Shelly D . Timmons - Academia.edu (original) (raw)

Papers by Shelly D . Timmons

Research paper thumbnail of Using the Abbreviated Injury Severity and Glasgow Coma Scale Scores to Predict 2-Week Mortality After Traumatic Brain Injury

Journal of Trauma-injury Infection and Critical Care, Nov 1, 2011

Research paper thumbnail of Prehospital Transportation and Optimal Utilization of Resources

Research paper thumbnail of Use of Multimodality Neuromonitoring in the Management of Traumatic Brain Injury

Multimodality neuromonitoring has become an essential part of neurocritical care over the past se... more Multimodality neuromonitoring has become an essential part of neurocritical care over the past several decades. Ideally, the management strategies employed based on the information provided by multimodality monitoring should minimize secondary injury and not instigate deleterious effects. The aim of this chapter is to discuss available advanced neuromonitoring techniques, to review evidence for patient outcomes in the setting of multimodality monitoring, and to discuss in brief the logistical implications of implementing these techniques in the neurocritical care unit.

Research paper thumbnail of Management to Optimal Parameters: Euboxia?

Springer eBooks, 2018

The critical care management of patients with traumatic brain injury (TBI) has undergone major ad... more The critical care management of patients with traumatic brain injury (TBI) has undergone major advancements over the last several decades. Improved evidence-based research has allowed us a greater understanding of the pathophysiology and parameters that impact outcomes. Despite this, much uncertainty still remains, and further studies should be performed to identify ways to optimize parameters to achieve the best outcomes for TBI patients.

Research paper thumbnail of Editorial. The challenges of estimating the cost of traumatic brain injury worldwide

Neurosurgical Focus, May 1, 2018

Research paper thumbnail of Letter to the Editor. Education and evidence-based medicine in neurosurgery

Journal of neurosurgery, Jul 1, 2020

We thank Maduri and colleagues for their interest in our article and for bringing our attention t... more We thank Maduri and colleagues for their interest in our article and for bringing our attention to their recently published technique. 1 They describe a method of preoperative localization using fluoroscopically guided trephination of a thoracic vertebra. They percutaneously remove from the thoracic pedicle a cylinder of cortical and

Research paper thumbnail of Mild traumatic brain injury

Neurosurgical Focus, Nov 1, 2010

Research paper thumbnail of The power of discernment

Journal of Neurosurgery, Dec 1, 2019

The 2019 scientific meeting of the American Association of Neurological Surgeons (AANS) focused o... more The 2019 scientific meeting of the American Association of Neurological Surgeons (AANS) focused on the theme “The Science of Practice.” In her presidential address, 2018 AANS President Shelly Timmons discusses evolutions in medical and surgical practice, and explores how current technologies can be used to advance knowledge through thoughtful analyses of clinical observations and experiences.

Research paper thumbnail of Casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study

The Lancet Neurology, 2022

BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a sub... more BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. METHODS We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. FINDINGS Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49). INTERPRETATION Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. FUNDING National Institute for Health Research Global Health Research Group.

Research paper thumbnail of XV. Steroids

Journal of Neurotrauma, May 1, 2007

Research paper thumbnail of Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children

JAMA Pediatrics, Nov 5, 2018

IMPORTANCE-Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing pu... more IMPORTANCE-Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidencebased clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States. OBJECTIVE-To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI. EVIDENCE REVIEW-The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were Lumba-Brown et al.

Research paper thumbnail of Acute Extra-Axial Hematoma

Research paper thumbnail of Intracranial Pressure Rescued by Decompressive Surgery after Traumatic Brain Injury

The New England Journal of Medicine, Sep 22, 2016

Hutchinson et al.1 report in the Journal the results of the Randomised Evaluation of Surgery with... more Hutchinson et al.1 report in the Journal the results of the Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) trial, which compared decompressive craniectomy with continued medical management for refractory elevation of intracranial pressure after severe traumatic brain injury. Urgent treatment of patients with such an injury focuses on minimizing secondary brain injury, particularly from increased intracranial pressure. When common medical interventions fail to control intracranial pressure, decompressive craniectomy to prevent herniation may be considered. This surgery addresses a physiological problem (refractory elevation of intracranial pressure) and has a proven benefit in the management of . . .

