scholarly journals Does General Comorbidity Impact the Postoperative Outcomes After Surgery for Large and Giant Petroclival Meningiomas?

2021 ◽  
Author(s):  
Alexandre Roux ◽  
Lucas Troude ◽  
Guillaume Baucher ◽  
Florian Bernard ◽  
Johan Pallud ◽  
...  
Keyword(s):  
General Condition ◽  
Frailty Index ◽  
Petrous Apex ◽  
Multicenter Studies ◽  
Petroclival Meningioma ◽  
Asa Score ◽  
Petroclival Meningiomas ◽  
Neurological Morbidity ◽  
History Of ◽  
Modified Frailty Index

Abstract ObjectiveWe 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.MethodsSingle-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.ResultsA 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.ConclusionsThis 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.

5-Item Modified Frailty Index Predicts Outcomes After Below-Knee Amputation in the Vascular Quality Initiative Amputation Registry

2020 ◽  
Vol 86 (10) ◽  
pp. 1225-1229
Author(s):  
James C. Andersen ◽  
Joshua A. Gabel ◽  
Kristyn A. Mannoia ◽  
Sharon C. Kiang ◽  
Sheela T. Patel ◽  
...  
Keyword(s):  
Frailty Index ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Frailty Status ◽  
Knee Amputation ◽  
Point Increase ◽  
Increased Risk ◽  
History Of ◽  
Modified Frailty Index

Patient frailty indices are increasingly being utilized to anticipate post-operative complications. This study explores whether a 5-factor modified frailty index (mFI-5) is associated with outcomes following below-knee amputation (BKA). All BKAs in the vascular quality initiative (VQI) amputation registry from 2012-2017 were reviewed. Preoperative frailty status was determined with the mFI-5 which assigns one point each for history of diabetes, chronic obstructive pulmonary disease or active pneumonia, congestive heart failure, hypertension, and nonindependent functional status. Outcomes included 30-day mortality, unplanned return to odds ratio (OR), post-op myocardial infarction (MI), post-op SSI, all-cause complication, revision to higher level amputation, disposition status, and prosthetic use. 2040 BKAs were performed. Logistic regression showed an increasing mFI-5 score that was associated with higher risk of combined complications (OR 1.22, confidence interval [CI] 1.07-1.38, P < .05), 30-day mortality (OR 1.60, CI 1.19-2.16, P < .05), post-op MI (OR 1.79, CI 1.30-2.45, P < .05), and failure of long-term prosthetic use (OR 1.17, CI 1.03-1.32, P < .05). In the VQI, every one-point increase in mFI-5 is associated with an increased risk of 22% for combined complications, 60% for 30-day mortality, nearly 80% for post-op MI, and 17% for failure of prosthetic use in BKA patients. The mFI-5 frailty index should be incorporated into preoperative planning and risk stratification.

Pre-operative risk assessment by ASA score and modified Frailty Index (mFI) in oncological and non oncological urological surgery

2019 ◽  
Vol 18 (1) ◽  
pp. e1559
Author(s):  
V. Serretta ◽  
F. Muffoletto ◽  
G. Tulone ◽  
S. Dioguardi ◽  
C. Guzzardo ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Frailty Index ◽  
Operative Risk ◽  
Asa Score ◽  
Urological Surgery ◽  
Modified Frailty Index

scholarly journals MP10-12 COMPARISON BETWEEN THE ASA SCORE AND THE MODIFIED FRAILTY INDEX (MFI) IN UROLOGIC ONCOLOGICAL AND NON ONCOLOGICAL UROLOGICAL INTERVENTIONAL PROCEDURES

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Vincenzo Serretta ◽  
Francesco Muffoletto ◽  
Gabriele Tulone ◽  
Salvatore Dioguardi ◽  
Calogero Guzzardo ◽  
...  
Keyword(s):  
Interventional Procedures ◽  
Frailty Index ◽  
Asa Score ◽  
Modified Frailty Index

scholarly journals Resection of middle petroclival meningioma via combined anterior transpetrosal and retrosigmoid approaches at two separate stages: 3D operative video

