Neurocirugia (English Edition)最新文献

{"title":"Evaluation of the last 2 decades in the characteristics of presentation, management and prognosis of serious spontaneous intracerebral hemorrhage in a third level hospital","authors":"Francisco Javier Morán Gallego ,&nbsp;Marcelino Sanchez Casado ,&nbsp;Ismael López de Toro Martin Consuegra ,&nbsp;Luis Marina Martinez ,&nbsp;Javier Alvarez Fernandez ,&nbsp;María José Sánchez Carretero","doi":"10.1016/j.neucie.2023.11.001","DOIUrl":"10.1016/j.neucie.2023.11.001","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the change in the characteristics of presentation, evolution and treatment in the ICU, as well as the functional evolution at 12 months of spontaneous intracranial hemorrhages (ICHs) treated in an ICU reference center.</p></div><div><h3>Patient and methods</h3><p>Descriptive, retrospective study in a Neurocritical Reference Hospital. All admissions of patients with HICE during three periods are studied: 1999–2001 (I), 2015–2016 (II) and 2020–2021 (III). Evolution in the three periods of demographic variables, baseline characteristics of the patients, clinical variables and characteristics of bleeding, evolutionary data in the ICU are studied. At one year we assessed the GOS scale (Glasgow Outcome Score) according to whether they had a poor (GOS 1−3) or good (GOS 4−5) prognosis.</p></div><div><h3>Results</h3><p>300 admitted patients, distributed in periods: I: 28.7%, II: 36.3% and III: 35%. 56.7% were males aged 66 (55.5–74) years; ICH score 2 (1−3). The ICU stay was 5 (2–14) days with a mortality of 36.8%. GOS 1−3 a year in 67.3% and GOS 4−5 in 32.7%. Comparing the three periods, we observed a higher prevalence in women, and the presence of cardiovascular factors; no changes in etiology; in relation to the location, it increases cerebellar hemorrhage and in the brainstem. Although the severity was greater, the stay in the ICU, the use of invasive mechanical ventilation and tracheostomy were lower. Open surgery has decreased its use by 50%. Mortality continues to be high, stagnating in the ICU at 35% and entails a high degree of disability one year after assessment.</p></div><div><h3>Conclusions</h3><p>Severe ICH is a complex pathology that has changed some characteristics in the last two decades, with more severe patients, with more cardiovascular history and a greater predominance of brainstem and cerebellar hemorrhage. Despite the increase in severity, better parameters during the ICU stay, with open surgery used 50% less. Mortality remains stagnant at 35% with high disability per year.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 4","pages":"Pages 169-176"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for shunt-dependent hydrocephalus after spontaneous subarachnoid hemorrhage","authors":"Loreto Esteban Estallo,&nbsp;Juan Casado Pellejero,&nbsp;Silvia Vázquez Sufuentes,&nbsp;Laura Beatriz López López,&nbsp;David Fustero de Miguel,&nbsp;Luis Manuel González Martínez","doi":"10.1016/j.neucie.2024.03.002","DOIUrl":"10.1016/j.neucie.2024.03.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Subarachnoid haemorrhage (SAH) is one of the most frequent neurosurgical emergencies, most of them due to intracranial aneurysm rupture. Hydrocephalus is a prevalent complication with a high rate of complications. The aims of this study are to identify predictors of shunt-dependent hydrocephalus following aneurysmal SAH and to quantify the complications arising from ventriculoperitoneal shunts.</p></div><div><h3>Methods</h3><p>This study is about an observational retrospective analytic study of the patients with spontaneous SAH admitted to Miguel Servet Universitary Hospital between 2017 and 2022. Patients’ clinical and radiological characteristics, type of treatment, diagnoses and treatment of hydrocephalus, complications of ventriculoperitoneal shunts and mortality are some of the data achieved in this study. A descriptive study of these variables has been done and, subsequently, the most relevant variables have been statistically analysed to identify patients with increasing risk of shunting for hydrocephalus. This study was authorized by the Ethics Committee prior to its elaboration.</p></div><div><h3>Results</h3><p>A total of 359 patients with spontaneous SAH were admitted to Miguel Servet Universitary Hospital between 2017 and 2022, with an intrahospitalary death rate of 25.3%. 