Neurosurgery practice最新文献

{"title":"Novel Delivery of Cryoablation Through Transoral Surgical Approach for Atypical Presentation of Osteoid Osteoma of the C1 Lateral Mass: Technical Case Illustration.","authors":"Anand A Dharia, Adip G Bhargav, Christian B Kaufman, Douglas C Rivard, Paul A Grabb","doi":"10.1227/neuprac.0000000000000094","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000094","url":null,"abstract":"<p><strong>Background and importance: </strong>Neurosurgical literature rarely explores cases of osteoid osteomas of the atlas. Traditionally, neurosurgeons performed en bloc surgical resection for refractory osteoid osteomas in the subaxial and lumbar spine, but minimally invasive ablation therapies have gained favor. Complete lesioning of the nidus, either by surgical or minimally invasive therapies, produces curative results with recurrence only developing after partial lesioning.</p><p><strong>Clinical presentation: </strong>We discuss the case of a 16-year-old adolescent boy who presented with neck and occipital pain refractory to multimodal pain management. Prolonged workup demonstrated a subtle radiographic lesion of the left C1 lateral mass. Interventional radiologists attempted a posterior approach percutaneous computed tomography-guided radiofrequency ablation but aborted due to proximity of the vertebral artery. Surgeons then pursued an open transoral approach to provide a corridor for cyclical cryoablation therapy, which proceeded without complication. The patient was discharged on postoperative day one with remission of occipital pain at the 10-month follow-up. No clinical or radiographic evidence of instability appeared on postoperative cervical films.</p><p><strong>Conclusion: </strong>No reports exist in the literature of an osteoid osteoma of C1 treated by an open anterior approach and with cryoablation. The transoral approach is a safe, effective method to access ventral pathologies of C1. The transoral approach may minimize blood loss and reduce the risk of craniocervical instability, allowing for preserved cervical mobility and improved patient outcomes. Surgeons may especially consider cryoablation when the nidus is within proximity to critical neural structures.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00094"},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolution of Pediatric Spine Surgery: A Bibliometric Analysis of Publications From 1902 to 2023.","authors":"Jamshaid M Mir, David B Kurland, Alexander T M Cheung, Albert Liu, Nathan A Shlobin, Daniel Alber, Sumedha Rai, Vasvi Jain, Juan C Rodriguez-Olaverri, Richard C E Anderson, Darryl Lau, Douglas Kondziolka, Eric K Oermann","doi":"10.1227/neuprac.0000000000000092","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000092","url":null,"abstract":"<p><strong>Background and objectives: </strong>Pediatric spine surgery has evolved considerably over the past century. No previous study conducted a bibliometric analysis of the corpus of pediatric spine surgery. We used big data and advanced bibliometric analyses to evaluate trends in the progression of pediatric spine surgery as a distinct field since the beginning of the 20th century.</p><p><strong>Methods: </strong>A Web of Science query was designed to capture the representative corpus of pediatric spine literature. Statistical and bibliometric analyses were performed using various Python packages and the Bibliometrix R package.</p><p><strong>Results: </strong>The collection, published from 1902 to 2023, comprised a total of 11 861 articles from 61 journals and 32 715 unique authors. The overall growth rate annually for publications was 5.08%. An upsurge in publications was seen in the 1980s, after the advent of specialty and subspecialty journals. Illustratively, over 90% of all articles pertaining to pediatric spine surgery were published in the past 3 decades. International and domestic collaboration also increased exponentially over this time period. Reference publication year spectroscopy allowed us to identify 75 articles that comprise the historical roots of modern pediatric spine surgery. There was a recent lexical evolution of topics and terms toward alignment, outcomes, and patient-centric terms. Coauthorship among under-represented groups increased since 1990, but remains low, with disparities persisting across journals.