Research paper thumbnail of Current trends in neurotrauma care

Critical Care Medicine, Sep 1, 2010

Severe traumatic brain injury remains a significant cause of mortality and morbidity worldwide. T... more Severe traumatic brain injury remains a significant cause of mortality and morbidity worldwide. The use of therapeutic interventions such as hypertonic saline administration and decompressive craniectomy have solid foundations and can improve outcomes, although questions remain about patient selection, optimal timing, and comparisons to other treatments. Hypothermia, while having promise, has not definitively been shown to benefit patients with traumatic brain injury, although clinical trials are underway. The use of ␤-blockers in traumatic brain injury has been proposed as a neuroprotective measure, but data are lacking to support widespread clinical use. Brain tissue oxy-genation monitoring is gaining widespread acceptance as a safe tool to provide additional information both to guide therapeutic interventions and to further elucidate mechanisms of secondary brain injury. Evidence is also mounting that guided therapy using brain tissue oxygenation in addition to intracranial pressure and cerebral perfusion pressure monitoring leads to better outcomes after traumatic brain injury. (Crit Care Med 2010; 38[Suppl.]: S431-S444

Research paper thumbnail of XII. Nutrition

Journal of Neurotrauma, May 1, 2007

SUSAN L. BRATTON,1 RANDALL M. CHESTNUT,2 JAMSHID GHAJAR,3,4 FLORA F. MCCONNELL HAMMOND,5 ODETTE A... more SUSAN L. BRATTON,1 RANDALL M. CHESTNUT,2 JAMSHID GHAJAR,3,4 FLORA F. MCCONNELL HAMMOND,5 ODETTE A. HARRIS,6 ROGER HARTL,3 GEOFFREY T. MANLEY,7 ANDREW NEMECEK,8 DAVID W. NEWELL,9 GUY ROSENTHAL,7 JOOST SCHOUTEN,10 LORI ...

Research paper thumbnail of Emergency Crisis in the United States

Neurosurgery, Aug 1, 2006

CHRONICLING THE TIMES IN THE INFORMATION AGE Emergency Crisis in the United States orthopaedic an... more CHRONICLING THE TIMES IN THE INFORMATION AGE Emergency Crisis in the United States orthopaedic and neurosurgical procedures. The most striking part of that comment is its emphasis on saving the specialty of trauma surgery, not on providing the best care for patients. In Australian

Research paper thumbnail of Controversies in Severe Traumatic Brain Injury Management

Springer eBooks, 2018

The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Research paper thumbnail of Delivery of Emergency Neurosurgical Care

Journal of The American College of Surgeons, Dec 1, 2006

Research paper thumbnail of An Estimated Compliance Index Derived from Intracranial Pressure Recording

The purpose of this study is to test the validity of a proposed compliance index, percent change ... more The purpose of this study is to test the validity of a proposed compliance index, percent change of compliance per mmHg of intracranial pressure (%CC/mmHg), by comparison of values of the index with corresponding experimentally derived values of compliance. The derivation of %CC/mmHg is based on two assumptions: 1) the pressure-volume characteristic of the craniospinal sac can be linearized for small perturbations about an equilibrium; and 2) during a brief interval in which these perturbations occur the pathophysiologic state of the sac does not significantly change. By rapid infusion of 0.2 ml of mock cerebrospinal fluid (CSF) experimental values of compliance (n = 44) were obtained from 10 piglets during monitoring of intracranial pressure (ICP). A strong correlation (r = 0.89, p < .001, n = 44) was obtained between values of %CC/mmHg and corresponding values of experimentally derived compliance (ml/mmHg). The value of the proposed index of compliance, %CC/mmHg, needs to be evaluated in the clinical setting. However, from the view of validation of ICP instrumentation, high values of both mean ICP and mean %CC/mmHg are contradictory and indicative of the occurrence of instrumentation error due to electronic direct current drift.

Research paper thumbnail of Introduction. Machine learning in neurosurgery: transitioning to a new era of contemporary medicine

Neurosurgical Focus, Jun 1, 2023

R apid technological evolution has transformed clinical practice, constituting big data and artif... more R apid technological evolution has transformed clinical practice, constituting big data and artificial intelligence as omnipresent tools in the medical arsenal and creating extraordinary potential and unprecedented challenges. The paradigm shift witnessed by the healthcare sector as a result of the mass digitization of information has organically permeated neurosurgery. In recent years, surgical innovation compounded by clinical expertise, in conjunction with novel data-processing techniques, has enabled meaningful advancements in the application of machine learning in neurosurgery. This issue of Neurosurgical Focus embodies a representation of the progress in translating machine learning algorithms into clinical practice. The articles included in this issue invariably resonate with the drive to recruit artificial intelligence to address impactful questions, derive meaningful outcomes, and achieve personalized patient management. The authors study current machine learning models, evaluate novel algorithms, and discuss approaches to appraising machine learning techniques in neurosurgery. Machine learning in neurosurgery extends beyond the mere synthesis of existing research and exemplifies the power of merging information technology with medical science to transition clinical practice to a new era of contemporary medicine. In our attempt to open this Pandora's box, we hope to provide a long-lasting reference for clinicians and scientists, stimulate scientific thought, and provide a framework for a fruitful conversation on a highly complicated and challenging topic. We immensely appreciate the contributing authors' work in undertaking the formidable task of unraveling the highly convoluted role of machine learning in neurosurgery.

