Automated Preoperative and Postoperative Volume Estimates Risk of Retreatment in Chronic Subdural Hematoma: A Retrospective, Multicenter Study.

Autor:	Vargas J; Division of Neurosurgery, PRISMA Health, Greenville , South Carolina , USA., Pease M; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA., Snyder MH; Department of Neurosurgery, Tufts Medical Center, Boston , Massachusetts , USA., Blalock J; University of South Carolina School of Medicine Greenville, Greenville , South Carolina , USA., Wu S; Department of Neurosurgery, UPMC Healthcare System, Pittsburgh , Pennsylvania , USA., Nwachuku E; Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA., Mittal A; Department of Neurosurgery, University of Pittsburgh Medical Center Medical School, Pittsburgh , Pennsylvania , USA., Okonkwo DO; Department of Neurosurgery, UPMC Healthcare System, Pittsburgh , Pennsylvania , USA., Kellogg RT; Department of Neurosurgery, University of Virginia, Charlottesville , Virginia , USA.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2024 Feb 01; Vol. 94 (2), pp. 317-324. Date of Electronic Publication: 2023 Sep 25.
DOI:	10.1227/neu.0000000000002667
Abstrakt:	Background and Objectives: Several neurosurgical pathologies, ranging from glioblastoma to hemorrhagic stroke, use volume thresholds to guide treatment decisions. For chronic subdural hematoma (cSDH), with a risk of retreatment of 10%-30%, the relationship between preoperative and postoperative cSDH volume and retreatment is not well understood. We investigated the potential link between preoperative and postoperative cSDH volumes and retreatment. Methods: We performed a retrospective chart review of patients operated for unilateral cSDH from 4 level 1 trauma centers, February 2009-August 2021. We used a 3-dimensional deep learning, automated segmentation pipeline to calculate preoperative and postoperative cSDH volumes. To identify volume thresholds, we constructed a receiver operating curve with preoperative and postoperative volumes to predict cSDH retreatment rates and selected the threshold with the highest Youden index. Then, we developed a light gradient boosting machine to predict the risk of cSDH recurrence. Results: We identified 538 patients with unilateral cSDH, of whom 62 (12%) underwent surgical retreatment within 6 months of the index surgery. cSDH retreatment was associated with higher preoperative (122 vs 103 mL; P < .001) and postoperative (62 vs 35 mL; P < .001) volumes. Patients with >140 mL preoperative volume had nearly triple the risk of cSDH recurrence compared with those below 140 mL, while a postoperative volume >46 mL led to an increased risk for retreatment (22% vs 6%; P < .001). On multivariate modeling, our model had an area under the receiver operating curve of 0.76 (95% CI: 0.60-0.93) for predicting retreatment. The most important features were preoperative and postoperative volume, platelet count, and age. Conclusion: Larger preoperative and postoperative cSDH volumes increase the risk of retreatment. Volume thresholds may allow identification of patients at high risk of cSDH retreatment who would benefit from adjunct treatments. Machine learning algorithm can quickly provide accurate estimates of preoperative and postoperative volumes. (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
Databáze:	MEDLINE
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