内未破裂动脉瘤微手术中不良事件的风险模型
Victor E Staartjes1,2, Alexios A Adamides3, Pasquale Anania4
1Machine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zürich, Switzerland.
Neurosurgery
|December 8, 2025
概括
新的机器学习模型预测了微手术治疗未破裂的内动脉瘤 (UIA) 的风险. 这些工具为不良的神经结果和新的缺陷提供了个性化的风险估计,有助于临床决策.
科学领域:
- 神经外科 神经外科
- 医学机器学习 医学机器学习
- 临床预测模型临床预测模型
背景情况:
- 预防性治疗未破裂的内动脉瘤 (UIA) 需要平衡治疗风险与预期的益处.
- 目前对UIA破裂/生长风险的评分缺乏对微手术治疗风险的外部验证.
- 机器学习模型可以根据患者和动脉瘤特征提供针对UIA治疗的个性化风险评估.
研究的目的:
- 开发和外部验证UIAs微手术治疗后不良结果的临床预测模型.
- 评估模型预测神经系统不良结果,新的感觉运动缺陷和医院出院时所有原因的不良事件的能力.
主要方法:
- 利用来自20个国际中心的数据 (3705名患者) 进行"对内未破裂动脉瘤微手术后不良事件的预测"研究.
- 开发并验证了使用机器学习对患者和动脉瘤特征的模型.
- 基于来自7个中心 (824名患者) 的数据进行外部验证的模型.
主要成果:
- 模型表现出良好的校准和歧视,可以预测神经系统的不良结果 (AUC=0.70) 和新的感觉运动缺陷 (AUC=0.69).
- 所有原因不良事件的预测显示了公平的校准,AUC为0.59.
- 整合预测模型的Web应用程序可以在https://neurosurgery.shinyapps.io/PRAEMIUM/.
结论:
- 开发的模型用于预测不良的神经结果和新的感觉运动缺陷,在多国外部验证时显示出良好的校准和公平的歧视.
- 这些模型可能有助于客观地估计UIAs的微手术治疗风险.
- 预测的概率与现实世界的风险保持一致,这表明临床效用.
相关概念视频
01:26Aneurysm III: Interprofessional Care
245
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
245
01:22Aneurysm IV: Nursing Management
359
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
359
01:30Aneurysm I: Introduction
320
An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
320