Research paper thumbnail of Using the Abbreviated Injury Severity and Glasgow Coma Scale Scores to Predict 2-Week Mortality After Traumatic Brain Injury

Journal of Trauma-injury Infection and Critical Care, Nov 1, 2011

Research paper thumbnail of Prehospital Transportation and Optimal Utilization of Resources

Research paper thumbnail of Use of Multimodality Neuromonitoring in the Management of Traumatic Brain Injury

Multimodality neuromonitoring has become an essential part of neurocritical care over the past se... more Multimodality neuromonitoring has become an essential part of neurocritical care over the past several decades. Ideally, the management strategies employed based on the information provided by multimodality monitoring should minimize secondary injury and not instigate deleterious effects. The aim of this chapter is to discuss available advanced neuromonitoring techniques, to review evidence for patient outcomes in the setting of multimodality monitoring, and to discuss in brief the logistical implications of implementing these techniques in the neurocritical care unit.

Research paper thumbnail of Management to Optimal Parameters: Euboxia?

Springer eBooks, 2018

The critical care management of patients with traumatic brain injury (TBI) has undergone major ad... more The critical care management of patients with traumatic brain injury (TBI) has undergone major advancements over the last several decades. Improved evidence-based research has allowed us a greater understanding of the pathophysiology and parameters that impact outcomes. Despite this, much uncertainty still remains, and further studies should be performed to identify ways to optimize parameters to achieve the best outcomes for TBI patients.

Research paper thumbnail of Editorial. The challenges of estimating the cost of traumatic brain injury worldwide

Neurosurgical Focus, May 1, 2018

Research paper thumbnail of Letter to the Editor. Education and evidence-based medicine in neurosurgery

Journal of neurosurgery, Jul 1, 2020

We thank Maduri and colleagues for their interest in our article and for bringing our attention t... more We thank Maduri and colleagues for their interest in our article and for bringing our attention to their recently published technique. 1 They describe a method of preoperative localization using fluoroscopically guided trephination of a thoracic vertebra. They percutaneously remove from the thoracic pedicle a cylinder of cortical and

Research paper thumbnail of Mild traumatic brain injury

Neurosurgical Focus, Nov 1, 2010

Research paper thumbnail of The power of discernment

Journal of Neurosurgery, Dec 1, 2019

The 2019 scientific meeting of the American Association of Neurological Surgeons (AANS) focused o... more The 2019 scientific meeting of the American Association of Neurological Surgeons (AANS) focused on the theme “The Science of Practice.” In her presidential address, 2018 AANS President Shelly Timmons discusses evolutions in medical and surgical practice, and explores how current technologies can be used to advance knowledge through thoughtful analyses of clinical observations and experiences.

Research paper thumbnail of Casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study

The Lancet Neurology, 2022

BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a sub... more BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. METHODS We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. FINDINGS Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49). INTERPRETATION Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. FUNDING National Institute for Health Research Global Health Research Group.

Research paper thumbnail of XV. Steroids

Journal of Neurotrauma, May 1, 2007

Research paper thumbnail of Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children

JAMA Pediatrics, Nov 5, 2018

IMPORTANCE-Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing pu... more IMPORTANCE-Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidencebased clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States. OBJECTIVE-To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI. EVIDENCE REVIEW-The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were Lumba-Brown et al.

Research paper thumbnail of Acute Extra-Axial Hematoma

Research paper thumbnail of Intracranial Pressure Rescued by Decompressive Surgery after Traumatic Brain Injury

The New England Journal of Medicine, Sep 22, 2016

Hutchinson et al.1 report in the Journal the results of the Randomised Evaluation of Surgery with... more Hutchinson et al.1 report in the Journal the results of the Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) trial, which compared decompressive craniectomy with continued medical management for refractory elevation of intracranial pressure after severe traumatic brain injury. Urgent treatment of patients with such an injury focuses on minimizing secondary brain injury, particularly from increased intracranial pressure. When common medical interventions fail to control intracranial pressure, decompressive craniectomy to prevent herniation may be considered. This surgery addresses a physiological problem (refractory elevation of intracranial pressure) and has a proven benefit in the management of . . .