66.3% of the total of patients with SAH were due to intracranial aneurysm rupture (<em>n</em> = 238). 45.3% of the patients with aneurysmal SAH required an external ventricular drain (EVD) to treat acute hydrocephalus. 11.7% (<em>n</em> = 28) developed a shunt-dependent hydrocephalus. Statistical significance was found between shunt-dependent hydrocephalus and the following: high score in modified Fisher scale and placement of EVD. The mean interval from EVD to ventriculoperitoneal shunt placement was 26.1 days. The mean rate of reoperation of patients after shunt was 17.7%, mostly due to infection.</p></div><div><h3>Conclusions</h3><p>The most significant risk factor for shunt-dependent hydrocephalus after aneurysmal SAH was high Fisher grade and previous need of EVD. Shunt infections is the main cause of shunt reoperation. Early shunt placement in selected patients might reduce the rate of infectious complications.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 4","pages":"Pages 196-204"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous congestive encephalopathy secondary to arteriovenous fistula aggravated by cerebrospinal fluid shunt","authors":"Juan Casado Pellejero,&nbsp;Silvia Vázquez Sufuentes,&nbsp;Laura Beatriz López López,&nbsp;Rosario Barrena Caballo","doi":"10.1016/j.neucie.2024.03.001","DOIUrl":"10.1016/j.neucie.2024.03.001","url":null,"abstract":"<div><p>We present a unique clinical case of venous congestive encephalopathy in the context of a cerebral arteriovenous fistula with clinical worsening secondary to valvular overdrainage.</p><p>ICP monitoring, the different pressure settings of the programable CSF shunt and the detailed clinical description that is carried out offer us enough data to understand that this case provides important pathophysiological knowledge to a little-known disease.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 4","pages":"Pages 210-214"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral micro-orbitotomy as the technique of choice for orbital pseudotumor in IgG4-RD. Case report and review of the literature","authors":"Gema Bravo-Garrido ,&nbsp;Jose María Narro-Donate ,&nbsp;Gabriel María Valdenebro-Cuadrado ,&nbsp;José Masegosa-González","doi":"10.1016/j.neucie.2024.05.001","DOIUrl":"10.1016/j.neucie.2024.05.001","url":null,"abstract":"<div><p>Immunoglobulin G4-related disease (IgG4-RD) is characterized by a systemic fibroinflammatory infiltrate that often involves the orbit in addition to other tissues. Thus it has to be considered in the differential diagnosis of orbital tumors. We report the clinical case of a 64-year-old woman who presented with right mydriasis, progressive proptosis and paralysis of the third cranial nerve of 1 year of evolution. Cranial MRI identified an intraconal lesion of the right orbit, located between the external and inferior rectus muscles and the optic nerve, and she was scheduled for surgery by transcranial approach with lateral micro-orbitomy. A satisfactory macroscopic excision was achieved with no remarkable complications and a definitive deferred histological result of pseudotumor by IgG4-RD. Follow-up for 24 months showed no tumor recurrence, and the patient clinically improved from ophthalmoplegia. This case highlights the efficacy of lateral orbitotomy in the etiologic diagnosis and successful therapeutic outcome of complex orbital lesions associated with IgG4-RD pseudotumor.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 4","pages":"Pages 215-220"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring fenestrated aneurysm clips intraoperatively: Instant solution for a difficult problem","authors":"Pinar Eser,&nbsp;Ismail Seckin Kaya,&nbsp;Oguz Altunyuva,&nbsp;Hasan Kocaeli","doi":"10.1016/j.neucie.2023.09.002","DOIUrl":"10.1016/j.neucie.2023.09.002","url":null,"abstract":"<div><p>The anterior communicating artery (AcoA) aneurysms represent the most complex aneurysms of the anterior circulation. For years, surgical challenges including the intricate anatomy and narrow surgical corridor have been overcome using supplementary techniques including extended craniotomies, wide opening of the cisterns, gyrus rectus resection and special clips like fenestrated clips. However, imaginative solutions such as intraoperative clip modification may be inevitable in particular cases for safe clipping.