Machine Learning Algorithms for Neurosurgical Preoperative Planning: A Comprehensive Scoping Review of the Literature

IntroductionPreoperative neurosurgical planning is a keen step to avoiding surgical complications, reducing morbidity, and improving patient safety. The incursion of machine learning (ML) in this domain has recently gained attention, given the notable advantages in processing large data sets and potentially generating efficient and accurate algorithms in patient care. ObjectiveTo evaluate the evolving applications of ML algorithms in the preoperative planning of brain and spine surgery. MethodsIn accordance with the Arksey and OMalley framework, a scoping review was conducted using three databases (Pubmed, Embase, and Web of Science). Articles that described the use of ML for preoperative planning in brain and spine surgery were included. Relevant data were collected regarding the neurosurgical field of application, patient baseline features, disease description, type of ML technology, studys aim, preoperative ML algorithm description, and advantages and limitations of ML algorithms. ResultsOur search strategy yielded 7,407 articles, of which 8 studies (5 retrospective, 2 prospective, and 1 experimental study) satisfied the inclusion criteria. Clinical information from 518 patients (62.7% female; mean age: 44.8 years) was used for generating ML algorithms, including convolutional neural network (14.3%), logistic regression (14.3%), random forest (14.3%), and other algorithms (Table 1). Neurosurgical fields of applications included functional neurosurgery (37.5%), tumor surgery (37.5%), and spine surgery (25%). The main advantages of ML included automated processing of clinical and imaging information, selection of an individualized patient surgical approach and data-driven support for treatment decision-making. All studies reported technical limitations, such as long processing time, algorithmic bias, limited generalizability, and the need for database updating and maintenance. O_TBL View this table: org.highwire.dtl.DTLVardef@cddb4corg.highwire.dtl.DTLVardef@f87cd7org.highwire.dtl.DTLVardef@1cc34e3org.highwire.dtl.DTLVardef@1a4346aorg.highwire.dtl.DTLVardef@16d4f47_HPS_FORMAT_FIGEXP M_TBL O_FLOATNOTable 1.C_FLOATNO O_TABLECAPTIONCharacteristics of included studies, demographics, and clinical information. AI: artificial intelligence; AIS: adolescent idiopathic scoliosis; CT: computed tomography; DBS: deep brain stimulation; DL: deep learning; ML: machine learning; MRI: magnetic resonance imaging; PC: principal components; VS: vestibular schwannoma; 3D: Tridimensional. C_TABLECAPTION C_TBL ConclusionML algorithms for preoperative neurosurgical planning are being developed for efficient, automated, and safe treatment decision-making. Enhancing the robustness, transparency, and understanding of ML applications will be crucial for their successful integration into neurosurgical practice.