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. V12 ◽  
Author(s):  
Ihsan Dogan ◽  
Pinar Eser Ocak ◽  
G. Mark Pyle ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Male Patient ◽  
Individual Case ◽  
Surgical Approaches ◽  
Petroclival Meningioma ◽  
The Past ◽  
Surgical Access ◽  
Petroclival Meningiomas ◽  
Wide Range ◽  
History Of

Surgical access to the petroclival region poses a challenge to neurosurgeons. A wide range of approaches has been demonstrated in the past. In this video, the authors present a 69-year-old male patient who presented with 3-month history of worsening left-sided numbness. The tumor was totally removed in 2 sessions via anterior transpetrosal and retrosigmoid approaches, respectively. The authors demonstrate 2 separate skull base approaches to resect a petroclival meningioma and discuss pitfalls and problems of management for challenging meningiomas. The authors suggest that surgical approaches to petroclival meningiomas should be selected based on an individual case. A skull base team should be versatile in performing all these approaches.The video can be found here: https://youtu.be/BCVrn3TeNvE.

The Natural History of Petroclival Meningioma: A Volumetric Study

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Matthew Carlson ◽  
Jacob Hunter ◽  
Robert Yawn ◽  
Ray Wang ◽  
Brendan O'Connell ◽  
...  
Keyword(s):  
Natural History ◽  
Petroclival Meningioma ◽  
Volumetric Study ◽  
History Of

scholarly journals Frailty predicts outcome of partial nephrectomy and guides treatment decision towards active surveillance and tumor ablation

2021 ◽  
Author(s):  
M. T. Walach ◽  
M. F. Wunderle ◽  
N. Haertel ◽  
J. K. Mühlbauer ◽  
K. F. Kowalewski ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Surgical Outcome ◽  
Frailty Index ◽  
Treatment Decision ◽  
Solitary Kidney ◽  
Tumor Ablation ◽  
Renal Masses ◽  
Skeletal Muscle Index ◽  
Decision Tools ◽  
Modified Frailty Index

Abstract Purpose To examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA). Methods Frailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with localized renal masses. Renal tumor anatomy was classified according to the RENAL nephrometry system. Regression analyses were performed to assess predictors of surgical outcome of patients undergoing NSS as well as to identify possible influencing factors of patients undergoing alternative therapies (AS/TA). Results Overall 409 patient underwent NSS while 38 received AS or TA. Patients undergoing TA/AS were more likely to be frail or comorbid compared to patients undergoing NSS (aaCCI: p < 0.001, 11-CSHA: p < 0.001). Gender and tumor complexity did not vary between patients of different treatment approach. 11-CSHA and aaCCI were identified as independent predictors of major postoperative complications (11-CSHA ≥ 0.27: OR = 3.6, p = 0.001) and hospital re-admission (aaCCI ≥ 6: OR = 4.93, p = 0.003) in the NSS cohort. No impact was found for albumin levels and SMI. An aaCCI > 6 and/or 11-CSHA ≥ 0.27 (OR = 9.19, p < 0.001), a solitary kidney (OR = 5.43, p = 0.005) and hypoalbuminemia (OR = 4.6, p = 0.009), but not tumor complexity, were decisive factors to undergo AS or TA rather than NSS. Conclusion In patients with localized renal masses, frailty and comorbidity indices can be useful to predict surgical outcome and support decision-making towards AS or TA.

