Pub Date : 2024-05-01DOI: 10.1016/j.neucir.2023.10.004
Herbert Daniel Jiménez Zapata, Adrián Fernández García, Carla Timisoara Amilburu Sáenz, Carlos Alberto Rodríguez Arias
Objective
To use third ventricle morphometric variables as a tool for the selection of patients with idiopathic normal pressure hydrocephalus (iNPH) who are candidates for ventriculoperitoneal shunts (VPS).
Material and methods
Retrospective study enrolling patients with iNPH. Katzman infusion test was performed and a Rout >12 mmHg/ml/min was considered a positive result. The transverse diameter and the volume of the third ventricle were measured in the preoperative MRI. Postoperative improvement was assessed with the NPH score. The results were analysed with SPSS software.
Results
Fifty-two patients with a mean age of 76 years were analysed. There was no difference in the diameter of the third ventricle among patients with a positive result and those with a negative result in the infusion test (12.28 mm vs. 11.68 mm; p = 0.14). Neither were difference detected in the ventricle volume of both groups (3.6 cm3 vs. 3.5 cm3; p = 0.66). Those patients who improved after VPS had a smaller third ventricle compared to those who did not respond after surgery (11.85 mm vs. 12.96 mm; p = 0.009). Diameter and volume of third ventricle present a significant strong correlation (Pearson correlation coefficient = 0.72; p < 0.0001).
Conclusion
Morphometric variables of third ventricle may be useful in predicting a good response to VPS in patients with idiopathic normal pressure hydrocephalus.
{"title":"Utilidad de la volumetría del tercer ventrículo en pacientes con hidrocefalia a presión normal","authors":"Herbert Daniel Jiménez Zapata, Adrián Fernández García, Carla Timisoara Amilburu Sáenz, Carlos Alberto Rodríguez Arias","doi":"10.1016/j.neucir.2023.10.004","DOIUrl":"10.1016/j.neucir.2023.10.004","url":null,"abstract":"<div><h3>Objective</h3><p>To use third ventricle morphometric variables as a tool for the selection of patients with idiopathic normal pressure hydrocephalus (iNPH) who are candidates for ventriculoperitoneal shunts (VPS).</p></div><div><h3>Material and methods</h3><p>Retrospective study enrolling patients with iNPH. Katzman infusion test was performed and a Rout<!--> <!-->>12<!--> <!-->mmHg/ml/min was considered a positive result. The transverse diameter and the volume of the third ventricle were measured in the preoperative MRI. Postoperative improvement was assessed with the NPH score. The results were analysed with SPSS software.</p></div><div><h3>Results</h3><p>Fifty-two patients with a mean age of 76 years were analysed. There was no difference in the diameter of the third ventricle among patients with a positive result and those with a negative result in the infusion test (12.28<!--> <!-->mm vs. 11.68<!--> <!-->mm; <em>p</em> <!-->=<!--> <!-->0.14). Neither were difference detected in the ventricle volume of both groups (3.6<!--> <!-->cm<sup>3</sup> vs. 3.5<!--> <!-->cm<sup>3</sup>; <em>p</em> <!-->=<!--> <!-->0.66). Those patients who improved after VPS had a smaller third ventricle compared to those who did not respond after surgery (11.85<!--> <!-->mm vs. 12.96<!--> <!-->mm; <em>p</em> <!-->=<!--> <!-->0.009). Diameter and volume of third ventricle present a significant strong correlation (Pearson correlation coefficient<!--> <!-->=<!--> <!-->0.72; <em>p</em> <!--><<!--> <!-->0.0001).</p></div><div><h3>Conclusion</h3><p>Morphometric variables of third ventricle may be useful in predicting a good response to VPS in patients with idiopathic normal pressure hydrocephalus.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 3","pages":"Pages 122-126"},"PeriodicalIF":0.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135714939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.neucir.2023.11.003
Alejandra Mosteiro , Diego Culebras , Alberto Vargas Solano , Javier Luis Moreno Negrete , Antonio López-Rueda , Laura Llull , Daniel Santana , Leire Pedrosa , Sergio Amaro , Ramón Torné , Joaquim Enseñat
Background
In spontaneous subarachnoid haemorrhage (SAH) accurate determination of the bleeding source is paramount to guide treatment. Traditionally, the bleeding pattern has been used to predict the aneurysm location. Here, we have tested a software-based tool, which quantifies the volume of intracranial blood and stratifies it according to the regional distribution, to predict the location of the ruptured aneurysm.
