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Big Data in Neurosurgery: A Guideline on Data Structures, Machine Learning Models, and Ethical Considerations
No full textArtificial intelligence (AI) is reshaping neurosurgery, offering unprecedented opportunities to enhance diagnostics, personalize treatment, and predict outcomes. At the heart of this transformation is the ability to effectively harness big data (BD) within the electronic medical record. Understanding these data structures is essential for making sense of the vast volumes of information generated in modern neurosurgical practice. Equally important are the machine learning (ML) models driving these advancements. From supervised learning and convolutional neural networks to generative AI, these tools are already making a mark in areas such as brain tumor segmentation and spine surgery outcome predictions. Their versatility highlights the potential of ML to complement clinical expertise and streamline decision-making in neurosurgery. However, adopting BD and ML also brings ethical challenges that cannot be ignored. Bias in algorithms threatens to reinforce health disparities, whereas concerns about data privacy demand vigilance in handling sensitive patient information. In addition, the question of liability looms large as ML increasingly influences clinical decisions. The aim of the study was to provide a roadmap for neurosurgeons navigating the evolving intersection of BD, ML, and ethical responsibility in the AI era
Clinical Outcomes and Radiographic Results of Prone Transpsoas Lateral Lumbar Interbody Fusion: A Single-Institution Case Series
No full textBACKGROUND AND OBJECTIVES: This study assessed feasibility, radiologic parameters, and clinical outcomes in patients who underwent the prone transpsoas (PTP) approach for lateral lumbar interbody fusion. METHODS: This retrospective observational study included consecutive patients who underwent PTP performed by a single surgeon. Data were collected including age, sex, body mass index, operative levels, retraction time, complications, radiographic measurements, and visual analog scale pain scores. Statistical analyses were performed using nonparametric Wilcoxon 2-sample tests. RESULTS: A total of 106 consecutive patients (mean [SD] age, 66 [15] years; mean [SD] body mass index, 29.3 [5.0]) underwent PTP on 173 spinal levels, with a mean (SD) follow-up of 13 (8) months. Sixty of 106 (57%) patients underwent a 1-level PTP procedure (range, 1-4 levels), most commonly on L4-5. The mean (SD) retraction time was 10.4 (3.1) minutes for L1-2, 9.7 (2.8) minutes for L2-3, 9.3 (2.3) minutes for L3-4, and 9.5 (3.2) minutes for L4-5. Adverse events included incidental anterior longitudinal ligament release (3 of 173 [2%] levels) and transient ipsilateral hip flexor weakness (1 of 106 [0.9%] patients). The mean pelvic incidence was 57°. Lumbar lordosis increased from a mean of 44° to 51° ( P \u3c .001). Pelvic tilt decreased from a mean of 20° to 12° ( P \u3c .001). Pelvic incidence-lumbar lordosis mismatch decreased from a mean of 13 to 5 ( P \u3c .001). Visual analog scale pain scores improved from a mean of 6 preoperatively to 5 postoperatively ( P \u3c .001). CONCLUSION: In this single-institution patient series, the PTP approach was effective and safe for lateral lumbar fusion, with minimal complications and improved lumbar lordosis and patient-reported pain outcomes
U1-70K and U1A and tau pathogenesis in demented and non-demented individuals with Down syndrome
No full textINTRODUCTION: Splicing protein mislocalization is associated with tau pathogenesis, but its role in Down syndrome (DS) is under-investigated. METHODS: Spliceosome associations with tau and plaque pathology were examined in frontal cortex from DS with dementia (DSD+) and without dementia (DSD-) using quantitative immunoblotting and immunohistochemistry. RESULTS: U1-70K and U1A levels were downregulated, and hnRNPA2B1, 3Rtau, and 4Rtau were upregulated, whereas SRSF2 and CLK1 were unchanged in DSD+. The number of U1-70K lightly labeled cells was only greater in layer III in DSD+. U1A intensely stained nuclei decreased significantly in layer III in DSD+, whereas those lightly labeled significantly increased in layers III and V-VI in DSD+. U1 mislocalization and tangles appeared in each laminae examined in both DS groups but were significantly greater in DSD+. Mislocalized U1s that co-localized with AT8, and not TauC3, were significantly increased in DSD+. DISCUSSION: U1 splicing proteins play a key role in tau pathogenesis in individuals with DS. HIGHLIGHTS: U1 mislocalization and tangle-like profiles appeared in frontal cortex layer III and V-VI neurons in Down syndrome (DS). Frontal cortex hnRNPA2B1 nuclear morphometric values decreased in layer III in DS with dementia. Frontal cortex SRSF2 and CLK1 nuclear proteins were unchanged in DSD+ and without dementia (DSD-)
Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I-III: a propensity score matched study
No full textBACKGROUND: Arteriovenous malformations (AVMs) are uncommon cerebral lesions that can cause significant neurological complications. Surgical resection is the gold standard for treatment, but endovascular embolization and stereotactic radiosurgery (SRS) are viable alternatives. OBJECTIVE: To compare the outcomes of endovascular embolization versus SRS in the treatment of AVMs with Spetzler-Martin grades I-III. METHODS: This study combined retrospective data from 10 academic institutions in North America and Europe. Patients aged 1 to 90 years who underwent endovascular embolization or SRS for AVMs with Spetzler-Martin grades I-III between January 2010 and December 2023 were included. RESULTS: The study included 244 patients, including 84 who had endovascular embolization and 160 who had SRS. Before propensity score matching (PSM), complete obliteration at the last follow-up was achieved in 74.5% of the SRS group compared with 57.8% of the embolization group (OR=0.47; 95% CI 0.26 to 0.48; P=0.01). After propensity score matching, SRS still achieved significantly higher occlusion rates at last follow-up (78.9% vs 55.3%; OR=0.32; 95% CI 0.12 to 0.90; P=0.03).Hemorrhagic complications were higher in the embolization group than in the SRS group, although this difference did not reach statistical significance after PSM (13.2% vs 2.6%; OR=5.6; 95% CI 0.62 to 50.47; P=0.12). Similarly, re-treatment rate was higher in the embolization group (10.5% vs 5.3%; OR=2.11; 95% CI 0.36 to 12.31; P=0.40) compared with the SRS group. CONCLUSION: Our findings indicate that SRS has a significantly higher obliteration rate at last follow-up compared with endovascular embolization. Also, SRS has a higher tendency for fewer hemorrhagic complications and lower re-treatment rate. Further prospective studies are needed
Subtonsillar and vallecular triangles as gateways to dorsal brainstem and fourth ventricle lesions: descriptive and quantitative analysis of microsurgical anatomy
No full textThe subtonsillar triangle (ST) and the vallecular triangle (VT) are used for accessing brainstem lesions, particularly in the medulla. The microsurgical applications of these triangles were analyzed through descriptive and quantitative methods. Five formalin-fixed latex-injected cadaveric heads were examined to identify the ST and VT. Three additional cadaveric brains were dissected to explore the associated brainstem anatomy. Three-dimensional modeling and tractography with 7T magnetic resonance imaging allowed visualization of key fiber tracts. The longest edge of the ST was the medial edge (mean [SD], 12.9 [2.9] mm), while the longest edge of the VT was the right lateral edge (16.2 [3.8] mm). The mean surface area of the ST was 36.1 (14.4) mm² measured under full retraction to expose the lateral recess of the fourth ventricle. After full retraction, the area of the VT increased from 38.4 (30.0) mm² to 129.4 (50.9) mm² (P = 0.01). The ST allows access to the cerebellomedullary cistern, distal p3 and proximal p4 segments of the posterior inferior cerebellar artery, and ipsilateral foramen of Luschka. The VT allows access to the caudal loops and distal p3 segments of the posterior inferior cerebellar arteries and the upper rhomboid fossa. The ST and VT allow reliable access to the fourth ventricle, dorsal pons, medulla oblongata, and gracile/cuneate regions. The ST can be used during the suboccipital telovelar approach for inferior peduncular and cuneate lesions, and the VT allows access to gracile, trigonal zone, and rhomboid lesions through either the suboccipital transvermian or transventricular approach
Supracerebellar Transtentorial Approach for Resection of a Basal Ganglia Thalamic Cavernous Malformation: 2-Dimensional Operative Video
No full textThe Value of Machine Learning Models in Predicting Factors Associated with the Need for Permanent Shunting in Patients with Intracerebral Hemorrhage Requiring Emergency Cerebrospinal Fluid Diversion