Surgical Management of Petroclival Meningiomas: Defining Resection Goals Based on Risk of Neurological Morbidity and Tumor Recurrence Rates in 137 Patients

Neurosurgery ◽  
2005 ◽  
Vol 56 (3) ◽  
pp. 546-559 ◽  
Author(s):  
Kenneth M. Little ◽  
Allan H. Friedman ◽  
John H. Sampson ◽  
Masahiko Wanibuchi ◽  
Takanori Fukushima
Keyword(s):  
Cranial Nerve ◽  
Tumor Recurrence ◽  
Critical Role ◽  
Recurrence Rates ◽  
Total Resection ◽  
Petroclival Region ◽  
Petroclival Meningiomas ◽  
Increased Risk ◽  
Neurological Morbidity

Abstract OBJECTIVE: Meningiomas arising from the petroclival region remain a challenging surgical problem. Because of the substantial risk of neurological morbidity, uniformly pursuing a gross total resection (GTR) to minimize tumor recurrence rates may not be justified. We sought to define optimal resection goals based on risk factors for postoperative neurological morbidity and tumor recurrence rates. METHODS: This series represents our experience with 137 meningiomas arising from the petroclival region resected between June 1993 and October 2002. There were 38 male and 99 female patients with a mean age of 53 years. RESULTS: GTR was achieved in 40% of patients, and near total resection (NTR) was achieved in 40% of patients. One operative death occurred. Twenty-six percent of patients experienced new postoperative cranial nerve deficits, paresis, or ataxia when assessed at a mean follow-up of 8.3 months. The risk of cranial nerve deficits increased with prior resection (P &lt; 0.001), preoperative cranial nerve deficit (P = 0.005), tumor adherence to neurovascular structures (P = 0.046), and fibrous tumor consistency (P = 0.005). The risk of paresis or ataxia increased with prior resection (P = 0.001) and tumor adherence (P = 0.045). Selective NTR rather than GTR in patients with adherent or fibrous tumors significantly reduced the rate of neurological deficits. Radiographic recurrence or progression occurred in 17.6% of patients at a mean follow-up of 29.8 months. Tumor recurrence rates after GTR and NTR did not differ significantly (P = 0.111). CONCLUSION: Intraoperatively defined tumor characteristics played a critical role in identifying the subset of patients with an increased risk of postoperative deficits. By selectively pursuing an NTR rather than a GTR, neurological morbidity was reduced significantly without significantly increasing the rate of tumor recurrence.

Evolution of Surgical Approaches in the Treatment of Petroclival Meningiomas: A Retrospective Review

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS202-ONS211 ◽  
Author(s):  
Nicholas C. Bambakidis ◽  
U. Kumar Kakarla ◽  
Louis J. Kim ◽  
Peter Nakaji ◽  
Randall W. Porter ◽  
...  
Keyword(s):  
Survival Rates ◽  
Progression Free Survival ◽  
Surgical Approaches ◽  
Single Institution ◽  
Short Term ◽  
Total Resection ◽  
Free Survival ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas

Abstract Objective: We examined the surgical approaches used at a single institution to treat petroclival meningioma and evaluated changes in method utilization over time. Methods: Craniotomies performed to treat petroclival meningioma between September of 1994 and July of 2005 were examined retrospectively. We reviewed 46 patients (mean follow-up, 3.6 yr). Techniques included combined petrosal or transcochlear approaches (15% of patients), retrosigmoid craniotomies with or without some degree of petrosectomy (59% of patients), orbitozygomatic craniotomies (7% of patients), and combined orbitozygomatic-retrosigmoid approaches (19% of patients). In 18 patients, the tumor extended supratentorially. Overall, the rate of gross total resection was 43%. Seven patients demonstrated progression over a mean of 5.9 years. No patients died. At 36 months, the progression-free survival rate for patients treated without petrosal approaches was 96%. Of 14 patients treated with stereotactic radiosurgery, none developed progression. Conclusion: Over the study period, a diminishing proportion of patients with petroclival meningioma were treated using petrosal approaches. Utilization of the orbitozygomatic and retrosigmoid approaches alone or in combination provided a viable alternative to petrosal approaches for treatment of petroclival meningioma. Regardless of approach, progression-free survival rates were excellent over short-term follow-up period.

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