World Neurosurg
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Personalized medicine is a new paradigm of healthcare in which interventions are based on individual patient characteristics rather than on "one-size-fits-all" guidelines. As epidemiological datasets continue to burgeon in size and complexity, powerful methods such as statistical machine learning and artificial intelligence (AI) become necessary to interpret and develop prognostic models from underlying data. Through such analysis, machine learning can be used to facilitate personalized medicine via its precise predictions. ⋯ In the present report, we discuss the current strides made in incorporating AI into research on spine disease, especially traumatic spinal cord injury and degenerative spine disease. We describe studies using AI to build accurate prognostic models, extract important information from medical reports via natural language processing, and evaluate functional status in a granular manner using computer vision. Through a case illustration, we have demonstrated how these breakthroughs can facilitate an increased role for more personalized medicine and, thus, change the landscape of spine care.
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Observational Study
NEW INSIGHTS INTO EXPRESSION OF HORMONAL RECEPTORS BY MENINGIOMAS.
Meningiomas have a female predilection, which is even stronger for spinal than for intracranial meningiomas. The relationship between meningiomas and endogenous or exogenous sex hormones such as cyproterone acetate (CPA) is well documented, yet their underlying mechanism remains unknown. Clarification of the expression profile of hormonal receptors by meningiomas would help us to better understand their hormonal susceptibility. ⋯ Our study shows that intracranial meningiomas, spinal meningiomas, and meningiomas developed on CPA express specific hormonal receptor patterns. This result invites the scientific community to review the potential role of AR in the unbalanced sex ratio of meningiomas.
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The incidence of spine surgery in elderly patients is increasing. Geriatric spine surgery has 3 main concerns: osteoporosis, continuing degeneration and more deformity, and comorbidities. Measures taken regarding these concerns would improve results, and elderly patients will experience much more benefit from surgery. This study reviewed the most recent literature to improve outcomes of geriatric spine surgery. ⋯ Geriatric patients pose more concerns for spine surgery. To achieve better outcomes with fewer complications, we must concentrate more on comorbidities in elderly patients. Measures to treat osteoporosis; application of enhanced recovery after surgery protocols for patient preparation; use of less invasive surgical techniques; and good postoperative rehabilitation, pain, and psychological management would help to improve the outcomes of spine surgery in geriatric patients.
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Hyperperfusion in the posterior circulation is a rare complication after surgical revascularization for vertebrobasilar steno-occlusive diseases. We report a case of symptomatic cerebellar hyperperfusion after superficial temporal artery-superior cerebellar artery bypass for vertebrobasilar ischemia. ⋯ Serial hemodynamic study is useful for early detection of hyperperfusion. Steal phenomenon in the preoperative hemodynamic study could be one of the risk factors for postoperative hyperperfusion even in the posterior circulation.
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Cerebral venous sinus thrombosis is a rare cause of acute stroke. It may lead to hemorrhagic venous infarctions, brain swelling, or raised intracranial pressure and can be associated with significant mortality and morbidity. Low-molecular-weight heparin is the mainstay of treatment. Endovascular treatment is reserved for patients who deteriorate despite medical management. ⋯ The described technique appears to be simple, safe, and effective and results in a relatively short procedure time in achieving complete or partial recanalization of the dural sinuses in patients who deteriorate despite clinical management. Endovascular thrombectomy along with conventional medical management restores the final drainage pathway of the brain with good clinical outcome.