bluuebunny/crossref_metadata_2025_split huggingface dataset:
312 Dural Injury Treatment with a Full-endoscopic Approach: A Case Report and Description of the Surgical Technique
Authors: Sandon Luiz H. , Bergamaschi João P. 
Published: March 2022

INTRODUCTION:
The incidence of dural sac injuries during lumbar decompression surgery is highly variable, ranging from 1% to 17% in the literature. When present, these lesions can be small and punctate. Repairs are unnecessary; however, more complex, larger lesions may occur, in which repairs become necessary. Conversion to open surgery and repair in the traditional manner is usually recommended.

METHODS:
A technical description showing the possibility of primary correction of dural injury via endoscopy.

RESULTS:
A 5–0 Prolene thread with two needles was used. One of the needles must be passed through the working channel of the endoscope to the injury site. After the needle passes through the two edges of the lesion, the two ends of the thread are externalized to make the sliding knot. The execution of this knot allows it to slide to the lesion site without the need to pull the two ends of the wire. Bergamaschi's technique differs from Youn's technique by performing an RHAP sliding knot (reversing half-hitch alternating post knot) instead of a simple knot. The tension must be applied equally at both ends to tighten the knot.

CONCLUSION:
Endoscopic repair of dural lesions is a challenge for spine surgeons. The Bergamaschi technique described here represents an advance method of treatment capable of allowing more surgeons to treat dural injuries without the need to convert to open surgery.
313 Sacroiliac Joint Fusion Using Robotic Navigation: Technical Note and Case Series
Authors: Wang Timothy Y. , Bergin Stephen M. , Murphy Kelly R. , Mehta Vikram , Sankey Eric W. , Abd-El-Barr Muhammad M. , Grossi Peter M. , Than Khoi Duc 
Published: March 2022

INTRODUCTION:
Degenerative sacroiliac (SI) joint disease can cause significant pain and disability. Patients undergoing SI fusion can oftentimes experience significant improvements in pain and quality of life.

METHODS:
Patients undergoing standalone SI joint fusion from July 2020 through June 2021 were retrospectively enrolled. Demographic and comorbid variables collected included age, sex, body mass index, and laterality. Recorded operative variables included operative time, estimated blood loss, and any intraoperative complications. Pain scores in the post-anesthesia care unit (PACU) were recorded using the visual analogue scale (VAS) every 30 minutes, as were total morphine equivalents for PACU administered intravenous and oral narcotic pain medications according to pain scales. Length of stay and any postoperative complications including 30-day inpatient admissions or emergency department (ED) presentations were also recorded. Intraoperative radiation exposure was also recorded.

RESULTS:
A total of 8 patients were analyzed. Average patient age was 65.6 ± 7.6 years with BMI of 28.2 ± 3.6 kg/m2. Four (50.0%) patients were female and equal numbers of left and right-sided SI joint fusions were performed. Average operative time was 56 ± 9 minutes, and average estimated blood loss was 22.5 ± 18.7cc. Average intraoperative radiation exposure was 12.7 ± 6.7 mGy and there were no intraoperative complications. Average pain scores in PACU were 5.1 ± 1.0 with average maximum pain score of 7.6 ± 1.7 and average minimum pain score of 2.0 ± 2.2. Average narcotic administration in PACU was 22.8 ± 11.1 morphine equivalents. Average length of stay was 0.4 ± 0.8 days, with 75% of patients discharged on the same day of surgery. Two patients required inpatient stay: one patient required intravenous pain medications overnight and one patient had shortness of breath without clear etiology, resolved without sequela. No patients presented back to the ED or were admitted within 30-days of surgery.

CONCLUSION:
Robot-navigated SI joint fusion is a feasible and reproducible method for addressing refractory sacroiliac joint disease. Further investigation on clinical outcomes and long-term fusion rates is needed, as are studies comparing robot-navigated SI joint fusion to more traditional techniques.
322 Neuroinflammatory Biomarkers for Traumatic Brain Injury Diagnosis and Prognosis: Results From the TRACK-TBI Pilot Study
Authors: Yue John K. , Kobeissy Firas , Yang Zhihui , Xu Haiyan , Deng Hansen , Han Kasey , Puccio Ava , Sun Xiaoying , Rabinowitz Miri , Markowitz Amy , Okonkwo David O. , Diaz-Arrastia Ramon , Manley Geoffrey T. , Wang Kevin 
Published: March 2022

INTRODUCTION:
The relationship between systemic inflammation and traumatic brain injury (TBI) is complex. Primary injury triggers release of pro- and anti-inflammatory cytokines, chemokines, and alarmins/alarmin response proteins.

METHODS:
The prospective, multicenter TRACK-TBI Pilot study was used. Subjects received head CT and blood draw within 24h of TBI. Biomarkers were extracted from plasma and included: cytokines (IL-6, IL-10, IL-15, IL-16), chemokines (monocyte chemoattractant protein 4 (MCP-4), thymus activation-regulated chemokine (TARC)), alarmin/alarmin response proteins (high mobility group box 1 (HMGB-1), serum amyloid A (SAA), c-reactive protein (CRP)), and others. Area Under the Curve (AUC) was used to evaluate marker discriminability for clinical diagnosis (TBI vs. orthopedic control (OC)/healthy control (HC)), TBI severity (GCS 3-12 vs. 13-15), radiographic injury on CT, and unfavorable vs. favorable 3- and 6-month outcome (Glasgow Outcome Scale Extended (GOSE) 1-4 vs. 5-8). Statistical significance was assessed at p<0.05.

RESULTS:
One-hundred sixty-eight TBI subjects, 28 OC, and 18 HCs were included. Markers associated with TBI clinical diagnosis were: IL-6, IL-10, IL-16, MCP-4, TARC, HMGB-1, SAA, CRP. Markers for TBI severity: IL-6, IL-10, IL-15, IL-16, TARC, HMGB-1, SAA, CRP. Markers for radiographic TBI: IL-6, IL-10, IL-15, IL-16, HMGB-1, SAA, CRP. Predictors (AUC > 0.70) for TBI vs. OC: HMGB-1 (AUC = 0.84), IL-16 (AUC = 0.78), TARC (AUC = 0.73). Predictors for TBI vs. HC: IL-6 (AUC = 0.92), IL-10 (AUC = 0.87), HMGB-1 (AUC = 0.87), IL-16 (AUC = 0.72). Predictors for radiographic TBI: SAA (AUC = 0.77), IL-6 (AUC = 0.76), CRP (AUC = 0.73). IL-15 predicted 3- and 6-month GOSE (AUC = 0.74/0.70, respectively). SAA predicted 6-month GOSE (AUC = 0.70).

CONCLUSION:
We identified a distinct profile of cytokines, chemokines and alarmin/alarmin response proteins detectable systemically within 24h of TBI. These markers may have unique importance in TBI detection, severity differentiation, and prognosis. Future research on neuroinflammatory pathways will elucidate the evolution of injury and yield potential targets for therapeutic intervention.
326 Concussion Subtype Symptomatology in Complicated Mild Traumatic Brain Injury Patients
Authors: Knott Maxon , Folz Caroline , Viel Amy , Thomas Andrea , Ngwenya Laura B. 
Published: March 2022

INTRODUCTION:
Post-concussive symptom scales (PCSS) can help discern recently defined concussion subtypes such as cognitive, ocular-motor, headache/migraine, vestibular, and anxiety/mood with concussion-associated sleep disturbance and cervical strain. However, there is limited knowledge as to the utility of using subtype symptomatology in the assessment of complicated mild traumatic brain injury (TBI) patients.

METHODS:
We included mild TBI patients who presented to a neurosurgery TBI clinic and had completed a Rivermead Post Concussion Questionnaire (RPQ). Patient demographic factors such as age, sex, mechanism of injury, and arrival GCS were extracted from the medical record. Patients were characterized into groups based on imaging findings including epidural and subdural hematomas (extra-axial), or intraparenchymal, subarachnoid, or intraventricular blood (intra-axial) or both. We excluded patients with negative head CT results. We used the RPQ itemized questions to define symptom subtypes. Differences between groups were analyzed using an ANOVA and general linear model analysis in SPSS.

RESULTS:
We included a total of 163 patients, 52 showed intra-axial bleeds, 40 showed extra-axial bleeds, and 71 exhibited both intra- and extra-axial bleeds. ANOVA results show statistically significant differences in ocular-motor (p = 0.035), headache/migraine (p = 0.010), and vestibular (p = 0.032) subtype scores between groups. Specifically, multiple comparisons revealed the extra-axial means were lower in the ocular-motor (0.947 ± 0.235 SEM vs. 2.13 ± 0.312; p = 0.011), headache/migraine (1.50 ± 0.310 vs. 2.79 ± 0.258; p=0.003), and vestibular (1.18 ± 0.226 vs. 2.09 ± 0.198; p = 0.011) subtypes. Further analysis to determine the effects of several covariates found that age contributed significantly to the associated condition of sleep disturbance (p=0.049).