Research paper thumbnail of Current trends in neurotrauma care

Critical Care Medicine, Sep 1, 2010

Severe traumatic brain injury remains a significant cause of mortality and morbidity worldwide. T... more Severe traumatic brain injury remains a significant cause of mortality and morbidity worldwide. The use of therapeutic interventions such as hypertonic saline administration and decompressive craniectomy have solid foundations and can improve outcomes, although questions remain about patient selection, optimal timing, and comparisons to other treatments. Hypothermia, while having promise, has not definitively been shown to benefit patients with traumatic brain injury, although clinical trials are underway. The use of ␤-blockers in traumatic brain injury has been proposed as a neuroprotective measure, but data are lacking to support widespread clinical use. Brain tissue oxy-genation monitoring is gaining widespread acceptance as a safe tool to provide additional information both to guide therapeutic interventions and to further elucidate mechanisms of secondary brain injury. Evidence is also mounting that guided therapy using brain tissue oxygenation in addition to intracranial pressure and cerebral perfusion pressure monitoring leads to better outcomes after traumatic brain injury. (Crit Care Med 2010; 38[Suppl.]: S431-S444

Research paper thumbnail of XII. Nutrition

Journal of Neurotrauma, May 1, 2007

SUSAN L. BRATTON,1 RANDALL M. CHESTNUT,2 JAMSHID GHAJAR,3,4 FLORA F. MCCONNELL HAMMOND,5 ODETTE A... more SUSAN L. BRATTON,1 RANDALL M. CHESTNUT,2 JAMSHID GHAJAR,3,4 FLORA F. MCCONNELL HAMMOND,5 ODETTE A. HARRIS,6 ROGER HARTL,3 GEOFFREY T. MANLEY,7 ANDREW NEMECEK,8 DAVID W. NEWELL,9 GUY ROSENTHAL,7 JOOST SCHOUTEN,10 LORI ...

Research paper thumbnail of Emergency Crisis in the United States

Neurosurgery, Aug 1, 2006

CHRONICLING THE TIMES IN THE INFORMATION AGE Emergency Crisis in the United States orthopaedic an... more CHRONICLING THE TIMES IN THE INFORMATION AGE Emergency Crisis in the United States orthopaedic and neurosurgical procedures. The most striking part of that comment is its emphasis on saving the specialty of trauma surgery, not on providing the best care for patients. In Australian

Research paper thumbnail of Controversies in Severe Traumatic Brain Injury Management

Springer eBooks, 2018

The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Research paper thumbnail of Delivery of Emergency Neurosurgical Care

Journal of The American College of Surgeons, Dec 1, 2006

Research paper thumbnail of An Estimated Compliance Index Derived from Intracranial Pressure Recording

The purpose of this study is to test the validity of a proposed compliance index, percent change ... more The purpose of this study is to test the validity of a proposed compliance index, percent change of compliance per mmHg of intracranial pressure (%CC/mmHg), by comparison of values of the index with corresponding experimentally derived values of compliance. The derivation of %CC/mmHg is based on two assumptions: 1) the pressure-volume characteristic of the craniospinal sac can be linearized for small perturbations about an equilibrium; and 2) during a brief interval in which these perturbations occur the pathophysiologic state of the sac does not significantly change. By rapid infusion of 0.2 ml of mock cerebrospinal fluid (CSF) experimental values of compliance (n = 44) were obtained from 10 piglets during monitoring of intracranial pressure (ICP). A strong correlation (r = 0.89, p < .001, n = 44) was obtained between values of %CC/mmHg and corresponding values of experimentally derived compliance (ml/mmHg). The value of the proposed index of compliance, %CC/mmHg, needs to be evaluated in the clinical setting. However, from the view of validation of ICP instrumentation, high values of both mean ICP and mean %CC/mmHg are contradictory and indicative of the occurrence of instrumentation error due to electronic direct current drift.

Research paper thumbnail of Introduction. Machine learning in neurosurgery: transitioning to a new era of contemporary medicine

Neurosurgical Focus, Jun 1, 2023

R apid technological evolution has transformed clinical practice, constituting big data and artif... more R apid technological evolution has transformed clinical practice, constituting big data and artificial intelligence as omnipresent tools in the medical arsenal and creating extraordinary potential and unprecedented challenges. The paradigm shift witnessed by the healthcare sector as a result of the mass digitization of information has organically permeated neurosurgery. In recent years, surgical innovation compounded by clinical expertise, in conjunction with novel data-processing techniques, has enabled meaningful advancements in the application of machine learning in neurosurgery. This issue of Neurosurgical Focus embodies a representation of the progress in translating machine learning algorithms into clinical practice. The articles included in this issue invariably resonate with the drive to recruit artificial intelligence to address impactful questions, derive meaningful outcomes, and achieve personalized patient management. The authors study current machine learning models, evaluate novel algorithms, and discuss approaches to appraising machine learning techniques in neurosurgery. Machine learning in neurosurgery extends beyond the mere synthesis of existing research and exemplifies the power of merging information technology with medical science to transition clinical practice to a new era of contemporary medicine. In our attempt to open this Pandora's box, we hope to provide a long-lasting reference for clinicians and scientists, stimulate scientific thought, and provide a framework for a fruitful conversation on a highly complicated and challenging topic. We immensely appreciate the contributing authors' work in undertaking the formidable task of unraveling the highly convoluted role of machine learning in neurosurgery.