Meningiomas de la base de cráneo. Un sistema predictivo para conocer las posibilidades de su extirpación y pronóstico
Skull base meningiomas: a predictive system to know the extent of their surgical resection and patient outcome
F. Morales
, A. Maillo, A. Díaz-Álvarez, M. Merino, A. Muñoz-Herrera, J. Hernández, D. Santamarta
Servicio de Neurocirugia. Hospital Universitario de Salamanaca
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Un sistema predictivo para conocer las posibilidades de su extirpación y pronóstico</span> de Morales y cols" "tienePdf" => "es" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "485" ] ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Vilalta" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Vilalta" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147305703754?idApp=UINPBA00004B" "url" => "/11301473/0000001600000006/v1_201305151247/S1130147305703754/v1_201305151247/es/main.assets" ] "es" => array:15 [ "idiomaDefecto" => true "titulo" => "Meningiomas de la base de cráneo. Un sistema predictivo para conocer las posibilidades de su extirpación y pronóstico" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "477" "paginaFinal" => "485" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Morales, A. Maillo, A. Díaz-Álvarez, M. Merino, A. Muñoz-Herrera, J. Hernández, D. Santamarta" "autores" => array:7 [ 0 => array:3 [ "nombre" => "F." "apellidos" => "Morales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Maillo" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Díaz-Álvarez" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Merino" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Muñoz-Herrera" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Hernández" ] 6 => array:2 [ "nombre" => "D." "apellidos" => "Santamarta" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurocirugia. Hospital Universitario de Salamanaca" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Servicio de Neurocirugía. Hospital Universitario. Paseo de San Vicente, 58- 182. 37007 Salamanca." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Skull base meningiomas: a predictive system to know the extent of their surgical resection and patient outcome" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-10-14" "fechaAceptado" => "2005-03-17" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159066" "palabras" => array:3 [ 0 => "Meningiomas" 1 => "Base de cráneo" 2 => "Gradación extirpación quirúrgica" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159065" "palabras" => array:4 [ 0 => "Skull base" 1 => "Meningiomas" 2 => "Grading predicting system" 3 => "Outcome" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Encontrar un sistema predictivo que basándose únicamente en datos preoperatorios nos oriente, con fiabilidad, sobre : 1° qué meningiomas de la base de cráneo pueden ser extirpados total o parcialmente y 2° cual es su pronóstico postquirúrgico.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se ha revisado de forma retrospectiva, las historias clínicas e iconografías de 85 pacientes, con meningiomas de la base de cráneo, intervenidos entre 1990 al 2002. De ellas se han tomado nueve variables que han sido tratadas estadísticamente, mediante un test estándar, para correlacionarlas con: 1° resección total o parcial del tumor (Simpson, 5 grados) y 2° conocido el mencionado grado de resección total o parcial, éste se correlacionó con el pronóstico funcional postoperatorio del paciente (Karnofsky).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De las variables preoperatorios analizadas, solo dos demostraron tener una asociación significativa con la extirpación total o parcial del tumor, así como con el pronóstico postquirúrgico del paciente. Dichas variables fueron: a) las arterias englobadas por el tumor (p<span class="elsevierStyleHsp" style=""></span>= 0.001) y b) la afectación de pares craneales (p<<span class="elsevierStyleHsp" style=""></span>0.0001). Seguidamente, se conjugaron las diversas posibilidades de cada una de ellas para conocer el grado de extirpación tumoral (total o parcial). Para predecir el pronóstico funcional postoperatorio del enfermo, se relacionó la extirpación total o parcial con la escala de Karnofsky. De ambos análisis, grado de extirpación y pronóstico, se obtuvo el siguiente sistema de gradación:</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Grado I: meningiomas, de la base de cráneo, que no afectan a pares craneales ni engloban arterias o bien solamente afectan a un par craneal o engloban sólo una arteria.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En ellos las posibilidades de extirpación total se encuentran en un 98,3% (p<<span class="elsevierStyleHsp" style=""></span>0.0001) y las perspectivas de alcanzar 70 puntos en la escala de Karnofsky son de un 96,5%.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Grado II: meningiomas que afectan a un par craneal e incluyen dos o más arterias. La extirpación total en estos casos disminuye al 83,3% (p<<span class="elsevierStyleHsp" style=""></span>0.0001) y las perspectivas de alcanzar 70 puntos en la escala de Karnofsky descienden a un 70,6%.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Grado III: meningiomas que afectan dos o más pares craneales e incluyen varias arterias. En este grupo, las posibilidades de una extirpación total son de un 42,9% (p<<span class="elsevierStyleHsp" style=""></span>0.0001) con las perspectivas de alcanzar los 70 puntos en la escala de Karnofsky en sólo el 60%.