Which Clinical, Radiological, Inflammatory, and Lesion-Related Characteristics Are Associated with Early Neurological Decompensation After Intracranial Mass Lesion Surgery?

Abstract

Background: Early neurological decompensation is a clinically relevant concern following intracranial surgery, but factors associated with this early outcome remain incompletely characterized. This study evaluated factors associated with neurological decompensation within 48 h after surgery. Methods: This retrospective, single-center study included 301 surgical episodes involving intracranial mass lesions. Early neurological decompensation was defined as a ≥2-point decrease in Glasgow Coma Scale (GCS) score, the development of a new neurological deficit, or the objective worsening of a pre-existing deficit within 48 h. Clinical, radiological, lesion-related, and hematological factors were evaluated using logistic regression and ROC analyses, with bootstrap internal validation. Results: Early neurological decompensation occurred in 63 surgical episodes (20.9%). Preoperative Karnofsky Performance Status (KPS) was independently associated with the outcome (aOR = 0.50; 95% CI: 0.38-0.67 per 10-point increase; corresponding per-1-point aOR = 0.93; 95% CI: 0.91-0.96; p < 0.001), while peritumoral edema showed a statistically significant but imprecisely estimated association (aOR = 5.10; 95% CI: 1.14-22.79; p = 0.033). In extended models, malignant lesion category and peripheral contrast enhancement were independently associated with the outcome, whereas NLR was not after multivariable adjustment. The primary model had an AUC of 0.793 and a bootstrap-corrected AUC of 0.777. Conclusions: Preoperative KPS showed the most consistent independent association with early neurological decompensation. Additional radiological and lesion-related factors did not demonstrate significant incremental discrimination beyond KPS alone. External validation is required before clinical application.