CONCLUSION:
Patients with complicated mild TBI have post-injury symptoms that can be classified into concussion subtypes. Patients with extra-axial bleeds exhibited consistently better subtype scores compared to those with intra-axial bleeds. Understanding subtype symptomatology may allow for subtype directed therapy to improve symptom recovery for mild TBI patients.
341 SOncomagnetics: A Potential New Noninvasive Magnetic Stimulation Technology to Treat Glioblastoma
Authors: Baskin David S. , Sharpe Martyn , Hambarde Shashank , Helekar Santosh 
Published: March 2022

INTRODUCTION:
A new noninvasive oscillating magnetic field (OMF)-generating device called Oncomagnetic (OM) device, developed in our laboratory, disrupts mitochondrial electron transport to elevate intracellular reactive oxygen species (ROS) levels in patient derived glioblastoma (GBM) cells.

METHODS:
GBM cell death, ROS elevation and caspase 3 activation were studied by bright-field and fluorescence microscopy involving specific fluorescent probes. Device treatment of FOXN1-Nude mice with GBM xenografts was for 4 hours twice a day. Treatment of a 53-year-old male patient with recurrent GBM was done under a compassionate use protocol for 2–6 hours each weekday. Contrast-enhanced MRI scans assessed tumor size.

RESULTS:
OMF caused selective death of GBM cells, but not normal human cortical neurons and astrocytes. It altered mitochondrial oxygen consumption, increased mitochondrial and cellular ROS, and activated caspase 3. The overall survival of xenografted mice was prolonged by 6 days with treatment. A 26-day device treatment was well tolerated by the patient and decreased contrast-enhanced tumor volume by >30%. Patient’s autopsy after his death from closed head injury showed treatment effect, no tumor mass, and some evidence of active tumor.

CONCLUSION:
Noninvasive stimulation with the OM device is a potential powerful new treatment for GBM involving a novel mechanism of action.
346 Cancer-associated Fibroblasts in Glioblastoma Mouse Model Impact the Lymphoid Cells in the Tumor Microenvironment
Authors: Kim Timothy Y. , Srivastava Siddhartha , Patel Kisha K. , Pant Ayush , Lim Michael 
Published: March 2022

INTRODUCTION:
Cancer-associated fibroblasts (CAFs) have been demonstrated to play a prominent role in various solid tumors by remodeling and reprogramming the tumor microenvironment. Recently, they have been identified in glioblastoma (GBM) patients and believed to have a protumoral effect in GBM progression. Not only have CAFs been found to affect the myeloid compartment, but also the lymphoid compartment. Studies have shown that CAFs may mediate dysfunction of CD8 T-cells, decrease their cytotoxicity, and induce apoptosis.

METHODS:
6-week C57BL/6J wild-type female mice were intracranially implanted with either Gl261-luciferase (Gl261-luc) tagged cells alone or in combination with NIH/3T3 embryonic fibroblasts. Mice were monitored for survival in 4 arms (Gl261 vs Gl261 + anti-PD-1 vs Gl261 + NIH3T3 vs Gl261 + NIH3T3 + anti-PD-1) or sacrificed on post-implantation day 18 for flow cytometry analysis. Anti-PD-1 treatments occurred on post-implantation D10, 12, and 14. For flow cytometry, immune cells were isolated, were plated in a 96-well plate, and stained with antibodies for CD45, CD3, CD8, PD1, TIM3, LAG3, IFN-gamma, and TNF-alpha.

RESULTS:
The fibroblast-glioblastoma arms had significantly worse survival than non-fibroblast arms. Anti-PD-1 significantly improved survival in the fibroblast-glioblastoma arm. Fibroblast arms had statistically significant increased Cd8+ T-cell infiltration, reduced TIM-3 expression, reduced LAG3 expression, reduced IFN-gamma production in CD8+ T-cells, and trended toward significantly increased PD-1 expression.

