Free Article: Artificial Neural Networks and Brain Metastases

Background: Artificial neural networks (ANNs) excel at analyzing challenging data sets and can be exceptional tools for decision support in clinical environments. The present study pilots the use of ANNs for determining prognosis in neuro-oncology patients.

Objective: To determine whether ANNs perform better at predicting 1-year survival in a group of patients with brain metastasis compared with traditional predictive tools.

Methods: ANNs were trained on a multi-institutional data set of radiosurgery patients to predict 1-year survival on the basis of several input factors. A single ANN, an ensemble of 5 ANNs, and logistic regression analyses were compared for efficacy. Sensitivity analysis was used to identify important variables in the ANN model.

Free Article: Radiosurgery to the Tumor Bed After Resection of Brain Metastases

Background: Optimal postoperative management paradigm for brain metastases remains controversial.

Objective: To conduct a systematic review of the literature to understand the role of postoperative stereotactic radiosurgery after resection of brain metastases.

Methods: We performed a MEDLINE search of the literature to identify series of patients with brain metastases treated with stereotactic radiosurgery after surgical resection. Outcomes including overall survival, local control, distant intracranial failure, and salvage therapy use were recorded. Patient, tumor, and treatment factors were correlated with outcomes through the use of the Pearson correlation and 2-way Student t test as appropriate.

Ahead of Print: Simple and Reliable Determination of the Modified Rankin Scale

Background: The modified Rankin Scale (mRS) is a 6-level outcome scale used to assess level of function in neurological disease.

Objective: We examined the interobserver reliability and intraobserver reliability of the mRS-9Q, a 9 question “yes/no” survey that measures the mRS in Neurosurgical and Neurological patients.

Methods: The mRS-9Q was administered by form or telephone, and a web-based tool was used to calculate the mRS and perform error checking. Part 1 compared the mRS-9Q to a mRS Structured Interview (n=80). Part 2 compared mRS-9Q administration by telephone and by paper form (n=80). Part 3 compared mRS-9Q administration by an expert interviewer with administration by a non-expert (n=83). Part 4 examined repeatability of the mRS-9Q over a 2 week period (n=84).

Free Editor Choice: Do Outcomes Vary Across Centers for Surgery for Lumbar Disc Herniation?

Background: Lumbar discectomy is the most commonly performed spine procedure. Academic spine centers with potentially differing caseloads and experience may have different outcomes.

Objective: To determine whether the choice of center in which surgery is performed affects lumbar discectomy outcomes.

Methods: Spine Patient Outcomes Research Trial participants with a confirmed diagnosis of intervertebral disc herniation undergoing standard first-time open discectomy were followed from baseline at 6 weeks, and 3, 6, and 12 months, and yearly thereafter, at 13 spine clinics in 11 US states. Patient data from this prospective study were reviewed. Enrollment began in March 2000 and ended in November 2004.

Free Article: Rate of Return to Military Active Duty After Lumbar Interbody Fusion

Background: Lumbar interbody fusion has been extensively studied in the civilian population; however, data regarding its efficacy in the military are lacking.

Objective: To identify the rate of return to unrestricted active military duty after single-level lumbar interbody fusion surgery.

Methods: The surgical database at a single tertiary care military treatment facility was queried for active-duty patients who underwent a single-level lumbar interbody fusion over a 5-year period. A retrospective chart review was performed with backward stepwise logistic regression analysis, and Fisher exact and Wilcoxon rank sum tests were used for statistical analysis.