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Guo ZQ, Xia XY, Cao D, Chen X, He Y, Wang BF, Guo DS, Chen J. A nomogram for predicting the risk of major postoperative complications for patients with meningioma. Neurosurg Rev 2023; 46:288. [PMID: 37907646 DOI: 10.1007/s10143-023-02198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/25/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To identify risk factors for major postoperative complications in meningioma patients and to construct and validate a nomogram that identify patients at high risk of these complications. METHODS The medical records of meningioma patients who underwent surgical resection in our hospital from January 2018 to December 2020 were collected. The patients were divided into a training set (815 cases from the main campus in 2018 and 2019) and a validation set (300 cases from two other campuses in 2020). Major postoperative complications were defined as any new neurological deficits and complications classified as Clavien-Dindo Grading (CDG) II or higher. Univariate and multivariate analyses were conducted using the training set to identify independent risk factors. A nomogram was constructed based on these results. And then validated the nomogram through bootstrap re-sampling in both the training and validation sets. The concordance index (C-index) and the area under the curve (AUC) were used to assess the discriminative ability of the nomogram. The Hosmer-Lemeshow test was performed to evaluate the goodness-of-fit. The optimal cutoff point for the nomogram was calculated using Youden's index. RESULTS In the training set, 135 cases (16.56%) experienced major postoperative complications. The independent risk factors identified were male sex, recurrent tumors, American Society of Anesthesiologists (ASA) class III-IV, preoperative Karnofsky Performance Scale (KPS) score < 80, preoperative serum albumin < 35 g/L, tumor in the skull base or central sulcus area, subtotal tumor resection (STR), allogeneic blood transfusion, and larger tumor size. A nomogram was constructed based on these risk factors. It demonstrated good predictive performance, with a C-index of 0.919 for the training set and 0.872 for the validation set. The area under the curve (AUC) > 0.7 indicated satisfactory discriminative ability. The Hosmer-Lemeshow test showed no significant deviation from the predicted probabilities. And the cutoff for nomogram total points was about 200 (specificity 0.881 and sensitivity 0.834). CONCLUSIONS The constructed nomogram demonstrated robust predictive performance for major postoperative complications in meningioma patients. This model can be used by surgeons as a reference in clinical decision-making.
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Affiliation(s)
- Zheng-Qian Guo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Yu Xia
- Department of Psychology, Wuchang Hospital, Wuhan, China
| | - Dan Cao
- Department of Neurocritical Care Unit, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Xu Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue He
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bao-Feng Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Dong-Sheng Guo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Jian Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Telera S, Gazzeri R, Villani V, Raus L, Giordano FR, Costantino A, Delfinis CP, Piludu F, Sperduti I, Pace A. Surgical treatment of cerebellar metastases in elderly patients: A threshold that moves forward? World Neurosurg X 2023; 18:100164. [PMID: 36818737 PMCID: PMC9932212 DOI: 10.1016/j.wnsx.2023.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
The impact of surgery for cerebellar brain metastases in elderly population has been the object of limited studies in literature. Given the increasing burden of their chronic illnesses, the decision to recommend surgery remains difficult. All patients aged ≥65 years, who underwent surgical resection of a cerebellar brain metastasis from May 2000 and May 2021 at IRCCS National Cancer Institute "Regina Elena", were analyzed. The study cohort includes 48 patients with a mean age of 70.8 years. 7 patients belonged to the II Class according to the RPA classification, 41 to the III Class; the median GPA classification was 1.5. Median pre-operative and post-operative KPS was 60. Median Charlson Comorbidity Index (CCI) was 11; median 5-variable modified Frailty Index was 2. Overall, 14 patients (29%) presented perioperative neurologic and systemic complications. 34 patients (71%) were able to perform adjuvant therapies as RT and/or CHT after surgery. A higher CCI predicted complications occurrence (p = 0.044), while significant factors for a post-operative KPS ≥70, were i) hemispheric location of the metastasis, ii) higher pre-operative KPS, iii) RPA II classification. Median Overall Survival was 7 months. A post-operative KPS <70 (p = 0.004) and a short time interval between diagnosis of the primary tumor and cerebellar metastasis appearance, were predictive for a worse outcome (p = 0.012). Our study suggests that selected elderly patients with cerebellar metastases may benefit from microsurgery to continue their adjuvant therapies, although a high complications rate should be taken in account.
