{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:01:48Z","timestamp":1780131708945,"version":"3.54.0"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Given that resection of brainstem cavernous malformations (BSCMs) ends hemorrhaging but carries a high risk of neurological deficits, it is necessary to develop and validate a model predicting surgical outcomes. This study aimed to construct a BSCM surgery outcome prediction model based on clinical characteristics and T2-weighted MRI-based radiomics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Two separate cohorts of patients undergoing BSCM resection were included as discovery and validation sets. Patient characteristics and imaging data were analyzed. An unfavorable outcome was defined as a modified Rankin Scale score &gt; 2 at the 12-month follow-up. Image features were extracted from regions of interest within lesions and adjacent brainstem. A nomogram was constructed using the risk score from the optimal model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The discovery and validation sets comprised 218 and 49 patients, respectively (mean age 40 \u00b1 14 years, 127 females); 63 patients in the discovery set and 35 in the validation set had an unfavorable outcome. The eXtreme Gradient Boosting imaging model with selected radiomics features achieved the best performance (area under the receiver operating characteristic curve [AUC] 0.82). Patients were stratified into high- and low-risk groups based on risk scores computed from this model (optimal cutoff 0.37). The final integrative multimodal prognostic model attained an AUC of 0.90, surpassing both the imaging and clinical models alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Inclusion of BSCM and brainstem subregion imaging data in machine learning models yielded significant predictive capability for unfavorable postoperative outcomes. The integration of specific clinical features enhanced prediction accuracy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.4.focus24778","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T02:14:48Z","timestamp":1751336088000},"page":"E7","source":"Crossref","is-referenced-by-count":2,"title":["A multiregional multimodal machine learning model for predicting outcome of surgery for symptomatic hemorrhagic brainstem cavernous malformations"],"prefix":"10.3171","volume":"59","author":[{"given":"Xuchen","family":"Dong","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haohuai","family":"Gui","sequence":"additional","affiliation":[{"name":"School of Information Science and Technology, Fudan University, Shanghai;"},{"name":"Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Quan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zongze","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Xiao","sequence":"additional","affiliation":[{"name":"School of Information Science and Technology, Fudan University, Shanghai;"},{"name":"Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxi","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Information Science and Technology, Fudan University, Shanghai;"},{"name":"Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchuan","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Information Science and Technology, Fudan University, Shanghai;"},{"name":"Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongdong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Huashan Hospital, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingjian","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haojing","family":"Duan","sequence":"additional","affiliation":[{"name":"Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoxuan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolei","family":"Lin","sequence":"additional","affiliation":[{"name":"Huashan Institute of Medicine, Huashan Hospital, Shanghai;"},{"name":"School of Data Science, Fudan University, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Ma","sequence":"additional","affiliation":[{"name":"School of Information Science and Technology, Fudan University, Shanghai;"},{"name":"Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Neurosurgery","first-page":"573","article-title":"Cavernous malformation of brainstem, thalamus, and basal ganglia: a series of 176 patients","volume":"72","author":"Pandey P","year":"2013","unstructured":"Pandey P, Westbroek EM, Gooderham PA, Steinberg GK. Cavernous malformation of brainstem, thalamus, and basal ganglia: a series of 176 patients. Neurosurgery. 2013;72(4):573\u2013588."},{"issue":"3","key":"b2","series-title":"J Neurosurg","first-page":"917","article-title":"Natural history of brainstem cavernous malformations: prospective hemorrhage rate and adverse factors in a consecutive prospective cohort","volume":"134","author":"Li D","year":"2021","unstructured":"Li D, Wu ZY, Liu PP,  Natural history of brainstem cavernous malformations: prospective hemorrhage rate and adverse factors in a consecutive prospective cohort. J Neurosurg. 2021;134(3):917\u2013928."},{"issue":"1","key":"b3","series-title":"J Neurosurg","first-page":"32","article-title":"Hemorrhage risks and functional outcomes of untreated brainstem cavernous malformations: clinical article","volume":"121","author":"Li DA","year":"2014","unstructured":"Li DA, Hao SYU, Jia GJ, Wu Z, Zhang LIW, Zhang JT. 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Brainstem and cerebellar changes after cerebrovascular accidents: magnetic resonance imaging. Eur Radiol. 2006;16(3):592\u2013597."},{"issue":"1","key":"b26","series-title":"BMC Neurol","first-page":"409","article-title":"Hypertrophic olivary degeneration concomitant with bilateral middle cerebellar peduncles Wallerian degeneration following unilateral pontine infarction","volume":"20","author":"Bao B","year":"2020","unstructured":"Bao B, Wu X, Xia Z, Shen Y. Hypertrophic olivary degeneration concomitant with bilateral middle cerebellar peduncles Wallerian degeneration following unilateral pontine infarction. BMC Neurol. 2020;20(1):409\u2013404."},{"issue":"4","key":"b1","series-title":"Neurosurgery","first-page":"573","article-title":"Cavernous malformation of brainstem, thalamus, and basal ganglia: a series of 176 patients","volume":"72","author":"Pandey P","year":"2013","unstructured":"Pandey P, Westbroek EM, Gooderham PA, Steinberg GK. 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Hemorrhage risks and functional outcomes of untreated brainstem cavernous malformations: clinical article. J Neurosurg. 2014;121(1):32\u201341."},{"key":"b4","series-title":"Neurology","first-page":"1984","article-title":"Natural history of cavernous malformation: systematic review and meta-analysis of 25 studies","volume":"86 (21)","author":"Taslimi S","year":"2016","unstructured":"Taslimi S, Modabbernia A, Amin-Hanjani S,  Natural history of cavernous malformation: systematic review and meta-analysis of 25 studies. Neurology. 2016;86 (21):1984-1991."},{"issue":"12","key":"b5","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1366","article-title":"A risk factor analysis of prospective symptomatic haemorrhage in adult patients with cerebral cavernous malformation","volume":"85","author":"Jeon JS","year":"2014","unstructured":"Jeon JS, Kim JE, Chung YS,  A risk factor analysis of prospective symptomatic haemorrhage in adult patients with cerebral cavernous malformation. 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