Journal of neurosurgery
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Journal of neurosurgery · Apr 2023
Observational StudyNomogram for predicting an individual prospective hemorrhage risk in untreated brainstem cavernous malformations.
In this study, the authors aimed to create a nomogram for precisely predicting the 5-year prospective hemorrhage risk in brainstem cavernous malformations (BSCMs). ⋯ Independent predictors of the 5-year hemorrhage risk in untreated BSCMs were selected to create the first nomogram for predicting individual prospective hemorrhage. The nomogram was able to stratify patients into different risk groups and assist in clinical decision-making.
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Journal of neurosurgery · Apr 2023
Trends in utilization of standardized letters of recommendation in the 2021-2022 neurosurgery application process.
Standardized letters of recommendation (SLORs) were introduced during the 2020-2021 neurosurgery residency application cycle, but suffered from poor interrater reliability and grade inflation. Changes were made to the SLOR template and utilization patterns in response to these shortcomings. The authors examined the second year of SLOR utilization. They hypothesized that grade inflation and interrater reliability would be improved from the first iteration. They also hypothesized that increased numbers of letters by single writers would correlate with broader rating distributions. ⋯ Changes in the format and subsequent utilization patterns of SLORs have slightly decreased grade inflation; however, interrater reliability remains poor. The most wide-ranging evaluators submitted the highest number of SLORs, suggesting that future evaluation and usage of SLORs should emphasize letter-writer characteristics and numbers of SLORs written. Overall, SLORs have been well and broadly accepted with subtle improvements in the second year of utilization.
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Journal of neurosurgery · Apr 2023
Effect of embolization before stereotactic radiosurgery for brain arteriovenous malformations: a case-control study with propensity score matching.
The aim of this study was to evaluate whether endovascular embolization prior to stereotactic radiosurgery (SRS) has a negative impact on nidus obliteration for patients with arteriovenous malformations (AVMs). ⋯ Pre-SRS embolization did not affect nidus obliteration rates, cumulative hemorrhage rates, or the incidence of cyst formation or chronic encapsulated hematoma as late adverse radiation effects in patients with AVM treated with SRS.
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Journal of neurosurgery · Apr 2023
Automated detection and analysis of subdural hematomas using a machine learning algorithm.
Machine learning algorithms have shown groundbreaking results in neuroimaging. Herein, the authors evaluate the performance of a newly developed convolutional neural network (CNN) to detect and quantify the thickness, volume, and midline shift (MLS) of subdural hematoma (SDH) from noncontrast head CT (NCHCT). ⋯ The described Viz.ai SDH CNN performed exceptionally well at identifying and quantifying key features of SDHs in an independent validation imaging data set.
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Journal of neurosurgery · Apr 2023
Preoperative flow analysis of arteriovenous malformations and obliteration response after stereotactic radiosurgery.
Morphological and angioarchitectural features of cerebral arteriovenous malformations (AVMs) have been widely described and associated with outcomes; however, few studies have conducted a quantitative analysis of AVM flow. The authors examined brain AVM flow and transit time on angiograms using direct visual analysis and a computer-based method and correlated these factors with the obliteration response after Gamma Knife radiosurgery. ⋯ AVM flow analysis and categorization in terms of transit time are useful predictors of the probability of and the time to obliteration. The authors believe that a more quantitative understanding of flow can help to guide stereotactic radiosurgery treatment and set accurate outcome expectations.