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Affiliation(s)
- Stefano Telera
- UOSD Neurosurgery, IRCCS National Cancer Institute Regina Elena, Rome, Italy,Corresponding author. Neurosurgery, IRCCS National Cancer Institute Regina Elena , Rome, Italy.
| | - Roberto Gazzeri
- UOSD Pain Therapy, San Giovanni Addolorata Hospital, Rome, Italy
| | - Veronica Villani
- UOSD Neuro-Oncology, IRCCS National Cancer Institute Regina Elena, Rome, Italy
| | - Laura Raus
- UOSD Neurosurgery, IRCCS National Cancer Institute Regina Elena, Rome, Italy
| | | | - Alessandra Costantino
- UOC Anesthesia and Intensive Care, IRCCS National Cancer Institute Regina Elena, Rome, Italy
| | | | - Francesca Piludu
- UOC Radiology and Diagnostic Imaging, IRCCS National Cancer Institute Regina Elena, Rome, Italy
| | - Isabella Sperduti
- UOC Biostatistics, IRCCS National Cancer Institute Regina Elena, Rome, Italy
| | - Andrea Pace
- UOSD Neuro-Oncology, IRCCS National Cancer Institute Regina Elena, Rome, Italy
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Richardson GE, Islim AI, Albanese E, Ahmed A, Aly A, Ammar A, Amoo M, Bhatt H, Bodkin P, Coulter I, Corr P, Elmaadawi I, Elserius A, Fountain DM, George KJ, Gillespie CS, Goel A, Grundy PL, Gurusinghe N, Hartley J, Hasan MT, Javadpour M, Kalra N, Mallucci C, Millward CP, Mohamed B, Mohamed S, Mustafa MA, Nannapaneni R, Nolan D, Patel UJ, Piper RJ, Rajaraman C, Raza-Knight S, Rehman K, Rominiyi O, Sage W, Sharouf F, Sinha S, Sitaraman M, Smith S, Solth A, Stokes S, Taweel BA, Tyagi A, Zaben M, Jenkinson MD, Prasad M. Neurosurgery activity levels in the United Kingdom and republic of Ireland during the first wave of the covid-19 pandemic - a retrospective cross-sectional cohort study. Br J Neurosurg 2021:1-6. [PMID: 34472417 DOI: 10.1080/02688697.2021.1968341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/11/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022]
Abstract
The impact of Covid-19 on surgical patients worldwide has been substantial. In the United Kingdom (UK) and the Republic of Ireland (RoI), the first wave of the pandemic occurred in March 2020. The aims of this study were to: (1) evaluate the volume of neurosurgical operative activity levels, Covid-19 infection rate and mortality rate in April 2020 with a retrospective cross-sectional cohort study conducted across 16 UK and RoI neurosurgical centres, and (2) compare patient outcomes in a single institution in April-June 2020 with a comparative cohort in 2019. Across the UK and RoI, 818 patients were included. There were 594 emergency and 224 elective operations. The incidence rate of Covid-19 infection was 2.6% (21/818). The overall mortality rate in patients with a Covid-19 infection was 28.6% (6/21). In the single centre cohort analysis, an overall reduction in neurosurgical operative activity by 65% was observed between 2020 (n = 304) and 2019 (n = 868). The current and future impact on UK neurosurgical operative activity has implications for service delivery and neurosurgical training.