</p><p><strong>Conclusion: </strong>This comprehensive bibliometric analysis on the corpus of pediatric spine surgery offers insight into the evolving landscape of research, authorship, and publication trends over the past century. Advancements in the understanding of the natural history and technology have led the field to become increasingly outcomes focused, all of which have been fueled by pioneering authors. While diversity among authors improves, under-representation of various groups continues to persist, indicating a critical role for further outreach and promotion.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00092"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in the Treatment of Pediatric Hydrocephalus Since 2014: Understanding the Role of the 2014 Hydrocephalus Guidelines.","authors":"Thomas Larrew, Corinne Corrigan, David F Bauer","doi":"10.1227/neuprac.0000000000000088","DOIUrl":"10.1227/neuprac.0000000000000088","url":null,"abstract":"<p><strong>Background and objectives: </strong>The management of hydrocephalus has significantly changed over the past decade. Endoscopic third ventriculostomy has become more prevalent, and shunt surgery has become more protocolized through research efforts by the Hydrocephalus Clinical Research Network. In 2014, the Pediatric Hydrocephalus Guidelines were first published, providing a cohesive source for clinical guidance. We planned to investigate national trends in the management of pediatric hydrocephalus after the publication of the 2014 Pediatric Hydrocephalus Guidelines as guidelines act as a compilation of historic and recent literature in a scientific field.</p><p><strong>Methods: </strong>A multipronged approach was used to evaluate changes in the treatment of pediatric hydrocephalus since 2014. First, we queried the Pediatric Health Information System between 2013 and 2018 to identify national trends in shunt procedures for hydrocephalus. To assess the recommendation in the guidelines to use antibiotic-impregnated catheters (AICs) in shunts, national sales records of AICs were obtained from 2 large neurosurgical device companies.</p><p><strong>Results: </strong>A total of 11,179 shunt procedures were performed within the Pediatric Health Information System database in the study period. In the preguideline publication period (2013-2014), there was a shunt revision-to-placement ratio of 1.63 while in the postguideline publication period (2015-2018), there was a ratio of 0.84 (<i>P</i> < .0001). National sales data revealed that antibiotic-impregnated drain sales increased from 2% to 77% since publication.</p><p><strong>Conclusion: </strong>Findings from this investigation suggest progress in pediatric hydrocephalus management since 2014. The shunt revision-to-placement ratio improved, and the use of AICs increased over this period. Improved outcomes are likely associative findings rather than causative with the guidelines representing a culmination of widespread changes in hydrocephalus care such as increased use of endoscopic third ventriculostomies, protocolized care, and image-guided shunt placement. Further research into the impact of clinical practice guidelines is needed to better understand the impact of this tool on surgeons and patient care.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 2","pages":"e00088"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Global Technology Gap in Neurosurgery: Disparities in Access to Advanced Tools for Brain Tumor Resection.","authors":"Jose E Valerio, Felipe Ramirez-Velandia, Maria Paula Fernandez-Gomez, Noe S Rea, Andres M Alvarez-Pinzon","doi":"10.1227/neuprac.0000000000000090","DOIUrl":"10.1227/neuprac.0000000000000090","url":null,"abstract":"<p><strong>Background and objectives: </strong>The advent of advanced technologies has brought unprecedented precision and efficacy to neurosurgical procedures for brain tumor resection. Despite the remarkable progress, disparities in technology access across different nations persist, creating significant challenges in providing equitable neurosurgical care. The purpose of the following work was to comprehensively analyze the existing disparities in access to innovative neurosurgical technologies and the impact of such disparities on patient outcomes and research. We seek to shed light on the extent of the problem, the underlying causes, and propose strategies for mitigating these disparities.</p><p><strong>Methods: </strong>A systematic review of published articles, including clinical studies, reports, and healthcare infrastructure assessments, was conducted to gather data on the availability and utilization of advanced neurosurgical technologies in various countries.