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Machine learning applications to clinical decision support in neurosurgery: an artificial intelligence augmented systematic review

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Abstract

Machine learning (ML) involves algorithms learning patterns in large, complex datasets to predict and classify. Algorithms include neural networks (NN), logistic regression (LR), and support vector machines (SVM). ML may generate substantial improvements in neurosurgery. This systematic review assessed the current state of neurosurgical ML applications and the performance of algorithms applied. Our systematic search strategy yielded 6866 results, 70 of which met inclusion criteria. Performance statistics analyzed included area under the receiver operating characteristics curve (AUC), accuracy, sensitivity, and specificity. Natural language processing (NLP) was used to model topics across the corpus and to identify keywords within surgical subspecialties. ML applications were heterogeneous. The densest cluster of studies focused on preoperative evaluation, planning, and outcome prediction in spine surgery. The main algorithms applied were NN, LR, and SVM. Input and output features varied widely and were listed to facilitate future research. The accuracy (F(2,19) = 6.56, p < 0.01) and specificity (F(2,16) = 5.57, p < 0.01) of NN, LR, and SVM differed significantly. NN algorithms demonstrated significantly higher accuracy than LR. SVM demonstrated significantly higher specificity than LR. We found no significant difference between NN, LR, and SVM AUC and sensitivity. NLP topic modeling reached maximum coherence at seven topics, which were defined by modeling approach, surgery type, and pathology themes. Keywords captured research foci within surgical domains. ML technology accurately predicts outcomes and facilitates clinical decision-making in neurosurgery. NNs frequently outperformed other algorithms on supervised learning tasks. This study identified gaps in the literature and opportunities for future neurosurgical ML research.

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Authors and Affiliations

  1. School of Medicine, The University of Notre Dame, Sydney, NSW, Australia

    Quinlan D. Buchlak, Nazanin Esmaili & Christine Bennett

  2. Rozetta Institute, Sydney, NSW, Australia

    Nazanin Esmaili

  3. Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA

    Jean-Christophe Leveque, Farrokh Farrokhi & Rajiv K. Sethi

  4. Department of Neurosurgery, Virginia Mason Medical Center, Seattle, WA, USA

    Jean-Christophe Leveque, Farrokh Farrokhi & Rajiv K. Sethi

  5. University of Technology Sydney, Sydney, NSW, Australia

    Massimo Piccardi

  6. Department of Health Services, University of Washington, Seattle, WA, USA

    Rajiv K. Sethi

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  1. Quinlan D. Buchlak
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  2. Nazanin Esmaili
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  3. Jean-Christophe Leveque
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  5. Christine Bennett
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Correspondence to Quinlan D. Buchlak.

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Buchlak, Q.D., Esmaili, N., Leveque, JC. et al. Machine learning applications to clinical decision support in neurosurgery: an artificial intelligence augmented systematic review. Neurosurg Rev 43, 1235–1253 (2020). https://doi.org/10.1007/s10143-019-01163-8

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