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Affiliation(s)
- George E Richardson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Abdurrahman I Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Erminia Albanese
- Department of Neurosurgery, North Staffordshire Hospital Trust, Stoke on Trent, UK
| | - Ahmed Ahmed
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ahmed Aly
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Amr Ammar
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | - Michael Amoo
- Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | - Harsh Bhatt
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Peter Bodkin
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ian Coulter
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Paula Corr
- Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | | | - Anne Elserius
- Department of Neurosurgery, North Staffordshire Hospital Trust, Stoke on Trent, UK
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - K Joshi George
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Conor S Gillespie
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Aimee Goel
- Department of Neurosurgery, North Staffordshire Hospital Trust, Stoke on Trent, UK
| | - Paul L Grundy
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Jessica Hartley
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Md Tanvir Hasan
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Mohsen Javadpour
- Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | - Neeraj Kalra
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Christopher P Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Belal Mohamed
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Saffwan Mohamed
- Department of Neurosurgery, The James Cook University Hospital, Middlesbrough, UK
| | - Mohammad A Mustafa
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | | | - Deirdre Nolan
- Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | - Umang J Patel
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | | | | | - Kafeel Rehman
- Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Ola Rominiyi
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - William Sage
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | - Feras Sharouf
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Saurabh Sinha
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Stuart Smith
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | - Anna Solth
- Department of Neurosurgery, Ninewells Hospital, Dundee, UK
| | - Stuart Stokes
- Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Basel A Taweel
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Atul Tyagi
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Malik Zaben
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Manjunath Prasad
- Department of Neurosurgery, The James Cook University Hospital, Middlesbrough, UK
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Lai PF, Wu X, Lan SH, Tang B, Huang HY, Hong T. Anatomical study of a surgical approach through the neck to the jugular foramen under endoscopy. Surg Radiol Anat 2020; 43:251-260. [PMID: 32959079 DOI: 10.1007/s00276-020-02574-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 09/12/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the feasibility of an endoscopic surgical approach through the neck to the jugular foramen, to determine the relevant techniques and extent of exposure, and to provide a new surgical approach with minimal trauma. METHODS Nine cadaveric head specimens with attached necks were fixed with 10% formalin solution. Two of the heads were fixed and injected with colored silicone rubber. Through the dissection of these cadaver head and neck specimens, we designed a surgical approach from the neck to the jugular foramen area with the use of a neuroendoscope and performed simulated surgery to determine which anatomical structures were encountered in the approach. RESULTS The posterior aspect of the internal jugular vein is adjacent to the rectus capitis lateralis. The internal carotid artery is anteromedial to the internal jugular vein, with the glossopharyngeal nerve, accessory nerve, vagus nerve and hypoglossal nerve in between. Removal of the rectus capitis lateralis can reveal the jugular process, and exposing the space between the superior oblique muscle and the jugular process can reveal the atlanto-occipital joint. Drilling through the occipital condyle can facilitate entrance into the skull, expose the flank of the medulla oblongata, and reveal the medullary olive and accessory nerve, vagus nerve, hypoglossal nerve, vertebral artery and posterior inferior cerebellar artery. Removing the jugular vein and completely opening the posterior wall of the jugular foramen can expose the inferior wall of the jugular bulb and the inferior wall of the sigmoid sinus. Drilling through the styloid process, which is lateral to the internal jugular vein, can expose the lateral area and upper wall of the jugular bulb and cranial nerves (CN) IX-XII; and near the top of the jugular bulb, the tympanic cavity and the external auditory canal can be easily opened. CONCLUSION Endoscopic surgical access from the neck to the jugular foramen is feasible. This surgical approach can simultaneously remove intracranial and extracranial tumors and can also be used to remove tumors in the ventral region of the occipital foramen and the hypoglossal canal. Furthermore, this approach is advantageous in that minimal trauma is inflicted. With judicious patient selection, this approach may have significant advantages and may be used as a primary or secondary surgical approach in the future. Nonetheless, this approach is still in development in a laboratory setting, and further research and improvements are needed before facing more complicated situations in clinical practice.
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Affiliation(s)
- Peng Fei Lai
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, Jiangxi, China
| | - Xiao Wu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, Jiangxi, China
| | - Shi Hai Lan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, Jiangxi, China
| | - Bin Tang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, Jiangxi, China
| | - Hui Yan Huang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, Jiangxi, China
| | - Tao Hong
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, Jiangxi, China.
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