World Neurosurg
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Substantial healthcare resources have been diverted to manage the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, and nonemergency neurosurgery has been effectively closed. As we begin to emerge from the crisis, we will need to manage the backlog of nonemergency neurosurgical patients whose treatment has been delayed and remain responsive to further possible surges of SARS-CoV-2 infections. ⋯ The performance of nonemergency neurosurgery can start once minimum criteria have been fulfilled: 1) a structured prioritization of surgical cases; 2) virus infection incidence decreased sufficiently to release previously diverted healthcare resources; 3) adequate safety criteria met for patients and staff, including sufficient personal protective equipment and robust testing availability; and 4) maintenance of systems for rapid communication at organizational and individual levels.
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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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Intracranial hypotension (IH) has a widely variable clinical and radiologic presentation. Secondary IH may be caused by degenerative spine disorders and in particular by thoracic disk herniations (TDHs). ⋯ This paper adds to the evidence that some cases of IH and even superficial siderosis are caused by transdural erosion of a TDH that may be otherwise asymptomatic. The dura may degenerate due to chronic compression, and a longitudinal slitlike dural defect with smooth lining may develop, causing continuous (Case 1) or intermittent (Case 2) intraspinal CSF leakage. To the best of our knowledge, such dural defects closely resembling the ones observed in idiopathic spinal cord herniation have never been demonstrated on intraoperative endoscopic video in IH patients.
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Degenerative cervical myelopathy is the most common cause of spinal cord injury in the elderly population in the developed world, and it significantly affects the quality of life of patients and their caregivers. Surgery remains the only treatment option able to halt disease progression and provide neurological recovery for most patients. Although it has remained challenging to predict exactly who will experience improvement after surgery, increasingly it has been shown that clinical, imaging, and electrophysiological factors can predict, with relatively good capacity, those more likely to benefit. ⋯ However, large studies are lacking. Although multivariate models have been conducted using clinical and magnetic resonance imaging data, no multimodal prediction models are available that encompass the predictive capacity of clinical, imaging, and electrophysiological data. In the present review, we examined the rationale for clinical, imaging, and electrophysiological usage in clinical practice and discussed a model of multimodal assessment for the management of degenerative cervical myelopathy.
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Brain mapping and connectomics can probe networks that span the entire brain, producing a diverse range of outputs for probing specific clinically relevant questions. The potential for understanding the effect of focal lesions on brain function, cognition, and plasticity abounds, any one of which would likely yield more effective and safer neurosurgical strategies. However, the possibilities of advanced magnetic resonance imaging and connectomics have been somewhat underused in neurosurgery, arising from actual or perceived difficulties in either application or analysis. ⋯ The principles of study design will be introduced, including analysis tips and methods for making efficient use of available resources. Finally, a review of the best research practices for neuroimaging studies will be discussed, including principles of open access data sharing, study preregistration, and methods for improving replicability. Ultimately, we hope readers will be better placed to appraise the current connectomics studies in neurosurgery and empowered to develop their own high-quality studies, both of which are key steps in realizing the true potential of connectomics and advanced neuroimaging analyses in general.