PURPOSE:Incisional hernia (IH) is a pervasive surgical disease. Computer vision and machine learning (ML) were used to derive computed tomography (CT)-based features predictive of IH.
METHODS:Patients who underwent colorectal surgery between 2005-2017 were identified (n=14,345). Patients who developed IH were matched with those who did not (n=212). Preoperative abdominopelvic CT scans were segmented to derive linear, volumetric, intensity-based, and textural measurements. Optimal biomarkers (OBMs) were derived and used to test ML classifiers (SVMs, Random Forests, Ensemble Boosting) for IH prediction.RESULTS: 279 features were extracted from preoperative CTs. The most predictive combination of OBMs was: 1) abdominopelvic visceral adipose tissue volume (VAT); 2) abdominopelvic intra-abdominal musculature volume; and 3) pelvic VAT to outer abdominal musculature volume (OAM) ratio. ML models using these OBMs were tested, Ensemble Boosting outperformed other models across all metrics.CONCLUSION: These OBMs suggest intra-abdominal volume/pressure is the most salient pathophysiologic mechanism for IH formation. ML models using OBMs are highly predictive of IH. Image analysis is a powerful tool in surgical risk prediction.
BACKGROUND
Blastomyces dermatitidis is a fungus endemic to central and southern North America. While infection most commonly results in pneumonia, a small number of infections progress to systemic disease, which may include intracranial lesions. Progression to systemic disease is most common in immunocompromised patients, such as those with human immunodeficiency virus.
OBSERVATIONS
The authors present a 44-year-old immunocompetent male who presented following a tonic-clonic seizure. Initial workup revealed a 19-mm enhancing intracranial mass. There was avid uptake of fluorescein sodium, and an en bloc resection of the mass was performed. Histopathology revealed B. dermatitidis. Medical management included amphotericin B and azole therapy. Postoperative recovery was uneventful, and no focal neurological deficits were appreciated.
LESSONS
This case highlights the neurosurgical management of a rare intracranial fungal manifestation in an immunocompetent patient. A literature review was also performed to better understand the role of neurosurgery in fungal infections. There were limited cases of intracranial Blastomyces reported in immunocompetent patients, and neurosurgical management varied (no intervention, biopsy, resection) and was underreported. Too few cases are reported to suggest neurosurgical intervention for blastomycosis improves outcomes. Medical management was relatively standard with azole and amphotericin therapy.
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