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Reinforcement learning (RL), in conjunction with attack graphs and cyber terrain, are used to develop reward and state associated with determination of optimal paths for exfiltration of data in enterprise networks. This work builds on previous crown jewels (CJ) identification that focused on the target goal of computing optimal paths that adversaries may traverse toward compromising CJs or hosts within their proximity. This work inverts the previous CJ approach based on the assumption that data has been stolen and now must be quietly exfiltrated from the network. RL is utilized to support the development of a reward function based on the identification of those paths where adversaries desire reduced detection. Results demonstrate promising performance for a sizable network environment.

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Study Design. Retrospective observational study.Objective. The aim of this study was to investigate the spinal cord safety margins for C2 instrumentation. Summary of Background Data. Intraoperative spinal cord injury during C2 spine surgery is a rare, but potentially lifethreatening complication. Preoperative planning for C2 instrumentation mainly focuses on C2 pedicle bony dimensions on CT and the vertebral artery location and few studies have evaluated C2 spinal cord safety margins. Methods. We measured two distances in C2 bilaterally: C2 pedicle to dura distance (P-D), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and the dural sac, and C2 pedicle to spinal cord (P-SC), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and spinal cord. We defined the distances >4 mm as safe for instrumentation. Result. A total of 146 patients (mean age 71.2, 50.7% female) were included. The average distances were 5.5 mm for C2 left PD, 5.9 mm for C2 right P-D, 10.1 mm for C2 left P-SC, and 10.6 mm for C2 right P-SC. Twenty-eight (21.4%) patients had C2 P-D distances <4 mm and of those two (7%) patients had distances <2 mm. There were more female patients with C2 P-D distances under 4 mm compared to males. No patient had C2 P-SC distances <4 mm. Conclusion. We demonstrated that around 20% of patients had C2 P-D distance <4 mm, but no patient had C2 P-SC distance <4 mm. Since a lateral misplacement can lead to a potentially fatal vertebral artery injury, medial screw trajectory is recom-mended for C2 pedicle instrumentation with consideration of these safety margins.

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