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Clinical application of the “sellar barrier’s concept” for predicting intraoperative CSF leak in endoscopic endonasal surgery for pituitary adenomas with a machine learning analysis

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dc.contributor.author Villalonga, Juan Francisco
dc.contributor.author Solari, Domenico
dc.contributor.author Cuocuolo, R.
dc.contributor.author De Lucía, V.
dc.contributor.author Ugga, L.
dc.contributor.author Gragnaniello, C.
dc.contributor.author Pailler, José Ignacio
dc.contributor.author Cervio, Andrés Eduardo
dc.contributor.author Campero, Álvaro
dc.contributor.author Cavallo, Luigi M.
dc.contributor.author Cappabianca, P
dc.date.accessioned 2022-09-23T13:18:05Z
dc.date.available 2022-09-23T13:18:05Z
dc.date.issued 2022-09-08
dc.identifier.citation Villalonga JF, Solari D, Cuocolo R, De Lucia V, Ugga L, Gragnaniello C, Pailler JI, Cervio A, Campero A, Cavallo LM and Cappabianca P. Clinical application of the “sellar barrier’s concept” for predicting intraoperative CSF leak in endoscopic endonasal surgery for pituitary adenomas with a machine learning analysis. Front. Surg. 2022 (9):934721. doi: 10.3389/fsurg.2022.934721 es_ES
dc.identifier.uri https://repositorio.fleni.org.ar/xmlui/handle/123456789/673
dc.identifier.uri https://www.frontiersin.org/articles/10.3389/fsurg.2022.934721/full
dc.description.abstract 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. es_ES
dc.language.iso eng es_ES
dc.publisher Frontiers Media S.A
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Pituitary Gland es_ES
dc.subject Pituitary Neoplasms es_ES
dc.title Clinical application of the “sellar barrier’s concept” for predicting intraoperative CSF leak in endoscopic endonasal surgery for pituitary adenomas with a machine learning analysis es_ES
dc.type info:eu-repo/semantics/article es_ES
dc.type info:eu-repo/semantics/publishedVersion
dc.description.fil Fil: Villalonga, Juan Francisco. Universidad Nacional deTucumán. Facultad de Medicina. Laboratorio de Innovaciones Neuroquirúrgicas de Tucumán; Argentina. University of Naples Federico II. Department of Neuroscience and Reproductive and Odontostomatological Sciences; Italia.
dc.description.fil Fil: Cervio, Andrés.Fleni. Departamento de Neurocirugía; Argentina.
dc.description.fil Fil: Campero, Álvaro. Universidad Nacional de Tucumán. Facultad de Medicina. Laboratorio de Innovaciones Neuroquirúrgicas de Tucumán; Argentina.
dc.description.fil Fil: Solari, Domenico. University of Naples Federico II. Department of Neuroscience and Reproductive and Odontostomatological Sciences; Italia.
dc.description.fil Fil: Cuocuolo, R. University of Naples Federico II. Department of Advanced Biomedical Sciences; Italia.
dc.description.fil Fil: De Lucía, V. Universidad Nacional de Tucumán. Facultad de Medicina. Laboratorio de Innovaciones Neuroquirúrgicas de Tucumán; Argentina.
dc.description.fil Fil: Ugga, L. University of Naples Federico II. Department of Advanced Biomedical Sciences; Italia.
dc.description.fil Fil: Gragnaniello, C. University of Naples Federico II. Department of Neuroscience and Reproductive and Odontostomatological Sciences; Italia. Swedish Neuroscience Institute. Department of Neurological Surgery; Estados Unidos.
dc.description.fil Fil: Pailler, J.I. Universidad Nacional de Tucumán. Facultad de Medicina. Laboratorio de Innovaciones Neuroquirúrgicas de Tucumán; Argentina.
dc.description.fil Fil: Cavallo, Luigi M. University of Naples Federico II. Department of Neuroscience and Reproductive and Odontostomatological Sciences; Italia.
dc.description.fil Fil: Cappabianca, P. University of Naples Federico II. Department of Neuroscience and Reproductive and Odontostomatological Sciences; Italia.
dc.relation.ispartofNUMBER 9
dc.relation.ispartofPAGINATION 934721
dc.relation.ispartofCOUNTRY Suiza
dc.relation.ispartofCITY Lausana
dc.relation.ispartofTITLE Frontiers in surgery
dc.relation.ispartofISSN 2296-875X
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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