</p><p><strong>Results: </strong>Disparities in technology access in neurosurgery are evident, with high-income countries benefiting from widespread implementation, while low- and middle-income countries face significant challenges in technology adoption. These disparities contribute to variations in surgical outcomes and patient experiences. The root causes of these disparities encompass financial constraints, inadequate infrastructure, and insufficient training and expertise.</p><p><strong>Conclusion: </strong>Disparities in access to advanced neurosurgical technology remain a critical concern in global neurosurgery. Bridging this gap is essential to ensure that all patients, regardless of their geographic location, can benefit from the advancements in neurosurgical care. A concerted effort involving governments, healthcare institutions, and the international community is required to achieve this goal, advancing the quality of care for patients with brain tumors worldwide.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 2","pages":"e00090"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Hybrid Approach for the Treatment of a Pure Arterial Malformation Located at an Accessory Middle Cerebral Artery. Cerebral Revascularization Followed by Endovascular Occlusion Using nBCA: Case Report.","authors":"Pablo Albiña-Palmarola, Peter Kurucz, Ali Khanafer, Kamran Hajiyev, Hansjörg Bäzner, Hans Henkes","doi":"10.1227/neuprac.0000000000000089","DOIUrl":"10.1227/neuprac.0000000000000089","url":null,"abstract":"<p><strong>Background and importance: </strong>Pure arterial malformations (PAMs) are rare vascular lesions with unknown natural history. Described in 2013 and initially considered benign, recent evidence of ruptured cases and progressive angioarchitectural changes may support the need for interventional treatment for selected patients. We present the first case of an accessory middle cerebral artery PAM successfully treated using a hybrid approach, including microsurgical revascularization and endovascular occlusion using Glubran2/Lipiodol.</p><p><strong>Clinical presentation: </strong>A 58-year-old woman with a history of spontaneous basal ganglia hemorrhage 2 years before presented to our clinic with a dilated, multilobulated, and overlapping lesion located at a dominant left accessory middle cerebral artery, compatible with the diagnostic criteria of a PAM. The lesion was near the previous bleeding site, and since perforating and cortical vessels arose from its distal lobule, a safeguarding superficial temporal artery-MCA bypass was considered necessary before the successful endovascular embolization of the malformation using nBCA (Glubran2/Lipiodol).</p><p><strong>Conclusion: </strong>PAMs can be associated with intracranial bleeding; thus, active treatment is warranted for selected patients. A hybrid microsurgical-endovascular approach is feasible and can be considered the optimal treatment for specific complex anatomies.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 2","pages":"e00089"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study Protocol for a Randomized Controlled Clinical Trial on the Outcome of Surgical Versus Primary Nonsurgical Treatment of Traumatic Thoracolumbar Spine Burst Fractures in Patients Without Neurological Symptoms-A34RCT.","authors":"Sonja Häckel, Martin N Stienen, Benjamin Martens, Valentin Neuhaus, Christoph E Albers","doi":"10.1227/neuprac.0000000000000091","DOIUrl":"10.1227/neuprac.0000000000000091","url":null,"abstract":"<p><strong>Background and objectives: </strong>There are still major global differences in the treatment of acute traumatic thoracolumbar burst fractures in patients without neurological deficits and without posterior column injury. Treatment strategies range from conservative treatment with orthosis or early functional mobilization to various surgical stabilization techniques. The study's objectives are to evaluate the clinical (Oswestry Disability Index [ODI]) and radiographical outcomes (restoration and maintenance of spinal alignment; injury of the affected intervertebral disk) and determine the prevalence of complications until 24 months of follow-up.</p><p><strong>Methods: </strong>The study is designed as a randomized, controlled, noninferiority clinical trial. All patients with a thoracolumbar burst fracture (<i>Arbeitsgemeinschaft für Osteosynthesefragen</i> spine type A3 or A4) age 18 to 70 years without neurological deficit and without posterior ligament injury can be enrolled. We will randomly assign 52 patients for either surgical or nonsurgical treatment. The surgical group will receive combined anterior-posterior (360°) spinal stabilization therapy. Participants in the nonsurgical group will be treated with a 3-point hyperextension orthosis for 6 weeks. The primary outcome is the difference in ODI at 2 years after injury.