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El sistema de gradación que se propone permite, en los casos de meningiomas de la base de cráneo: 1° predecir las posibilidades de una extirpación total o parcial y 2° conocer el pronóstico quirúrgico de los pacientes en cada grupo. Aplicando este sistema podremos reducir nuestra morbilidad quirúrgica, anticipar la necesidad de una terapia con radiocirugía y dar una información, más precisa, al paciente y familiares sobre nuestras propuestas quirúrgicas.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to build a preoperative predictive system which could provide reliable information about: 1° which skull base meningiomas can be total or partially removed, and 2° their surgical outcome.</p> <span class="elsevierStyleSectionTitle">Method</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient histories and imaging data were reviewed retrospectively from 85 consecutive skull base meningiomas patients who underwent surgery from 1990 and 2002. From the preoperative data, nine variables were selected for conventional statistical analysis as regards their relationship with: 1° total vs partial tumor resection and 2° with patients outcome according to the degree of tumour removal.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">From the nine variables analysed only two had a statistical association with the type of tumour resection performed (total vs partial) and the patient outcome: 1) arteries encasement and 2) cranial nerves involvement. Upon correlating these two variables with the type of tumour resection performed (total vs partial) and with the Karnofsky'scale to evaluate patients surgical outcome, the following grading groups were identified:</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Grade I: skull base meningiomas which did not involve cranial nerves or artery or only encased one artery or one cranial nerve. In these cases the incidence of gross tumour resection was 98,3% (p<<span class="elsevierStyleHsp" style=""></span>0.0001) and the perspective to reach 70 points in the Karnofsky'scale was of 96,5% (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Grade II: skull base meningiomas which involved one cranial nerve and encased, at least, two main cerebral arteries. In these cases, the frequency of total resection, decreased to 83,3% (p<<span class="elsevierStyleHsp" style=""></span>0.0001) and the probability to reach 70 points in the Karnofsky'scale was 70,6% (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Grade III: skull base meningiomas which involved two or more cranial nerves and encased several arteries In this group, the frequency of a total resection was of 42,9% (p<<span class="elsevierStyleHsp" style=""></span>0.0001) and the probability of reaching 70 points in the Karnofsky'scale was only 60% (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">We propose a preoperative grading system for skull base meningiomas that helps predicting both whether total or partial tumor removal will be achieved during surgery and the immediate postsurgical outcome of the patient. In applying this predictive system we will be able to reduce surgical morbidity, to advance the possibility of a radiosurgical treatment and give a more precise information to the patients and their families about our surgical decision-making process.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Morales, F.; Maillo, A.; Díaz-Álvarez, A.; Merino, M.; Muñoz-Herrera, A.; Hernández, J.; Santamarta, D.: Meningiomas de la base de cráneo. Un sistema predictivo para conocer las posibilidades de su extirpación y pronóstico. Neurocirugía 2005; 16: 477–485.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 1 | 3 | 4 |
| 2021 Mayo | 0 | 2 | 2 |
| 2021 Enero | 0 | 2 | 2 |
| 2018 Febrero | 6 | 1 | 7 |
| 2018 Enero | 18 | 5 | 23 |
| 2017 Diciembre | 8 | 7 | 15 |
| 2017 Noviembre | 48 | 9 | 57 |
| 2017 Octubre | 9 | 5 | 14 |
| 2017 Septiembre | 10 | 6 | 16 |
| 2017 Agosto | 9 | 7 | 16 |
| 2017 Julio | 10 | 4 | 14 |
| 2017 Junio | 9 | 4 | 13 |
| 2017 Mayo | 17 | 3 | 20 |
| 2017 Abril | 17 | 5 | 22 |
| 2017 Marzo | 12 | 3 | 15 |
| 2017 Febrero | 3 | 7 | 10 |
| 2017 Enero | 6 | 5 | 11 |
| 2016 Diciembre | 18 | 8 | 26 |
| 2016 Noviembre | 30 | 5 | 35 |
| 2016 Octubre | 26 | 20 | 46 |
| 2016 Septiembre | 22 | 3 | 25 |
| 2016 Agosto | 32 | 5 | 37 |
| 2016 Julio | 26 | 18 | 44 |
| 2015 Diciembre | 3 | 0 | 3 |
| 2015 Octubre | 1 | 0 | 1 |
| 2015 Julio | 1 | 7 | 8 |
| 2015 Junio | 14 | 7 | 21 |
| 2015 Mayo | 15 | 12 | 27 |
| 2015 Abril | 15 | 9 | 24 |
| 2015 Marzo | 12 | 13 | 25 |
| 2015 Febrero | 11 | 12 | 23 |
| 2015 Enero | 24 | 16 | 40 |
| 2014 Diciembre | 18 | 15 | 33 |
| 2014 Noviembre | 10 | 8 | 18 |
| 2014 Octubre | 15 | 18 | 33 |
| 2014 Septiembre | 15 | 14 | 29 |
| 2014 Agosto | 11 | 8 | 19 |
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| 2014 Junio | 21 | 19 | 40 |
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| 2014 Marzo | 18 | 12 | 30 |
| 2014 Febrero | 10 | 16 | 26 |
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| 2013 Diciembre | 14 | 10 | 24 |
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| 2013 Octubre | 15 | 20 | 35 |
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| 2013 Marzo | 8 | 12 | 20 |
| 2013 Febrero | 12 | 5 | 17 |
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| 2012 Diciembre | 6 | 9 | 15 |
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| 2012 Enero | 12 | 0 | 12 |
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