RESUMO
Background: Recently, it was defined that the sellar barrier entity could be identified as a predictor of cerebrospinal fluid (CSF) intraoperative leakage. The aim of this study is to validate the application of the sellar barrier concept for predicting intraoperative CSF leak in endoscopic endonasal surgery for pituitary adenomas with a machine learning approach. Methods: We conducted a prospective cohort study, from June 2019 to September 2020: data from 155 patients with pituitary subdiaphragmatic adenoma operated through endoscopic approach at the Division of Neurosurgery, Università degli Studi di Napoli "Federico II," were included. Preoperative magnetic resonance images (MRI) and intraoperative findings were analyzed. After processing patient data, the experiment was conducted as a novelty detection problem, splitting outliers (i.e., patients with intraoperative fistula, n = 11/155) and inliers into separate datasets, the latter further separated into training (n = 115/144) and inlier test (n = 29/144) datasets. The machine learning analysis was performed using different novelty detection algorithms [isolation forest, local outlier factor, one-class support vector machine (oSVM)], whose performance was assessed separately and as an ensemble on the inlier and outlier test sets. Results: According to the type of sellar barrier, patients were classified into two groups, i.e., strong and weak barrier; a third category of mixed barrier was defined when a case was neither weak nor strong. Significant differences between the three datasets were found for Knosp classification score (p = 0.0015), MRI barrier: strong (p = 1.405 × 10-6), MRI barrier: weak (p = 4.487 × 10-8), intraoperative barrier: strong (p = 2.788 × 10-7), and intraoperative barrier: weak (p = 2.191 × 10-10). We recorded 11 cases of intraoperative leakage that occurred in the majority of patients presenting a weak sellar barrier (p = 4.487 × 10-8) at preoperative MRI. Accuracy, sensitivity, and specificity for outlier detection were 0.70, 0.64, and 0.72 for IF; 0.85, 0.45, and 1.00 for LOF; 0.83, 0.64, and 0.90 for oSVM; and 0.83, 0.55, and 0.93 for the ensemble, respectively. Conclusions: There is a true correlation between the type of sellar barrier at MRI and its in vivo features as observed during endoscopic endonasal surgery. The novelty detection models highlighted differences between patients who developed an intraoperative CSF leak and those who did not.
RESUMO
Osteoblastoma (OB) is a rare primary benign bone tumor. It generally occurs in the axial skeleton, where it preferentially involves the neural arch. The peak incidence of this neoplasm is in the first two decades of life. Female/male ratio is 2:1. It is important to differentiate OB from osteoid osteoma, a very similar bone tumor. Neuroradiological imaging are diagnostics in most of the cases. This article describes a 18-year-old female affected from a thoracic osteoblastoma stemming from T9 lamina and extending to T11, with a diameter of about 2.5 cm. The patient complained of dorsal pain with progressive weakness to lower limbs. A dorsal approach was performed with a right partial T9 and T11 right laminectomy with total T10 right laminectomy. The mass was totally removed by a limited approach, with no consequent instability and no reason for any stabilization. OB is rare benign bone neoplasm that generally affect the posterior elements of the spine. Surgery is the treatment of choice in this kind of lesions: total removal is effective with no recurrence. When the lesion is placed in the cervical and thoracic spine the goal is to decompress spinal cord and reach the stability of the spine.
