Evaluation Of Presurgical Outcome Predictors In Oncological Neurosurgery.

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-09-27 DOI:10.1016/j.wneu.2025.124518

Michela E Moretti, Morgan Broggi, Marco Schiariti, Francesco Restelli, Edoardo M Barbieri, Marco M Fontanella, Davide Maltoni, Antonio Fioravanti, Cesare Zoia, Andrea Montalbetti, Matilde Leonardi, Giorgia Camarda, Elisabetta Soldini, Leonardo Maresca, Luca Mattioli, Riccardo Ciocca, Erica Boccardi, Francesco Dimeco, Paolo Ferroli

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引用次数: 0

Abstract

Background: Brain tumor (BT) resection carries a significant risk of postoperative functional impairment. Existing surgical complexity scales (e.g., Milan Complexity Scale) do not account for factors such as preoperative tumoral edema or deep tumor location (DTL), which may influence outcome. This study evaluates whether these variables improve prediction of six-month postoperative functional outcomes.

Methods: We conducted a prospective multicenter cohort study including 231 patients undergoing BT resection. Preoperative variables (tumor size, eloquence, deep location, vascular/cranial nerve manipulation, posterior fossa location, edema) were collected. Functional status was assessed preoperatively and six months postoperatively using the Karnofsky Performance Scale (KPS) and modified Rankin Scale (mRS). Patients were grouped based on whether their six-month KPS/mRS scores worsened versus remained stable/improved. Correlations and multivariate logistic regression identified predictors of functional decline. Hierarchical clustering explored risk combinations.

Results: Among 231 patients, 59% had tumors located in eloquent areas, 18% in DTL and 39% presented with edema. Both preoperative edema and DTL were significantly associated with functional deterioration at six months. Multivariate analysis identified edema (p=0.011), eloquent region involvement (p=0.037), vascular manipulation (p=0.040), tumor size >4 cm (p=0.041) and DTL (p=0.046) as independent predictors of decline. Cluster analysis showed that combinations of adverse factors-particularly edema, large size, deep or posterior fossa location, and neurovascular manipulation-were associated with the highest risk of poor outcomes.

Conclusions: Preoperative tumoral edema and DTL are underrecognized predictors of functional deterioration after BT surgery. Their inclusion in preoperative risk models could enhance prognostic accuracy and guide surgical decision-making in neuro-oncology.

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肿瘤神经外科手术预后预测因素的评价。

背景：脑肿瘤（BT）切除术具有显著的术后功能损害风险。现有的手术复杂性量表（如Milan复杂性量表）没有考虑术前肿瘤水肿或深部肿瘤位置（DTL）等可能影响预后的因素。本研究评估这些变量是否能改善对术后6个月功能预后的预测。方法：我们进行了一项前瞻性多中心队列研究，包括231例接受BT切除术的患者。收集术前变量（肿瘤大小、口才、深部位置、血管/颅神经操作、后窝位置、水肿）。术前和术后6个月采用Karnofsky功能量表（KPS）和改良Rankin量表（mRS）评估功能状态。根据患者的六个月KPS/mRS评分是恶化还是保持稳定/改善进行分组。相关性和多变量逻辑回归确定了功能衰退的预测因子。分层聚类探索风险组合。结果：231例患者中肿瘤位于雄辩区59%，DTL 18%，水肿39%。术前水肿和DTL均与6个月时的功能恶化显著相关。多因素分析发现水肿（p=0.011）、雄辩区受累（p=0.037）、血管操作（p=0.040）、肿瘤大小bbb4cm （p=0.041）和DTL （p=0.046）是衰退的独立预测因素。聚类分析显示，不良因素的组合——特别是水肿、大尺寸、深窝或后窝位置以及神经血管操作——与不良结果的最高风险相关。结论：术前肿瘤水肿和DTL是未被充分认识的BT手术后功能恶化的预测因素。将其纳入术前风险模型可以提高预后准确性并指导神经肿瘤学手术决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS