald A. , Prolo Laura M. 
Published: March 2022

INTRODUCTION:
Neonatal intraventricular hemorrhage (IVH) is a major source of mortality and morbidity in infants, particularly following premature birth. Even after the acute phase, post-hemorrhagic hydrocephalus is a long-term complication, frequently requiring permanent ventriculoperitoneal shunt placement (VPS). Currently, there are no risk classification methods integrating the constellation of clinical data to predict short- and long-term prognosis in neonatal IVH.

METHODS:
Neonates with IVH were identified from the Optum Clinformatics DataMart administrative claims database using ICD-9/10 codes. Matched maternal-childbirth characteristics were obtained. Primary endpoints were short-term (30-day) mortality and long-term VPS placement. Classification of short-term mortality risk was evaluated using five different machine learning approaches and the best-performing method was validated using a withheld validation subset. Prediction of long-term shunt risk was performed using a multivariable Cox regression model with stepwise variable selection, which was subsequently converted to an easily applied integer risk scale.

RESULTS:
A total of 5,926 neonate-maternal pairs were included. Empiric 30-day neonatal mortality risk was 10.9% across all IVH grades and highest among grade IV IVH (34.3%). Among those surviving beyond 30 days, actuarial 12-month risk of shunt placement was 5.4% across all IVH grades and 31.3% for grade IV IVH. The optimal short-term risk classifier was a random forest model achieving an AUROC of 0.882 with important predictors ranging from gestational age to diverse comorbid medical conditions. The final multivariable Cox regression model for long-term shunt risk stratification following stepwise feature selection included IVH grade, respiratory distress syndrome, disseminated intravascular coagulation, and maternal preeclampsia/eclampsia. An integer risk scale termed the Shunt Prediction After IVH in Neonates (SPAIN) scale was developed from these four features which, evaluated on withheld validation cases, demonstrated improved risk stratification compared to IVH grade alone (Harrell’s concordance index 0.869 vs 0.852).

CONCLUSION:
We developed an integrated risk classification approach to anticipate short-term mortality and long-term shunt risk. Application of such approaches may improve outcome prognostication and identification of higher risk individuals warranting careful surveillance and early intervention.
138 Neuroprotection in the Facial Nerve
Authors: Hafez Daniel , Kim Albert H. , Millbrandt Jeffrey , Sasaki Yo 
Published: March 2022

INTRODUCTION:
Facial nerve injury is disabling for patients with skull base brain tumors or head trauma. NAD+ is a key cofactor in metabolism and is an important component in axonal survival. Exogenous NAD+ prolongs axonal survival after axotomy in both in vitro and in vivo studies. Additionally, axonal survival is improved by blocking enzymes that decrease NAD+ levels (ex SARM1). Nicotinamide precursors like nicotinamide mononucleotide (NMN) have demonstrated neuroprotective benefits in aging and cellular death.

METHODS:
We developed a model of facial nerve injury by subjecting mice to 200 Hz of vibratory injury to the facial nerve distal to the stylomastoid foramen using SARM1KO and littermate controls, as well as mice implanted with intraventricular pumps containing 400 mM NMN or saline one week before facial nerve injury. EMG was performed using the NIM Nerve Monitoring System. Whisker movements were recorded and scored daily using Vibrissae observation scale. NAD+ metabolite levels were measured using liquid-chromatography/mass-spectrometry. NF200 immunofluorescence of facial nerves was performed.

RESULTS:
SARM1KO mice demonstrated robust axoprotection to vibratory injury for both 15 and 30 second durations and regained normal whisker movement in significantly less time compared to controls. Post-injury, SARM1 KO facial nerves required a lower stimulus current to elicit electrical responses in vibrissae muscles. We then used intracranial NMN delivery to test if raising NAD+ levels is axoprotective. NMN delivery increased brain NAD+ 1.5-fold. NMN significantly shortened the time to normal whisker movement, required a lower stimulus current for muscle response, and showed increased axonal integrity by NF200 staining.

CONCLUSION:
Continuous delivery of the NAD+ metabolite, NMN, allows for neuroprotective benefits in the vibratory neuropraxia nerve injury model, likely through sustained elevated NAD+ levels. These benefits are magnified through inhibition of the NADase enzyme, SARM1. This research demonstrates NMN as a neuroprotective pretreatment adjuvant in patients undergoing planned surgical invention where facial nerve injury is a possible outcome.
144 Interstitial Laser Anterior Capsulotomy for Obsessive-compulsive Disorder: Lesion Size and Tractography Correlate with Outcome
Authors: Satzer David I. , Mahavadi Anil , Lacy Maureen , Grant Jon , Warnke Peter C. 
Published: March 2022

INTRODUCTION:
Anterior capsulotomy is a well-established treatment for refractory obsessive-compulsive disorder (OCD) and has been performed with radiofrequency ablation, stereotactic radiosurgery, and focused ultrasound. MRI-guided laser interstitial thermal therapy (LITT) allows creation of larger, more demarcated lesions with the safety conferred by real-time imaging of the ablation volume.

METHODS:
Patients with severe OCD refractory to pharmacotherapy and cognitive-behavioral therapy underwent bilateral anterior capsulotomy via LITT. The primary outcome was percent reduction in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score over time. Lesion size was measured on post-ablation MRI. Disconnection of the anterior limb of the internal capsule (ALIC) was assessed via individual and normative tractography.

RESULTS:
Eighteen patients underwent laser anterior capsulotomy. Median follow-up was 6 months (range 3-51 months). Time occupied by obsessions improved immediately (median Y-BOCS item 1 score 4 to 1, P = 0.0002). Mean (± standard deviation) decrease in Y-BOCS score at last follow-up was 46 ± 32% (16 ± 11 points; P = 0.0002). Sixty-one percent of patients were responders. One patient had an asymptomatic intracerebral hemorrhage. Reduction in Y-BOCS score was positively associated with ablation volume (P = 0.006). Individual tractography demonstrated durable ALIC disconnection. Normative tractography revealed a dorsal-ventral gradient, with disconnection of orbitofrontal streamlines most strongly associated with a positive response to surgery (P < 0.0001).

CONCLUSION:
Laser anterior capsulotomy resulted in immediate, marked improvement in OCD symptom severity. Larger lesions can be created safely and permit greater disconnection of the prefrontal-subcortical pathways involved in OCD. The importance of greater disconnection is presumably related to variation in ALIC structure and the complex role of the PFC in OCD.