</p><p>We retrospectively analyzed clinical records of two patients who required clip modification intraoperatively.</p><p>Case #1 underwent microsurgical clipping of a ruptured, 4-mm AcoA aneurysm. Unfortunately, given the short distance between the two A2s, it was not possible to clip the aneurysm without a compromise to the contralateral A2 with the available shortest 3<!--> <!-->mm-fenestrated clip. We then used the clip modification technique intraoperatively by shortening the clip tips with mesh-plaque cutter and smoothening the remaining sharp ends using cautery sanding. Eventually, the aneurysm was clipped successfully with the modified-fenestrated clip. Post-clipping imagings confirmed complete occlusion of the aneurysm and patency of parent arteries. Case 2# underwent microsurgical clipping for a ruptured, 1-mm AcoA aneurysm. Like Case 1#, the initial clipping attempt with the available shortest 4<!--> <!-->mm-fenestrated clip failed given the excessive length of the tips. The patient, thus, required clip modification as described above. The aneurysm was then clipped successfully using the modified-fenestrated clip, protecting bilateral A2s. Post-clipping imagings demonstrated patency of parent arteries with no residual aneurysm filling.</p><p>Clip modification seems to be an effective option in clipping the AcoA aneurysms when available clips are too long to secure them safely.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 4","pages":"Pages 205-209"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endonasal versus supraorbital approach for anterior skull base meningiomas: Results and quality of life assessment from a single-surgeon cohort","authors":"Jorge Torales ,&nbsp;Alberto Di Somma ,&nbsp;Isam Alobid ,&nbsp;Mauricio Lopez ,&nbsp;Jhon Hoyos ,&nbsp;Abel Ferres ,&nbsp;Ruben Morillas ,&nbsp;Luis Reyes ,&nbsp;Pedro Roldan ,&nbsp;Ricard Valero ,&nbsp;Joaquim Enseñat","doi":"10.1016/j.neucie.2023.12.001","DOIUrl":"10.1016/j.neucie.2023.12.001","url":null,"abstract":"<div><h3>Objective</h3><p>In this prospective non-randomized study we reported our experience related to planum sphenoidale (PS) and tuberculum sellae<span> (TS) meningiomas in a similar cohort of patients operated via the endonasal or the supraorbital route. A comprehensive quality of life analysis has been performed.</span></p></div><div><h3>Methods</h3><p><span>Being comparable in general features, between November 2017 to January 2020, a total of 20 patients with anterior skull base meningioma were included. Hence, 10 patients were treated using the supraorbital keyhole procedure (SO) while 10 patients received an endoscopic endonasal approach (EEA). Both surgical techniques were analyzed and compared. </span>Quality of life has been analyzed with the SF-36 questionnaire.</p></div><div><h3>Results</h3><p>Twenty patients were identified who underwent either EEA (n<!--> <!-->=<!--> <!-->10) or SO (n<!--> <!-->=<!--> <span>10). The average extent of resection achieved was not significantly different between the 2 groups. Post-operatively, the EEA group demonstrated a longer hospital stay and bed days compared with SO patients as well as a longer surgical time. There was a significant rate of more CSF leakage after EEA then after SO (20% vs 0%, p</span> <!-->=<!--> <!-->0,0491). The follow-up period resulted shorter in the SO group, with a slight increased recurrence rate. Overall, no differences in visual outcome were detected. There were no differences in terms of quality of life between the two groups in all the explored items.</p></div><div><h3>Conclusions</h3><p><span>In this single-center single-surgeon study of similarly sized and located PS and TS meningiomas, EEA showed longer hospital stays with higher degree of CSF leak compared with the SO group. Supraorbital craniotomy via eyebrow </span>incision reported a comparable quality of life results, even if with a slightly higher percentage of recurrence and less follow-up.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 4","pages":"Pages 177-185"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric atlas anatomy and its implications for fracture treatment: an anatomical and radiological study","authors":"Lucie Salavcová ,&nbsp;Jan Štulík ,&nbsp;Vojtěch Štulík ,&nbsp;Michaela Rybárová ,&nbsp;Gábor Geri ,&nbsp;Ondřej Naňka","doi":"10.1016/j.neucie.2024.01.001","DOIUrl":"10.1016/j.neucie.2024.01.001","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>The objective of the study was: (1) to describe changes in the shape of the atlas during growth, including gender and side differences; (2) to assess the dimension essential for identification of the optimal entry point; (3) to determine the age limit for a safe insertion of 3.5-mm screws into the lateral masses according to our own limiting parameters.