Methods
A consecutive series of SAH patients admitted to a single tertiary centre between 2012–2018, within 72 h of onset, harbouring a single intracranial aneurysm. A semi-automatized method of blood quantification, based on the relative density increase, was applied to initial non-contrast CTs. Five regions were used to define the bleeding patterns and to correlate them with aneurysm location: perimesencephalic, interhemispheric, right/left hemisphere and intraventricular.
Results
68 patients were included for analysis. There was a strong association between the distribution of blood and the aneurysm location (p < 0.001). In particular: ACom and interhemispheric fissure (p < 0.001), MCA and ipsilateral hemisphere (p < 0.001), ICA and ipsilateral hemisphere and perimesencephalic cisterns (p < 0.001), PCom and hemispheric, perimesencephalic and intraventricular (p = 0.019), and PICA and perimesencephalic and intraventricular (p < 0.001). The internal diagnostic value was high (AUROC ≥ 0.900) for these locations.
Conclusion
Regional automatised volumetry seems a reliable and objective tool to quantify and describe the distribution of blood within the subarachnoid spaces. This tool accurately predicts the location of the ruptured aneurysm; its use may be prospectively considered in the emergency setting when speed and simplicity are attained.
{"title":"Aneurysmal subarachnoid haemorrhage: Volumetric quantification of the blood distribution pattern to accurately predict the ruptured aneurysm location","authors":"Alejandra Mosteiro , Diego Culebras , Alberto Vargas Solano , Javier Luis Moreno Negrete , Antonio López-Rueda , Laura Llull , Daniel Santana , Leire Pedrosa , Sergio Amaro , Ramón Torné , Joaquim Enseñat","doi":"10.1016/j.neucir.2023.11.003","DOIUrl":"https://doi.org/10.1016/j.neucir.2023.11.003","url":null,"abstract":"<div><h3>Background</h3><p>In spontaneous subarachnoid haemorrhage (SAH) accurate determination of the bleeding source is paramount to guide treatment. Traditionally, the bleeding pattern has been used to predict the aneurysm location. Here, we have tested a software-based tool, which quantifies the volume of intracranial blood and stratifies it according to the regional distribution, to predict the location of the ruptured aneurysm.</p></div><div><h3>Methods</h3><p>A consecutive series of SAH patients admitted to a single tertiary centre between 2012–2018, within 72 h of onset, harbouring a single intracranial aneurysm. A semi-automatized method of blood quantification, based on the relative density increase, was applied to initial non-contrast CTs. Five regions were used to define the bleeding patterns and to correlate them with aneurysm location: perimesencephalic, interhemispheric, right/left hemisphere and intraventricular.</p></div><div><h3>Results</h3><p>68 patients were included for analysis. There was a strong association between the distribution of blood and the aneurysm location (p < 0.001). In particular: ACom and interhemispheric fissure (p < 0.001), MCA and ipsilateral hemisphere (p < 0.001), ICA and ipsilateral hemisphere and perimesencephalic cisterns (p < 0.001), PCom and hemispheric, perimesencephalic and intraventricular (p = 0.019), and PICA and perimesencephalic and intraventricular (p < 0.001). The internal diagnostic value was high (AUROC ≥ 0.900) for these locations.</p></div><div><h3>Conclusion</h3><p>Regional automatised volumetry seems a reliable and objective tool to quantify and describe the distribution of blood within the subarachnoid spaces. This tool accurately predicts the location of the ruptured aneurysm; its use may be prospectively considered in the emergency setting when speed and simplicity are attained.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 3","pages":"Pages 136-144"},"PeriodicalIF":0.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140816743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.neucir.2023.10.003
Pedro David Delgado-López, Antonio Montalvo-Afonso, Javier Martín-Alonso, Vicente Martín-Velasco, Rubén Diana-Martín, José Manuel Castilla-Díez
Introduction
Predicting the histopathologic grade of meningioma is relevant because local recurrence is significantly greater in WHO grade II–III compared to WHO grade I tumors, which would ideally benefit from a more aggressive surgical strategy. It has been suggested that higher WHO grade tumors are more irregularly-shaped. However, irregularity is a subjective and observer-dependent feature. In this study, the tumor surface irregularity of a large series of meningiomas, measured upon preoperative MRI, is quantified and correlated with the WHO grade.