No full textOBJECTIVE: To assess the efficacy of machine learning models in identifying factors associated with the need for permanent ventricular shunt placement in patients experiencing intracerebral hemorrhage (ICH) who require emergency cerebrospinal fluid (CSF) diversion. METHODS: A retrospective review was performed on patients with ICH requiring urgent CSF diversion who were admitted to our facility between July 2009 and May 2023. A binary logistic regression analysis was carried out to determine independent predictors linked to the development of shunt-dependent hydrocephalus following ICH. Five different machine learning models-random forest (RF), support vector machine (SVM), k-nearest neighbor (k-NN), logistic regression (LR), and Adaptive Boosting (AdaBoost)-were utilized to predict the need for permanent shunting in those with spontaneous ICH necessitating emergency CSF diversion. Additionally, RF techniques were applied to identify the factors affecting the need for permanent ventricular shunt placement in these patients. RESULTS: A total of 578 patients were included in the analysis. Shunt-dependent hydrocephalus occurred in 121 individuals (20.9%). In the multivariate analysis, the Graeb Score, the length of time the external ventricular drain was in place, and an elevated intracranial pressure greater than 30 mm Hg were significant predictors for the need for permanent CSF diversion (P \u3c 0.05). All predictive models showed commendable performance, with RF achieving the highest accuracy (0.921), followed by SVM (0.906), k-NN (0.889), LR (0.881), and AdaBoost (0.823). RF also excelled over the other models in terms of sensitivity and specificity, with a sensitivity of 0.912 and specificity of 0.892. The area under the curve values for RF, SVM, k-NN, LR, and AdaBoost were recorded at 0.903, 0.820, 0.804, 0.801, and 0.798, respectively. CONCLUSIONS: This research demonstrates that machine learning models can effectively predict the need for permanent CSF diversion in patients with ICH who underwent external ventricular drain placement for urgent CSF diversion, offering important prognostic insights that could facilitate early intervention and lead to potential cost reductions
Sex Differences in Long COVID.
No full textIMPORTANCE: A substantial number of individuals worldwide experience long COVID, or post-COVID condition. Other postviral and autoimmune conditions have a female predominance, but whether the same is true for long COVID, especially within different subgroups, is uncertain.
OBJECTIVE: To evaluate sex differences in the risk of developing long COVID among adults with SARS-CoV-2 infection.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER)-Adult cohort, which consists of individuals enrolled in and prospectively followed up at 83 sites in 33 US states plus Washington, DC, and Puerto Rico. Data were examined from all participants enrolled between October 29, 2021, and July 5, 2024, who had a qualifying study visit 6 months or more after their initial SARS-CoV-2 infection.
EXPOSURE: Self-reported sex (male, female) assigned at birth.
MAIN OUTCOMES AND MEASURES: Development of long COVID, measured using a self-reported symptom-based questionnaire and scoring guideline at the first study visit that occurred at least 6 months after infection. Propensity score matching was used to estimate risk ratios (RRs) and risk differences (95% CIs). The full model included demographic and clinical characteristics and social determinants of health, and the reduced model included only age, race, and ethnicity.
RESULTS: Among 12 276 participants who had experienced SARS-CoV-2 infection (8969 [73%] female; mean [SD] age at infection, 46 [15] years), female sex was associated with higher risk of long COVID in the primary full (RR, 1.31; 95% CI, 1.06-1.62) and reduced (RR, 1.44; 95% CI, 1.17-1.77) models. This finding was observed across all age groups except 18 to 39 years (RR, 1.04; 95% CI, 0.72-1.49). Female sex was associated with significantly higher overall long COVID risk when the analysis was restricted to nonpregnant participants (RR, 1.50; 95%: CI, 1.27-1.77). Among participants aged 40 to 54 years, the risk ratio was 1.42 (95% CI, 0.99-2.03) in menopausal female participants and 1.45 (95% CI, 1.15-1.83) in nonmenopausal female participants compared with male participants.
