Although machine learning (ML) has shown promise across disciplines, out-of-sample generalizability is concerning. This is currently addressed by sharing multi-site data, but such centralization is challenging/infeasible to scale due to various limitations. Federated ML (FL) provides an alternative paradigm for accurate and generalizable ML, by only sharing numerical model updates. Here we present the largest FL study to-date, involving data from 71 sites across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, reporting the largest such dataset in the literature (n = 6, 314). We demonstrate a 33% delineation improvement for the surgically targetable tumor, and 23% for the complete tumor extent, over a publicly trained model. We anticipate our study to: 1) enable more healthcare studies informed by large diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further analyses for glioblastoma by releasing our consensus model, and 3) demonstrate the FL effectiveness at such scale and task-complexity as a paradigm shift for multi-site collaborations, alleviating the need for data-sharing.
High-energy traumas frequently result in lumbar spine fractures such as spondyloptosis is the maximum expression of instability and severity. The management of spondyloptosis is complex and, essentially, surgical. It usually presents with irreversible neurological compromise. This paper aimed to present a case of lumbar spondyloptosis and its early confrontation, partial neurological involvement, and progressive postoperative retrieval.Clinical caseA male patient aged 42 years had multiple injuries with asymmetric paraparesis and sphincter involvement. Computed tomography (CT) revealed L3 vertebral spondyloptosis detached from the rest of the spine, spinal canal stenosis, sagittal imbalance, and angular kyphosis. Surgical resolution was defined by performing an en bloc corpectomy through lumbotomy and the installation of an expandable cage with posterior transpedicular fixation of L2–L4, thereby recovering the spinal canal diameter, lumbar lordosis, sagittal balance, and improving motor function progressively.ConclusionComplex spinal injuries warrant an early resolution by a trained surgical team to ensure normal spinal parameters and to achieve a progressive neurological recovery.
Artículo de publicación ISIIntracranial aneurysm in the pediatric population is very rare; the prevalence has been reported from 0.5% to 4.6% [1–3]. This pathology is completely different from aneurysms in adults: gender predominance; location of aneurysm; incidence of spontaneous thrombosis; incidence of giant, dissecting, and fusiform aneurysm; and rate of subarachnoid hemorrhage, among others [4]. Different multidisciplinary approaches have been used, ranging from conservative follow-up to the most complex microsurgical and endovascular treatments. In the microsurgical group, there are different alternatives, direct clipping and reconstruction or trapping with bypass from extracranial–intracranial (EC–IC) or intracranial–intracranial (IC–IC) types. For the middle cerebral artery aneurysms, the revascularization is an excellent option, especially for the giant lesions in which the reconstruction is not an option. Even more, if we analyze this subject, the overall complication rate of EC–IC procedures is very low, and the 10-year patency rate is as high as 73% [5]. Different types of graft used in children have been reported for EC–IC bypasses with vein graft [5], with radial artery graft [2], and superficial temporal artery (STA) [2, 6]. In the pediatric group, the youngest patient previously reported with an EC–IC bypass with STA–middle cerebral artery (MCA) for a MCA aneurysm had 11 years [6]. We present our case report as the youngest patient ever treated with a combination of trapping with a successful STA–MCA bypass in a giant MCA aneurysm
Upper thoracic tumors may develop spinal cord compression. By surgery at the time of diagnosis, a neurological deficit can be avoided. However, this particular localization requires a double approach to decompress the spinal cord and thoracic structures. The posterior extracavitary approach results in resection of the spinal canal, the foraminal component, and the extraspinal fragment, but is not routinely used by most neurosurgeons. A 56-year-old woman with a two-month history of axial thoracic pain and cough. The patient has a normal neurological examination. Thoracic computed tomography (CT) scan with contrast agent was performed, evincing a dumbbell-shaped tumor on the left T3-T4. Magnetic resonance imaging (MRI) confirms the diagnosis, showing a 4 cm diameter tumor that compresses the spinal cord without myelopathy. The surgery was performed posteriorly, with costotransversectomy, allowing complete resection under intraoperative neurophysiological monitoring. The patient developed no thoracic or neurological complications. One-stage posterior approach is possible and effective during the treatment of the upper thoracic dumbbell-shaped tumors, avoiding a change in surgical position, thoracic morbidity, and dependence on assisting surgeons.
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