Methods
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 tumor against the actual surface of the tumor. 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.
Results
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 tumors (0.8651 ± 0.049 versus 0.7081 ± 0.105, p < 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 yielded SF as an independent prognostic factor of WHO grade.
Conclusion
The surface factor 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.
导言：预测脑膜瘤的组织病理学分级具有重要意义，因为与WHO分级为I级的肿瘤相比，WHO分级为II-III级的肿瘤的局部复发率要高得多。有人认为，WHO 分级越高的肿瘤形状越不规则。然而，不规则是一种主观的、依赖观察者的特征。本研究对术前核磁共振成像测量的大量脑膜瘤的肿瘤表面不规则度进行了量化，并将其与WHO分级相关联。方法对2015年1月至2022年12月期间手术切除的一组无症状脑膜瘤进行了非中心回顾性观察研究。使用特定的分割软件计算每个脑膜瘤的表面因子（SF）。SF 是一个客观参数，用于比较具有相同体积肿瘤的球体表面（给定体积的最小表面积）与肿瘤的实际表面。该比率从 0 到 1 不等，1 为最大球形度。由于形状不规则的脑膜瘤表面积按比例增大，因此 SF 值会随着不规则程度的增加而减小。研究共纳入 176 名患者（64.7% 为女性），其中 120 名为 WHO I 级（71.9%），43 名为 WHO II 级（25.7%），4 名为 WHO III 级（2.4%）。WHO I级和WHO II-III级肿瘤的平均SF值差异有统计学意义（0.8651 ± 0.049对0.7081 ± 0.105，p <0.0001）。在全球范围内，SF 能对 90% 以上的病例进行正确分类（ROC 曲线下面积为 0.940），灵敏度为 93.3%，特异度为 80.9%。截断值为 0.79 的精确度最高，阳性和阴性预测能力分别为 82.6% 和 92.6%。结论表面因子是一个客观的定量参数，有助于术前识别侵袭性脑膜瘤。0.79的临界值可以高精度地区分WHO I级和WHO II-III级。
{"title":"Predicción del grado histológico en meningiomas sintomáticos mediante una estimación objetiva de la irregularidad de su superficie","authors":"Pedro David Delgado-López, Antonio Montalvo-Afonso, Javier Martín-Alonso, Vicente Martín-Velasco, Rubén Diana-Martín, José Manuel Castilla-Díez","doi":"10.1016/j.neucir.2023.10.003","DOIUrl":"10.1016/j.neucir.2023.10.003","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 tumors, which would ideally benefit from a more aggressive surgical strategy. It has been suggested that higher WHO grade tumors are more irregularly-shaped. However, irregularity is a subjective and observer-dependent feature. In this study, the tumor 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 tumor against the actual surface of the tumor. 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 tumors (0.8651<!--> <!-->±<!--> <!-->0.049 versus 0.7081<!--> <!-->±<!--> <!-->0.105, <em>p</em> <!--><<!--> <!-->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 yielded SF as an independent prognostic factor of WHO grade.</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":51145,"journal":{"name":"Neurocirugia","volume":"35 3","pages":"Pages 113-121"},"PeriodicalIF":0.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135371222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.neucir.2023.11.002
Carlos Roberto Vargas Gálvez, Omar López Arbolay, Marlon Manuel Ortiz Machín
Introduction
Skull base meningiomas constitute a complex group of skull base tumors. The endoscopic endonasal approaches (EEA) and endoscopic Keyhole have a minimally invasive philosophy with high effectiveness, safety, and a significant decrease in postoperative morbidity in these tumors.
Objective
To describe the results of the use of minimally invasive approaches to skull base meningiomas.
Method
A descriptive, retrospective study was carried out in 140 patients at the Hermanos Ameijeiras Hospital who underwent surgery for cranial base meningiomas using minimally invasive approaches to the cranial base. The degree of tumor resection, tumor recurrence, reinterventions, and complications were evaluated.
Results
EEA were used in 72.8% of the study, while endoscopic Keyholes were used in 26.4% and combined approaches in 0.7%. In relation to total tumor resection, 91.9% was generally achieved. Overall tumor recurrence and reinterventions were less than 8.5% and 4%, respectively. Complications in EEA were: cerebrospinal fluid fistula (2.1%), diabetes insipidus, hydrocephalus, cerebral infarction, surgical site hematoma, worsening of cranial nerves i-iv (1.4%) respectively. While in the Keyhole type approaches: seizures (2.9%), hydrocephalus (1.4%), cerebrospinal fluid fistula (1.4%), worsening of nerves ix-xii (0.7%).
Conclusions
The following study reaffirms that minimally invasive approaches for skull base meningiomas constitute advanced surgical techniques for these tumors, associated with a low rate of postoperative complications.
{"title":"Abordajes mínimamente invasivos para meningiomas de la base craneal","authors":"Carlos Roberto Vargas Gálvez, Omar López Arbolay, Marlon Manuel Ortiz Machín","doi":"10.1016/j.neucir.2023.11.002","DOIUrl":"10.1016/j.neucir.2023.11.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Skull base meningiomas constitute a complex group of skull base tumors. The endoscopic endonasal approaches (EEA) and endoscopic Keyhole have a minimally invasive philosophy with high effectiveness, safety, and a significant decrease in postoperative morbidity in these tumors.</p></div><div><h3>Objective</h3><p>To describe the results of the use of minimally invasive approaches to skull base meningiomas.</p></div><div><h3>Method</h3><p>A descriptive, retrospective study was carried out in 140 patients at the Hermanos Ameijeiras Hospital who underwent surgery for cranial base meningiomas using minimally invasive approaches to the cranial base. The degree of tumor resection, tumor recurrence, reinterventions, and complications were evaluated.</p></div><div><h3>Results</h3><p>EEA were used in 72.8% of the study, while endoscopic Keyholes were used in 26.4% and combined approaches in 0.7%. In relation to total tumor resection, 91.9% was generally achieved. Overall tumor recurrence and reinterventions were less than 8.5% and 4%, respectively. Complications in EEA were: cerebrospinal fluid fistula (2.1%), diabetes insipidus, hydrocephalus, cerebral infarction, surgical site hematoma, worsening of cranial nerves <span>i-iv</span> (1.4%) respectively. While in the Keyhole type approaches: seizures (2.9%), hydrocephalus (1.4%), cerebrospinal fluid fistula (1.4%), worsening of nerves <span>ix-xii</span> (0.7%).</p></div><div><h3>Conclusions</h3><p>The following study reaffirms that minimally invasive approaches for skull base meningiomas constitute advanced surgical techniques for these tumors, associated with a low rate of postoperative complications.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 3","pages":"Pages 127-135"},"PeriodicalIF":0.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139395926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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