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09-05-2024 | Motor Evoked Potential | Original Research

Bayesian networks for Risk Assessment and postoperative deficit prediction in intraoperative neurophysiology for brain surgery

Authors: Ana Mirallave Pescador, José Pedro Lavrador, Arjel Lejarde, Cristina Bleil, Francesco Vergani, Alba Díaz Baamonde, Christos Soumpasis, Ranjeev Bhangoo, Ahilan Kailaya-Vasan, Christos M. Tolias, Keyoumars Ashkan, Bassel Zebian, Jesús Requena Carrión

Published in: Journal of Clinical Monitoring and Computing

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Abstract

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 mathematical tool to calculate the utility of conducting IONM, which could save costs in healthcare when performed.
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Metadata
Title
Bayesian networks for Risk Assessment and postoperative deficit prediction in intraoperative neurophysiology for brain surgery
Authors
Ana Mirallave Pescador
José Pedro Lavrador
Arjel Lejarde
Cristina Bleil
Francesco Vergani
Alba Díaz Baamonde
Christos Soumpasis
Ranjeev Bhangoo
Ahilan Kailaya-Vasan
Christos M. Tolias
Keyoumars Ashkan
Bassel Zebian
Jesús Requena Carrión
Publication date
09-05-2024
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-024-01159-w