</p><p><strong>Expected outcomes: </strong>We expect to find that conservative treatment of burst fractures in the thoracolumbar spine will be noninferior to the surgical treatment.</p><p><strong>Discussion: </strong>This study will provide high-quality data comparing a modern surgical treatment regime with a standardized conservative treatment in patients with thoracolumbar burst fractures.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 2","pages":"e00091"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversal of Middle Cerebral Artery Stenosis by Minimally Invasive Intracerebral Hematoma Evacuation.","authors":"Yigit Can Senol, Mona Asghariahmadabad, Alexander Haddad, Wade S Smith, Luis E Savastano","doi":"10.1227/neuprac.0000000000000087","DOIUrl":"10.1227/neuprac.0000000000000087","url":null,"abstract":"<p><strong>Background and importance: </strong>Acute intracerebral hematomas are known to induce significant mass effects within the brain, leading to critical complications such as cerebral midline shift, herniation, and increased intracranial pressure. The timing and efficacy of intracerebral hematoma evacuation remain subjects of ongoing debate in current literature.</p><p><strong>Clinical presentation: </strong>In our case report, we present a 74-year-old female patient diagnosed with basal ganglia hematoma. The resultant mass effect from the intracerebral hematoma led to middle cerebral artery (MCA) stenosis. Notably, early-stage minimally invasive hematoma evacuation was pivotal in facilitating successful revascularization of the MCA.</p><p><strong>Conclusion: </strong>Our case underscores the significance of prompt identification and management of MCA stenosis arising from intracerebral hematoma. Early intervention through minimally invasive hematoma evacuation proved instrumental in achieving successful MCA revascularization. These findings emphasize the critical role of timely interventions in mitigating potential complications associated with intracerebral hematoma.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 2","pages":"e00087"},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Interhemispheric Dural Inversion Technique for Indirect Parafalcine Cerebral Revascularization: Case Report.","authors":"Nadia A Atai, Vincent N Nguyen, Alexandra Kammen, Sarah Sternbach, Robert C Rennert, Jonathan J Russin","doi":"10.1227/neuprac.0000000000000085","DOIUrl":"10.1227/neuprac.0000000000000085","url":null,"abstract":"<p><strong>Background and importance: </strong>Variety of revascularization strategies have been deployed to treat the deterioration of cerebral blood flow. Blood flow restoration can be achieved by direct or indirect procedures. The indirect reconstructive procedure to augment blood flow involves encephalomyosynangiosis, encephaloduroarteriosynangiosis, or encephalodurosynangiosis, and has been used effectively in ischemic Moyamoya disease. However, the preferred procedure must be evaluated on a case-by-case basis and remains controversial in other cerebral arterial diseases. Here, we report the \"interhemispheric dural inversion (IDI)\" as a novel technique for indirect parafalcine cortical revascularization.</p><p><strong>Clinical presentation: </strong>A 54-year-old white man with a complex history of neck radiation secondary to childhood Hodgkin's lymphoma presented with focal perfusion deficit in the right mesial occipital lobe near the primary visual cortex. A large c-shaped dural flap with a paramedian base is harvested and, after an interhemispheric dissection, placed in contact with the ischemic parafalcine cortical tissue (IDI).</p><p><strong>Conclusion: </strong>The IDI was used successfully for indirect revascularization of a focal right paramedian occipital lobe deficit in a 54-year-old man with complex cerebro-occlusive disease from childhood radiation and multiple previous bypass surgeries. The IDI is a simple approach for targeted indirect parafalcine cortical revascularization to facilitate an increased blood supply and prompt new vessels to sprout from preexisting dural arteries. It can be used as a standalone technique or combined with other revascularization strategies, as warranted.