CONCLUSION:
The addition of fibroblasts led to greater CD8+ T-cell infiltration but resulted in worse survival and an overall exhausted T-cell phenotype, as evidenced by equal or increased expression of LAG3 and PD-1. This corroborates why anti-PD-1 administration resulted in greater survival. Interestingly, TIM-3 expression was decreased in the fibroblast arms.
349 Locally Recurrent GBM Treated with Resection and Immediate Initiation of Radiation Therapy: Results from a Prospective Trial
Authors: Smith Kris , Nakaji Peter , Thomas Theresa , Pinnaduwage Dilini , Wallstrom Garrick , Brachman David 
Published: March 2022

INTRODUCTION:
Treatment for recurrent GBM remains problematic. Resection (R) alone is insufficient, and survivals achieved with systemic therapy with or without radiation therapy (RT) are typically <1 year.

METHODS:
From 2/2013-2/2018, locally recurrent GBM were treated in a single arm trial (ClinicalTrials.gov, NCT#03088579) of R plus implantation of a surgically targeted radiation therapy (STaRT) device utilizing Cs-131 in bioresorbable collagen tiles (GammaTile, GT Medical Technologies, Tempe AZ USA).

RESULTS:
28 patients (pts) were treated, 20 at first recurrence (range 1-3). Median age 58 (range 21-80), KPS 80 (60-100), female:male ratio 10:18. Median OS 10.7 mo., radiographic LC 8.8 mo., and no first failure was local. MGMT, KPS, and sex were non-predictive. Post hoc analysis disclosed after R+STaRT, 17 pts (54%) received >1 cycle of systemic (Sys) treatment (“Sys+”) and 13 pts (46%) did not (“Sys- “). Sys was given as adjuvant, salvage, or both, either alone or in combination. 15 pts received bevacizumab (BEV), 12 temozolomide (TMZ) and 8 lomustine (CCNU). Median OS (mo.) for Sys+ vs. Sys- was 15.1/6.5 (hazard ratio (HR) .38, p = .017); OS for BEV+ vs. BEV- was 16.7/4.5 (HR .38, p = .017), TMZ+ vs. TMZ- 17.5/6.7 (HR .40, p = .025) and for CCNU+ vs. CCNU- 17.5/7.9 (HR .61, p = .25), respectively. LC was 11.4 mo. for Sys+ vs. 2.1 mo. for Sys- (HR .44; p = .16). Three attributed serious AE occurred, 1 wound infection requiring surgery and 2 radiation brain effects, managed medically.

CONCLUSION:
Post hoc analysis suggests R+STaRT+Sys may have the potential to impact OS in locally recurrent GBM, possibly by allowing sufficient time for biologically slower but effective treatments to have an impact.
355 Use of Novel Telemedicine Software to Automate Cranial Nerve and Neuro-Ophthalmic Remote Testing
Authors: Mouchtouris Nikolaos , Yu Si Yuan , Karsy Michael , Sergott Robert , Moster Mark , Farrell Christopher J. , Evans James J. 
Published: March 2022

INTRODUCTION:
Despite the rapid surge in telemedicine use due to the COVID-19 pandemic, there is still a paucity of telemedicine tools for the remote assessment of patients with neurological diagnoses. Current telemedicine platforms lack the capabilities to perform thorough cranial nerve and neuro-ophthalmic testing. To address this need, we developed a novel software that patients can use to undergo cranial nerve and neuro-ophthalmic testing remotely via their own personal computer.

METHODS:
We conducted a pilot study of patients above 18 years old diagnosed with a brain tumor who receive their care at our institution. Ten patients were enrolled to undergo a comprehensive cranial nerve and neuro-ophthalmic testing using our proprietary telemedicine software. We assessed visual acuity, visual fields, extraocular movements, facial sensitivity, facial symmetry, hearing, uvula/palatal movement, shoulder elevation, tongue deviation, and speech. Their performance on the telemedicine software to physical examination by their treating physician. All patients were given a patient satisfaction survey upon completion of the telemedicine visit.

RESULTS:
Ten patients have been enrolled so far with a mean age of 47±14.3 years old (4 males, 6 females). Diagnoses included brain metastases, pituitary adenoma, craniopharyngioma and meningiomas. Visual acuity, facial sensitivity, facial symmetry, shoulder elevation, tongue deviation were consistent with physical examination findings in all six patients. Extraocular movements were consistent in 80% of patients. Assessment of the uvula was the most challenging, comparable to physical examination in only 20% of patients. Visual fields were equivalent in 80% of patients and superior than confrontation testing in 10% of patients.

