Bayesian Networks for Risk Assessment and Postoperative Deficit Prediction in Intraoperative Neurophysiology for Brain Surgery
Published in: Journal of Clinical Monitoring and Computing
Authors: Ana Mirallave Pescador; Jose Pedro Lavrador; Arjel Lejarde; Cristina Bleil; Francesco Vergani; Alba Diaz-Baamonde; Christos Soumpasis; Ranjeev Bhangoo; Ahilan Kailaya-Vasan; Christos M. Tolias; Keyoumars Ashkan; Bassel Zebian; Jesus Requena
Year: 2024
Publication details: 38(5):1043-1055
DOI: 10.1007/s10877-024-01159-w
Publication type: Journal article
Topic: Intraoperative neuromonitoring, brain surgery risk, Bayesian networks, postoperative deficit, complex neurosurgery
Simple summary
This study explores how Bayesian networks may help assess risk and predict postoperative neurological deficit in brain surgery using intraoperative monitoring data. It is relevant to website content on careful intraoperative decision-making, monitoring and risk reduction in complex neurosurgery.
Mr Kailaya-Vasan’s involvement
Mr Kailaya-Vasan, consultant neurosurgeon and neurovascular surgeon, is listed as a contributing author on this publication.
Published abstract
The following abstract is reproduced from the original publication and is provided for reference. It may include technical terminology intended for clinical or academic audiences.
Purpose: To this day there is no consensus regarding evidence of usefulness of Intraoperative Neurophysiological Monitoring (IONM). Randomized controlled trials have not been performed in the past mainly because of difficulties in recruitment control subjects. In this study, we propose the use of Bayesian Networks to assess evidence in IONM. Methods Single center retrospective study from January 2020 to January 2022. Patients admitted for cranial neurosurgery with intraoperative neuromonitoring were enrolled. We built a Bayesian network with utility calculation using expert domain knowledge based on logistic regression as potential causal inference between events in surgery that could lead to central nervous system injury and postoperative neurological function. Results A total of 267 patients were included in the study: 198 (73.9%) underwent neuro-oncology surgery and 69 (26.1%) neurovascular surgery. 50.7% of patients were female while 49.3% were male. Using the Bayesian Network's original state probabilities, we found that among patients who presented with a reversible signal change that was acted upon, 59% of patients would wake up with no new neurological deficits, 33% with a transitory deficit and 8% with a permanent deficit. If the signal change was permanent, in 16% of the patients the deficit would be transitory and in 51% it would be permanent. 33% of patients would wake up with no new postoperative deficit. Our network also shows that utility increases when corrective actions are taken to revert a signal change. Conclusions Bayesian Networks are an effective way to audit clinical practice within IONM. We have found that IONM warnings can serve to prevent neurological deficits in patients, especially when corrective surgical action is taken to attempt to revert signals changes back to baseline properties. We show that Bayesian Networks could be used as a tool to calculate the utility of conducting IONM, which could save costs in healthcare when performed.
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