</p></div><div><h3>Materials and methods</h3><p>Dimensions of the atlas were measured on 200 CT scans of the craniocervical junction in individuals aged 0–18 years and on 34 anatomical specimens of the first cervical vertebra (aged 2.5–18 years). Both series were divided according to the gender and age. The values measured on CT scans were used for statistical comparison of data in boys and girls and comparison of the right and left sides.</p></div><div><h3>Results</h3><p>The atlas reaches its maximum growth rate between 0 and 2 years of age, then the growth decelerates and continues until the age of 18 years. The proportion of dimensions of C1 vertebral foramens changes with age. The youngest children show a relatively greater distance from the left to the right medial pedicle; around the age of 5 the values get even and subsequently the distance from the inner wall of anterior to posterior arch gets relatively greater. The transverse foramen has a slightly oval shape throughout the period of growth. Statistically significant differences between boys and girls were observed primarily between 12 and 18 years of age.</p></div><div><h3>Conclusion</h3><p>The study has proved adequate size of lateral masses for insertion of 3.5-mm screws in all patients from the age of 5 years. In younger children, the patient´s anatomy should be respected and the surgical technique tailored accordingly.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 4","pages":"Pages 186-195"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the importance of the endoscope in the sealing of the superior canal dehiscence syndrome, how we do it","authors":"Carlos Doval-Rosa ,&nbsp;Francisco Javier Dorado-Capote ,&nbsp;Alvaro Toledano-Delgado ,&nbsp;Jose Miguel Sequí-Sabater ,&nbsp;Román Carlos-Zamora ,&nbsp;Juan Solivera-Vela","doi":"10.1016/j.neucie.2024.05.002","DOIUrl":"10.1016/j.neucie.2024.05.002","url":null,"abstract":"<div><p>The superior canal dehiscence syndrome is a pathology that affects the arcuate eminence creating a “third window” between the inner ear and the middle fossa. This condition can lead to symptoms such as hearing loss, autophony, or sound-induced vertigo. Traditionally, surgical treatment has been performed by microscope-assisted temporal craniotomy, but when the dehiscence is in the medial part of the arcuate eminence the bone defect may not be seen.</p><p>We present case series treated at our institution diagnosed of superior canal dehiscence syndrome involving the medial slope of the arcuate eminence. During surgery, the bone defect could not be visible with traditional microscopic techniques. Nonetheless, by introducing the endoscope with the 0º and 30º optics, the dehiscence could be clearly observed and treated correctly.</p><p>Our results show a clinical improvement without side effects or complications in the patients undergoing this technique. Endoscope-assisted surgery is a safe procedure and provides a better visualization of medial defects.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 4","pages":"Pages 221-224"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative risk factors for major complications after bone replacement in decompressive craniectomy","authors":"Antonio Montalvo-Afonso,&nbsp;José Manuel Castilla-Díez,&nbsp;Vicente Martín-Velasco,&nbsp;Javier Martín-Alonso,&nbsp;Rubén Diana-Martín,&nbsp;Pedro David Delgado-López","doi":"10.1016/j.neucie.2024.03.003","DOIUrl":"10.1016/j.neucie.2024.03.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Bone flap replacement after a decompressive craniectomy is a low complexity procedure, but with complications that can negatively impact the patient's outcome. A better knowledge of the risk factors for these complications could reduce their incidence.</p></div><div><h3>Patients and methods</h3><p>A retrospective review of a series of 50 patients who underwent bone replacement after decompressive craniectomy at a tertiary center over a 10-year period was performed. Those clinical variables related to complications after replacement were recorded and their risk factors were analyzed.