Abstract:
:OBJECTIVEPituitary adenomas occur in a heterogeneous patient population with diverse perioperative risk factors, endocrinopathies, and other tumor-related comorbidities. This heterogeneity makes predicting postoperative outcomes challenging when using traditional scoring systems. Modern machine learning algorithms can automatically identify the most predictive risk factors and learn complex risk-factor interactions using training data to build a robust predictive model that can generalize to new patient cohorts. The authors sought to build a predictive model using supervised machine learning to accurately predict early outcomes of pituitary adenoma surgery.METHODSA retrospective cohort of 400 consecutive pituitary adenoma patients was used. Patient variables/predictive features were limited to common patient characteristics to improve model implementation. Univariate and multivariate odds ratio analysis was performed to identify individual risk factors for common postoperative complications and to compare risk factors with model predictors. The study population was split into 300 training/validation patients and 100 testing patients to train and evaluate four machine learning models using binary classification accuracy for predicting early outcomes.RESULTSThe study included a total of 400 patients. The mean ± SD patient age was 53.9 ± 16.3 years, 59.8% of patients had nonfunctioning adenomas and 84.7% had macroadenomas, and the mean body mass index (BMI) was 32.6 ± 7.8 (58.0% obesity rate). Multivariate odds ratio analysis demonstrated that age < 40 years was associated with a 2.86 greater odds of postoperative diabetes insipidus and that nonobese patients (BMI < 30) were 2.2 times more likely to develop postoperative hyponatremia. Using broad criteria for a poor early postoperative outcome-major medical and early surgical complications, extended length of stay, emergency department admission, inpatient readmission, and death-31.0% of patients met criteria for a poor early outcome. After model training, a logistic regression model with elastic net (LR-EN) regularization best predicted early postoperative outcomes of pituitary adenoma surgery on the 100-patient testing set-sensitivity 68.0%, specificity 93.3%, overall accuracy 87.0%. The receiver operating characteristic and precision-recall curves for the LR-EN model had areas under the curve of 82.7 and 69.5, respectively. The most important predictive variables were lowest perioperative sodium, age, BMI, highest perioperative sodium, and Cushing's disease.CONCLUSIONSEarly postoperative outcomes of pituitary adenoma surgery can be predicted with 87% accuracy using a machine learning approach. These results provide insight into how predictive modeling using machine learning can be used to improve the perioperative management of pituitary adenoma patients.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Hollon TC,Parikh A,Pandian B,Tarpeh J,Orringer DA,Barkan AL,McKean EL,Sullivan SEdoi
10.3171/2018.8.FOCUS18268subject
Has Abstractpub_date
2018-11-01 00:00:00pages
E8issue
5issn
1092-0684pii
2018.8.FOCUS18268journal_volume
45pub_type
杂志文章abstract::Epidermoid cysts or tumors comprise 1% of intracranial tumors with a predilection for the cerebellopontine angle or parasellar cisterns. These tumors are derived from an ectopic ectodermal implant seeded between fusing ectodermal surfaces. This results in a benign proliferation of stratified squamous epithelium along ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2016.1.FocusVid.15466
更新日期:2016-01-01 00:00:00
abstract::Interventional neuroradiology is a less invasive modality than open neurosurgery for the treatment of a wide range of neurovascular disorders. Refinements in technique and improvements in the design of microcatheters, guide wires, and embolic materials have yielded superior clinical outcomes and provided an impetus to...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2003.15.4.7
更新日期:2003-10-15 00:00:00
abstract::Cerebral venous sinus thrombosis (CVST) is characterized by formation of widespread thrombus within the cerebral venous sinus system. CVST can cause venous hypertension, venous infarcts, hemorrhage and seizures. It is managed in most cases with systemic anticoagulation through the use of heparin to resolve the thrombu...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.V2.FOCUS14186
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.6.FOCUS15220
更新日期:2015-09-01 00:00:00
abstract:OBJECT:The purpose of this study was to elucidate the anatomy of the trigeminal nerve (cranial nerve [CN] V), Meckel cave (MC), and lateral wall of the cavernous sinus (CS). METHODS:Ten fresh cadaver heads (20 sides) and 2 middle fossa embalmed specimens were removed, decalcified, sectioned, stained, and studied micro...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/FOC.2008.25.12.E2
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.V3.FOCUS14155
更新日期:2014-09-01 00:00:00
abstract::The surgical management of intramedullary spinal cord ependymomas remains a formidable challenge amongst neurosurgeons because of the potential risk of surgical morbidity. From on an oncological perspective, complete resection-if technically feasible-should be the goal of surgery, since this can result in excellent lo...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2012.V2.FOCUS12142
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abstract:OBJECT:The management of pediatric intraventricular tumors is highly dependent on identification of the tumor type. Choroid plexus papillomas, a common intraventricular tumor in children, can be difficult to distinguish radiographically from choroid plexus carcinomas and other common pediatric central nervous system (C...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:
更新日期:2005-06-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,多中心研究
doi:10.3171/2017.7.FOCUS17351
更新日期:2017-10-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/FOC.2009.26.1.E4
更新日期:2009-01-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.3.FOCUS1850
更新日期:2018-06-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.2.FOCUS207
更新日期:2020-05-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2010.6.FOCUS10135
更新日期:2010-09-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:10.3171/2014.2.FOCUS13564
更新日期:2014-04-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/FOC/2008/24/3-4/E22
更新日期:2008-01-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.9.FOCUS20559
更新日期:2020-12-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2000.9.4.8
更新日期:2000-10-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/FOC-07/08/E1
更新日期:2007-01-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/FOC.2008.25.10.E2
更新日期:2008-10-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2019.11.FOCUS19785
更新日期:2020-02-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2002.12.4.10
更新日期:2002-04-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.4.FOCUS18120
更新日期:2018-07-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2000.8.5.2
更新日期:2000-05-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2010.1.FOCUS09253
更新日期:2010-03-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2007.22.6.4
更新日期:2007-06-15 00:00:00
abstract::Neuroimaging has expanded beyond its traditional diagnostic role and become a critical tool in the evaluation and management of stroke. The objectives of imaging include prompt accurate diagnosis, treatment triage, prognosis prediction, and secondary preventative precautions. While capitalizing on the latest treatment...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2013.10.FOCUS13396
更新日期:2014-01-01 00:00:00
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pub_type: 杂志文章
doi:10.3171/2019.2.FOCUS18723
更新日期:2019-05-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2011.2.FOCUS1164
更新日期:2011-06-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1999.6.4.13
更新日期:1999-04-15 00:00:00