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 2","pages":"e00085"},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Delta T1 maps for quantitative and objective assessment of extent of resection and survival prediction in glioblastoma.","authors":"Brandon R Laing, Melissa A Prah, Benjamin J Best, Max O Krucoff, Wade M Mueller, Kathleen M Schmainda","doi":"10.1227/neuprac.0000000000000077","DOIUrl":"10.1227/neuprac.0000000000000077","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gross-total resection (GTR) and low residual tumor volume (RTV) have been associated with increased survival in glioblastoma. Largely due to the subjectivity involved, the determination of GTR and RTV remains difficult in the postoperative setting. In response, the objective of this study is to evaluate the clinical efficacy of an easy-to-use MRI metric, called delta T1 (dT1), to quantify extent of resection (EOR) and RTV, in comparison to radiologist impression, to predict overall survival (OS) in glioblastoma patients.</p><p><strong>Methods: </strong>59 patients who underwent resection of glioblastoma were retrospectively identified. Delta T1 (dT1) images, automatically created from the difference between calibrated post- and pre-contrast T1-weighted images, were used to quantify EOR and RTV. Kaplan-Meier survival estimates were determined for EOR categories, an RTV cutoff of 5cm³ and radiologist interpretation of EOR. Multivariate Cox proportional hazard regression analysis was used to evaluate RTV and EOR along with effects related to sex, KPS, MGMT, and age on OS.</p><p><strong>Results: </strong>Kaplan-Meier analysis revealed a statistically significant difference in median OS for a dT1-determined RTV cutoff of 5 cm³ (P=.0024, HR=2.18 (1.232-3.856)), but not for radiological impression (P=0.666) or dT1-determined EOR (P=0.0803), which was limited to a comparison between partial and subtotal resections. Furthermore, when covariates were accounted for in multivariate Cox regression, significant differences in OS were retained for dT1-determined RTV. Additionally, a significantly strong yet short-term effect of MGMT methylation status on OS was revealed for each RTV and EOR model.</p><p><strong>Conclusion: </strong>The utility of dT1 maps to quantify EOR and RTV in glioblastoma and predict survival, suggests an emerging role for dT1s with relevance for intraoperative MRI, neuro-navigation and postoperative disease surveillance.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11198967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-Driven Prognostication in Traumatic Subdural Hematoma: Development of a Predictive Web Application.","authors":"Mert Karabacak, Konstantinos Margetis","doi":"10.1227/neuprac.0000000000000079","DOIUrl":"10.1227/neuprac.0000000000000079","url":null,"abstract":"<p><strong>Background and objectives: </strong>Our focus was on creating an array of machine learning (ML) models to predict unfavorable in-hospital outcomes after acute traumatic subdural hematoma (atSDH). Our subsequent aim was to deploy these models in an accessible web application, showcasing their practical value.</p><p><strong>Methods: </strong>Data from the American College of Surgeons Trauma Quality Program database were used to identify patients with atSDH. In-hospital mortality was the primary outcome of interest. Secondary outcomes were (1) nonhome discharges, (2) prolonged length of stay (LOS), (3) prolonged length of stay in the intensive care unit (ICU-LOS), and (4) major complications. Feature selection was performed with least absolute shrinkage and selection operator algorithm. Five ML algorithms, including TabPFN, TabNET, XGBoost, LightGBM, and Random Forest, were used along with the Optuna optimization library for hyperparameter tuning.</p><p><strong>Results: </strong>There were 104 055 patients included in the analysis for the outcome mortality, 82 988 for the outcome nonhome discharges, 104 207 for the outcome prolonged LOS, 62 543 for the outcome prolonged ICU-LOS, and 100 241 for the outcome major complications. The models with the highest area under receiver operating characteristic curve (AUROC) values included TabPFN for mortality and major complications, and LightGBM for nonhome discharges, prolonged LOS, and ICU-LOS. The TabPFN model for the primary outcome of our study, in-hospital mortality, showed an AUROC of 0.934. The models with the highest AUROC values were integrated into an application to predict the outcomes of interest.</p><p><strong>Conclusion: </strong>Our findings show that ML tools aid in predicting various outcomes for patients with atSDH. We developed a web application that has the potential to integrate the developed models into clinical practice.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00079"},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}