</p></div><div><h3>Results</h3><p>A total of 18 patients (36%) presented complications after bone flap replacement, of which 10 (55.5%) required a new surgery for their treatment. Most of the replacements (95%) were performed in the first 90 days after the craniectomy, with a tendency to present more complications compared to the subsequent period (37.8% vs 20%, <em>p</em> &gt; 0.05). The most frequent complication was subdural hygroma, which appeared later than infection, the second most frequent complication. The need for ventricular drainage or tracheostomy and the mean time on mechanical ventilation, ICU admission, or waiting until bone replacement were greater in patients who presented post-replacement complications. Previous infections outside the nervous system or the surgical wound was the only risk factor for post-bone flap replacement complications (<em>p</em> = 0.031).</p></div><div><h3>Conclusions</h3><p>Postoperative complications were recorded in more than a third of the patients who underwent cranial bone flap replacement, and at least half of them required a new surgery. A specific protocol aimed at controlling previous infections could reduce the risk of complications and help establish the optimal time for cranial bone flap replacement.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 3","pages":"Pages 145-151"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting histological grade in symptomatic meningioma by an objective estimation of the tumoral surface irregularity","authors":"Pedro David Delgado-López,&nbsp;Antonio Montalvo-Afonso,&nbsp;Javier Martín-Alonso,&nbsp;Vicente Martín-Velasco,&nbsp;Rubén Diana-Martín,&nbsp;José Manuel Castilla-Díez","doi":"10.1016/j.neucie.2023.10.002","DOIUrl":"10.1016/j.neucie.2023.10.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Predicting the histopathologic grade of meningioma is relevant because local recurrence is significantly greater in WHO grade II–III compared to WHO grade I tumours, which would ideally benefit from a more aggressive surgical strategy. It has been suggested that higher WHO grade tumours are more irregularly-shaped. However, irregularity is a subjective and observer-dependent feature. In this study, the tumour surface irregularity of a large series of meningiomas, measured upon preoperative MRI, is quantified and correlated with the WHO grade.</p></div><div><h3>Methods</h3><p>Unicentric retrospective observational study of a cohort of symptomatic meningiomas surgically removed in the time period between January 2015 and December 2022. Using specific segmentation software, the Surface Factor (SF) was calculated for each meningioma. SF is an objective parameter that compares the surface of a sphere (minimum surface area for a given volume) with the same volume of the tumour against the actual surface of the tumour. This ratio varies from 0 to 1, being 1 the maximum sphericity. Since irregularly-shaped meningiomas present proportionally greater surface area, the SF tends to decrease as irregularity increases. SF was correlated with WHO grade and its predictive power was estimated with ROC curve analysis.</p></div><div><h3>Results</h3><p>A total of 176 patients (64.7% females) were included in the study; 120 WHO grade I (71.9%), 43 WHO grade II (25.7%) and 4 WHO grade III (2.4%). A statistically significant difference was found between the mean SF of WHO grade I and WHO grade II–III tumours (0.8651 ± 0.049 versus 0.7081 ± 0.105, <em>p</em><span> &lt; 0.0001). Globally, the SF correctly classified more than 90% of cases (area under ROC curve 0.940) with 93.3% sensibility and 80.9% specificity. A cutoff value of 0.79 yielded the maximum precision, with positive and negative predictive powers of 82.6% and 92.6%, respectively. Multivariate analysis<span> yielded SF as an independent prognostic factor of WHO grade.</span></span></p></div><div><h3>Conclusion</h3><p>The <em>Surface Factor</em> is an objective and quantitative parameter that helps to identify aggressive meningiomas preoperatively. A cutoff value of 0.79 allowed differentiation between WHO grade I and WHO grade II–III with high precision.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 3","pages":"Pages 113-121"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139513354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}