RESUMEN
A cerebral arteriovenous malformation (AVM) is a tangle of abnormal blood vessels that irregularly connects arteries and veins. Stereotactic radiosurgery (SRS) has been shown to be an effective treatment for AVM patients, but the factors associated with AVM obliteration remains a matter of debate. In this study, we aimed to develop a model that can predict whether patients with AVM will be cured 36 months after intervention by means of SRS and identify the most important predictors that explain the probability of being cured. A machine learning (ML) approach was applied using decision tree (DT) and logistic regression (LR) techniques on historical data (sociodemographic, clinical, treatment, angioarchitecture, and radiosurgery procedure) of 202 patients with AVM who underwent SRS at the Instituto de Radiocirugía del Perú (IRP) between 2005 and 2018. The LR model obtained the best results for predicting AVM cure with an accuracy of 0.92, sensitivity of 0.93, specificity of 0.89, and an area under the curve (AUC) of 0.98, which shows that ML models are suitable for predicting the prognosis of medical conditions such as AVM and can be a support tool for medical decision-making. In addition, several factors were identified that could explain whether patients with AVM would be cured at 36 months with the highest likelihood: the location of the AVM, the occupation of the patient, and the presence of hemorrhage.
RESUMEN
Presentamos un caso poco frecuente de hidatidosis de columna vertebral dorso-lumbar. La paciente es una adolescente de 15 años de edad procedente de Chincha, Ica, que por cuadro de dolor lumbar persistente y Paraparesia severa progresiva de un año de evolución es transferida al Hospital Maria Auxiliadora. Las radiografías, tomografías computadas y estudios de RMN mostraron imágenes quísticas vertebrales múltiples a nivel L1 y L2 con invasión severa del canal vertebral las que fueron informadas como probable quiste óseo aneurismático. La paciente fue intervenida con exploración percutánea previa y precauciones apropiadas para cirugía exploratoria y descompresiva, evidenciándose múltiples vesículas quísticas compatibles con hidatidosis espinal, la que fue confirmada posteriormente por anatomía patológica. La recuperación clínica fue paulatina y sin recidiva quística mostrando total recuperación con último control a los 4 años de la intervención.