This preprint is under consideration at Neurosurgical Review. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research Article
Alexandre Roux
GHU Paris: Groupe Hospitalier Universitaire Paris psychiatrie & neurosciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9597-673X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objective
We assessed the role of the general condition of the patient in addition to usual anatomical reasoning to improve the prediction of personalized surgical risk for patients harbouring a large and giant petroclival meningiomas.
Methods
Single-center, retrospective observational study including adult patients surgically treated for a large and giant petroclival meningioma between January 2002 and October 2019 in a French tertiary neurosurgical skull-base center by one Neurosurgeon. Inclusion criteria were: 1) histopathologically proven meningioma; 2) larger than 3cm in diameter; 2) located within the upper two-thirds of the clivus, the inferior petrosal sinus, or the petrous apex around the trigeminal incisura, medial to the trigeminal nerve. Clinical and radiological characteristics were gathered preoperatively including ASA score, the modified Frailty Index and the Charlson Comorbidity Index. Post-operative severe neurological and non-neurological complications were collected.
Results
A total of 102 patients harbouring a large and giant petroclival meningioma were included. The rate of postoperative death was 3.0% related to a congestive heart failure (n=1), a surgical site hematoma (n=1), and an ischemic stroke (n=1). A severe neurological impairment was found in 12.8% and a severe non-neurological morbidity was found in 4.0%. The overall rate of severe morbidity and mortality was 15.7% after large and giant petroclival meningioma surgery. The presence of brainstem peri-tumoral edema (adjusted OR, 4.83 [95% CI 1.84–7.52], p=0.028) was independently associated with a history of postoperative severe neurological morbidity. Male gender (adjusted OR, 7.42 [95% CI 1.05–49.77], p=0.044), major cardiovascular morbidity (adjusted OR, 9.5 [95% CI 1.05–86.72], p=0.045), and an ASA score ≥ 2 (adjusted OR, 11.09 [95% CI 1.46–92.98], p=0.038) were independently associated with a history of postoperative severe non-neurological morbidity. A modified Frailty index ≥ 1 (adjusted OR, 3.13 [95% CI 1.07–9.93], p=0.047), and a low neurosurgical experience (adjusted OR, 5.38 [95% CI 1.38–20.97], p=0.007) were independently associated with a history of postoperative overall morbidity and mortality.
Conclusions
This study suggests to add scores assessing the patient general condition in daily practice to improve the selection of patients eligible for surgery. Collaborative international multicenter studies will be necessary to confirm these results and allow their implementation in clinical routine.
Keywords
Petroclival meningioma, Morbidity, Risk factors, General condition, Surgery
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Subject Areas
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This preprint is under consideration at Neurosurgical Review. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Alexandre Roux
GHU Paris: Groupe Hospitalier Universitaire Paris psychiatrie & neurosciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9597-673X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 15 Mar, 2021
No community comments so far
Reviewers invited
Invitations sent on 04 Mar, 2021
Review #? received
Received 04 Mar, 2021
Editor assigned
On 01 Mar, 2021
First submitted
On 27 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Neurosurgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objective
We assessed the role of the general condition of the patient in addition to usual anatomical reasoning to improve the prediction of personalized surgical risk for patients harbouring a large and giant petroclival meningiomas.
Methods
Single-center, retrospective observational study including adult patients surgically treated for a large and giant petroclival meningioma between January 2002 and October 2019 in a French tertiary neurosurgical skull-base center by one Neurosurgeon. Inclusion criteria were: 1) histopathologically proven meningioma; 2) larger than 3cm in diameter; 2) located within the upper two-thirds of the clivus, the inferior petrosal sinus, or the petrous apex around the trigeminal incisura, medial to the trigeminal nerve. Clinical and radiological characteristics were gathered preoperatively including ASA score, the modified Frailty Index and the Charlson Comorbidity Index. Post-operative severe neurological and non-neurological complications were collected.
Results
A total of 102 patients harbouring a large and giant petroclival meningioma were included. The rate of postoperative death was 3.0% related to a congestive heart failure (n=1), a surgical site hematoma (n=1), and an ischemic stroke (n=1). A severe neurological impairment was found in 12.8% and a severe non-neurological morbidity was found in 4.0%. The overall rate of severe morbidity and mortality was 15.7% after large and giant petroclival meningioma surgery. The presence of brainstem peri-tumoral edema (adjusted OR, 4.83 [95% CI 1.84–7.52], p=0.028) was independently associated with a history of postoperative severe neurological morbidity. Male gender (adjusted OR, 7.42 [95% CI 1.05–49.77], p=0.044), major cardiovascular morbidity (adjusted OR, 9.5 [95% CI 1.05–86.72], p=0.045), and an ASA score ≥ 2 (adjusted OR, 11.09 [95% CI 1.46–92.98], p=0.038) were independently associated with a history of postoperative severe non-neurological morbidity. A modified Frailty index ≥ 1 (adjusted OR, 3.13 [95% CI 1.07–9.93], p=0.047), and a low neurosurgical experience (adjusted OR, 5.38 [95% CI 1.38–20.97], p=0.007) were independently associated with a history of postoperative overall morbidity and mortality.
Conclusions
This study suggests to add scores assessing the patient general condition in daily practice to improve the selection of patients eligible for surgery. Collaborative international multicenter studies will be necessary to confirm these results and allow their implementation in clinical routine.
Figure 1
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