CONCLUSIONS AND RELEVANCE: In this prospective cohort study of the NIH RECOVER-Adult cohort, female sex was associated with an increased risk of long COVID compared with male sex, and this association was age, pregnancy, and menopausal status dependent. These findings highlight the need to identify biological mechanisms contributing to sex specificity to facilitate risk stratification, targeted drug development, and improved management of long COVID
hiPSC-neurons recapitulate the subtype-specific cell intrinsic nature of susceptibility to neurodegenerative disease-relevant aggregation.
No full textAlzheimer\u27s disease (AD) is characterized by the accumulation and spread of Tau intraneuronal inclusions throughout most of the telencephalon, leaving hindbrain regions like the cerebellum and spinal cord largely spared. These neuropathological observations, along with the identification of specific vulnerable sub-populations from AD brain-derived single nuclei transcriptomics, suggest that a subset of brain regions and neuronal subtypes possess a selective vulnerability to Tau pathology. Given the inability to culture neurons from patient brains, a disease-relevant in vitro model which recapitulates these features would serve as a critical tool to validate modulators of vulnerability and resilience. Using our recently established platform for inducing endogenous Tau aggregation in human induced pluripotent stem cell (hiPSC)-derived cortical excitatory neurons via application of AD brain-derived exogenous Tau aggregates, we explored whether Tau aggregates preferentially induce aggregation in specific neuronal subtypes. We compared Tau seeding in hiPSC-derived neuron subtypes representing regional identities across the forebrain, midbrain, and hindbrain. Higher susceptibility (i.e. more Tau aggregation) was consistently observed among cortical neuron subtypes, with CTIP2-positive, somatostatin (SST)-positive cortical inhibitory neurons showing the greatest aggregation levels across hiPSC lines from multiple donors. hiPSC-neurons also delineated between the disease-specific vulnerabilities of different protein aggregates, as α-synuclein preformed fibrils showed an increased propensity to induce aggregates in midbrain dopaminergic (mDA)-like neurons, mimicking Parkinson\u27s disease (PD)-specific susceptibility. Aggregate uptake and degradation rates were insufficient to explain differential susceptibility. The absence of a consistent transcriptional response following aggregate seeding further indicated that intrinsic neuronal subtype-specific properties could drive susceptibility. The present data provides evidence that hiPSC-neurons exhibit features of selective neuronal vulnerability which manifest in a cell autonomous manner, suggesting that mining intrinsic (or basal) transcriptomic signatures of more vulnerable compared to more resilient hiPSC-neurons could uncover the molecular underpinnings of differential susceptibility to protein aggregation found in a variety of neurodegenerative diseases
Biomarker changes associated with fornix deep brain stimulation in Alzheimer\u27s disease
No full textINTRODUCTION: Deep brain stimulation of the fornix (fx-DBS) is being investigated for treatment of Alzheimer\u27s disease (AD). The therapy aims at alleviating memory and cognitive circuit dysfunction. In preclinical models of AD, electrical stimulation of the memory circuit has demonstrated a possible disease-modifying potential. Here we examined changes resulting from fx-DBS in hippocampal atrophy and amyloid accumulation in AD patients with fx-DBS. METHODS: Repeated magnetic resonance imaging and positron emission tomography (PET) images acquired over the course of 12 months were used to assess changes in hippocampal volume in 36 ADvance trial patients compared to 40 matched untreated AD patients from the Alzheimer\u27s Disease Neuroimaging Initiative, and in 10 separate patients with repeated flutemetamol PET and cerebrospinal fluid (CSF) markers. RESULTS: We observed a reduction of hippocampal atrophy and amyloid beta (Aβ) PET binding, and an increase in the CSF Aβ/total-tau ratio in DBS patients. DISCUSSION: These findings highlight the potential of fornix deep brain stimulation to modify AD biomarkers and possibly progression in some patients. HIGHLIGHTS: Fornix deep brain stimulation (fx-DBS) is being investigated to treat Alzheimer\u27s disease (AD). Results show that fx-DBS modifies imaging and cerebrospinal fluid (CSF) markers. It reduces hippocampal atrophy and increases the amyloid beta/total-tau CSF ratio. These findings highlight the potential of fx-DBS to modify AD