CONCLUSION:
While this is a very early experience with a new telemedicine software, we demonstrate the feasibility of performing comprehensive cranial nerve and neuro-ophthalmic testing. We provide a detailed account of the challenges encountered, the patient experience and satisfaction results.
359 The Cost of Illness of an Aneurysm Rupture: A Prospective Study to Quantity the Unseen Cost of Aneurysmal Subarachnoid Hemorrhage
Authors: Mohammadi Nicki , Spica Natalia R. , Yaeger Kurt , Chada Deeksha , Smith Colton , Reynolds Alexandra , Lay Cappi C. , Mocco J. D. , Dangayach Neha , Kellner Christopher P. 
Published: March 2022

INTRODUCTION:
Subarachnoid hemorrhage (SAH) is a devastating neurological event affecting 1/10,000 adults globally with a mortality of more than 30%. SAH is financially straining for both the patient and caretaker due to its high morbidity, prolonged hospital stay, intensive treatments, and involved recovery. In this prospective study, we aim to quantify the total direct and indirect costs of SAH throughout the acute and subacute care periods.

METHODS:
Patients and their self-reported primary caregivers were prospectively followed for up to a year after the ictus hemorrhagic event, and queried monthly about expenses related to the recovery process. Additional clinical and cost information was obtained from the hospital finance department and directly from patient/caregiver follow-up interviews.

RESULTS:
Thirty-three patients were enrolled in this prospective study including 28 females (85%) and 5 males (15%) with a median (quartile range) age of 58 (47-66). Thirty-nine designated caregivers were also enrolled. The median ICU and hospital length of stay were 14 (11-19) and 19 (15-23) days, respectively. The median total cost for these patients was $135,568 ($38,082 - $644,688) and the median direct cost was $73,161 ($55,138 - $91,596) with a median expected patient payment of $114,453 ($70,772 -$204,855). The median percentage of direct costs attributed to the ICU was 40% (32-45). Patients with Medicare had smaller ranges of costs. Additionally indirect hospital costs reported were for travel related costs (hotels, ride shares, metro cards), toiletries, home modifications and medications ranging from $0 to $1000 a day.

CONCLUSION:
SAH is consistently a devastating neurological event affecting active members of society and their social networks. Its complicated course and recovery process can leave patients confined to a hospital for extended periods of time. As providers, we must investigate avenues to mitigate the costs and burdens patients and their support networks face.
373 Transependymal Cerebrospinal Fluid Flow is Etiology and Region Specific
Authors: Yang Peter H. , Almgren-Bell Alison , Dupepe Esther , Strahle Jennifer 
Published: March 2022

INTRODUCTION:
Transependymal movement of cerebrospinal fluid (CSF) is a recognized imaging finding in the setting of hydrocephalus. However it is not well known which ependymal regions display transependymal flow (TEF) and which etiologies of CSF disturbances are associated with TEF. Furthermore, the association of specific TEF patterns with underlying pathology is not known.

METHODS:
We performed a cross-sectional study of 219 pediatric patients at St. Louis Children’s Hospital between 2008 and 2019 who were found to have TEF on imaging with images available for direct review. TEF pattern, degree, location, underlying pathology and other radiographic and clinical features pertaining to CSF autoregulation and intracranial pressure were noted.

RESULTS:
Average age of the cohort was 8.2 years and 45.4% were female. TEF was most commonly seen in the setting of an obstructive tumor (70.8%) and rarely in the setting of myelomeningocele (1.8%). TEF was most frequently found in the anterior aspect of the frontal horns and posterior aspect of the occipital horns of the lateral ventricles (typical TEF pattern) and this pattern was seen in 69.4%. TEF less frequently occurred across the ependyma of the third ventricle (37.4%). TEF extension to the splenium of the corpus callosum was more commonly seen in those with medulloblastoma compared to patients with pilocytic astrocytoma (P = .0149). Patients who required temporary, but not ultimately permanent, CSF diversion had a larger degree of TEF, presence of papilledema, a typical TEF pattern, and higher opening pressure. Conversely, patients who ultimately required permanent CSF diversion had a smaller degree of TEF, lack of papilledema, an atypical TEF pattern, and a lower opening pressure.

CONCLUSION:
TEF is commonly confined to the lateral ventricles (anterior aspect of the frontal horns and posterior aspect of the occipital horns) and is etiology specific. Atypical TEF patterns are associated with need for permanent CSF diversion. Finally, tumor pathology may dictate variations in TEF, suggesting a possible tumor-CSF-ependymal interaction distant from the tumor.