Introduction. Adult hydrocephalus: advancements in diagnosis, treatment, and patient outcomes
Bibliographic record
Abstract
H ydrocepHalus in adults comprises a diverse grouping of etiologies, pathophysiology, diagnostic criteria, and treatment needs.Furthermore, hydrocephalus is more common in adults than in children, 1 and surgical procedures for hydrocephalus in adults in the US are annually performed almost five times more frequently compared with pediatric patients.2 A previously described pragmatic, clinically oriented organizational scheme helps to ensure we distinguish four types of patients within the spectrum of adult hydrocephalus: 1) transitional patients (previously diagnosed with hydrocephalus and treated as children), 2) patients with previously unrecognized congenital hydrocephalus, 3) patients with acquired hydrocephalus with an identifiable etiology (e.g., subarachnoid hemorrhage, cerebral trauma, or infection), and 4) patients with suspected or proven idiopathic normal pressure hydrocephalus. 3 There are distinct differences in these four patient groupings regarding diagnostic, treatment, and outcome issues.This is the third issue of Neurosurgical Focus since 2007 devoted to adult hydrocephalus, with the current emphasis on advancements in diagnosis, treatment, and patient outcomes.This issue provides an excellent overview of these essential topics.Two crucial messages can be identified.The first is that while treatment for adult hydrocephalus patients with CSF shunts is common, failure rates, despite being poorly reported, are significant, with shunt obstruction and infection remaining substantial issues to overcome.We need to standardize the mode and quality of said data to allow a better understanding of shunt failure-related issues.The second message is that efforts to enhance our ability to select adult patients with hydrocephalus who will benefit from treatment with shunt surgery are improving.Consequently, it is no longer sufficient to report outcomes only in terms of surgical technical success or complications.Instead, as shown in this issue, clinical hydrocephalus studies should, when possible, include patient-relevant and patient-centered measures such as cognition, mobility, urinary control, and quality of life.We hope that this issue will inspire readers to attend as much to the functional outcomes as they do to the surgical outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.017 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".