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        "titulo" => "Skull base meningiomas&#58; a predictive system to know the extent of their surgical resection and patient outcome"
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    "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 bas&#225;ndose &#250;nicamente en datos preoperatorios nos oriente&#44; con fiabilidad&#44; sobre &#58; 1&#176; qu&#233; meningiomas de la base de cr&#225;neo pueden ser extirpados total o parcialmente y 2&#176; cual es su pron&#243;stico postquir&#250;rgico&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se ha revisado de forma retrospectiva&#44; las historias cl&#237;nicas e iconograf&#237;as de 85 pacientes&#44; con meningiomas de la base de cr&#225;neo&#44; intervenidos entre 1990 al 2002&#46; De ellas se han tomado nueve variables que han sido tratadas estad&#237;sticamente&#44; mediante un test est&#225;ndar&#44; para correlacionarlas con&#58; 1&#176; resecci&#243;n total o parcial del tumor &#40;Simpson&#44; 5 grados&#41; y 2&#176; conocido el mencionado grado de resecci&#243;n total o parcial&#44; &#233;ste se correlacion&#243; con el pron&#243;stico funcional postoperatorio del paciente &#40;Karnofsky&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De las variables preoperatorios analizadas&#44; solo dos demostraron tener una asociaci&#243;n significativa con la extirpaci&#243;n total o parcial del tumor&#44; as&#237; como con el pron&#243;stico postquir&#250;rgico del paciente&#46; Dichas variables fueron&#58; a&#41; las arterias englobadas por el tumor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61; 0&#46;001&#41; y b&#41; la afectaci&#243;n de pares craneales &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; Seguidamente&#44; se conjugaron las diversas posibilidades de cada una de ellas para conocer el grado de extirpaci&#243;n tumoral &#40;total o parcial&#41;&#46; Para predecir el pron&#243;stico funcional postoperatorio del enfermo&#44; se relacion&#243; la extirpaci&#243;n total o parcial con la escala de Karnofsky&#46; De ambos an&#225;lisis&#44; grado de extirpaci&#243;n y pron&#243;stico&#44; se obtuvo el siguiente sistema de gradaci&#243;n&#58;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Grado I&#58; meningiomas&#44; de la base de cr&#225;neo&#44; que no afectan a pares craneales ni engloban arterias o bien solamente afectan a un par craneal o engloban s&#243;lo una arteria&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En ellos las posibilidades de extirpaci&#243;n total se encuentran en un 98&#44;3&#37; &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; y las perspectivas de alcanzar 70 puntos en la escala de Karnofsky son de un 96&#44;5&#37;&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Grado II&#58; meningiomas que afectan a un par craneal e incluyen dos o m&#225;s arterias&#46; La extirpaci&#243;n total en estos casos disminuye al 83&#44;3&#37; &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; y las perspectivas de alcanzar 70 puntos en la escala de Karnofsky descienden a un 70&#44;6&#37;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Grado III&#58; meningiomas que afectan dos o m&#225;s pares craneales e incluyen varias arterias&#46; En este grupo&#44; las posibilidades de una extirpaci&#243;n total son de un 42&#44;9&#37; &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; con las perspectivas de alcanzar los 70 puntos en la escala de Karnofsky en s&#243;lo el 60&#37;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El sistema de gradaci&#243;n que se propone permite&#44; en los casos de meningiomas de la base de cr&#225;neo&#58; 1&#176; predecir las posibilidades de una extirpaci&#243;n total o parcial y 2&#176; conocer el pron&#243;stico quir&#250;rgico de los pacientes en cada grupo&#46; Aplicando este sistema podremos reducir nuestra morbilidad quir&#250;rgica&#44; anticipar la necesidad de una terapia con radiocirug&#237;a y dar una informaci&#243;n&#44; m&#225;s precisa&#44; al paciente y familiares sobre nuestras propuestas quir&#250;rgicas&#46;</p>"
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      "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&#58; 1&#176; which skull base meningiomas can be total or partially removed&#44; and 2&#176; their surgical outcome&#46;</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&#46; From the preoperative data&#44; nine variables were selected for conventional statistical analysis as regards their relationship with&#58; 1&#176; total vs partial tumor resection and 2&#176; with patients outcome according to the degree of tumour removal&#46;</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 &#40;total vs partial&#41; and the patient outcome&#58; 1&#41; arteries encasement and 2&#41; cranial nerves involvement&#46; Upon correlating these two variables with the type of tumour resection performed &#40;total vs partial&#41; and with the Karnofsky&#39;scale to evaluate patients surgical outcome&#44; the following grading groups were identified&#58;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Grade I&#58; skull base meningiomas which did not involve cranial nerves or artery or only encased one artery or one cranial nerve&#46; In these cases the incidence of gross tumour resection was 98&#44;3&#37; &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and the perspective to reach 70 points in the Karnofsky&#39;scale was of 96&#44;5&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Grade II&#58; skull base meningiomas which involved one cranial nerve and encased&#44; at least&#44; two main cerebral arteries&#46; In these cases&#44; the frequency of total resection&#44; decreased to 83&#44;3&#37; &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and the probability to reach 70 points in the Karnofsky&#39;scale was 70&#44;6&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Grade III&#58; skull base meningiomas which involved two or more cranial nerves and encased several arteries In this group&#44; the frequency of a total resection was of 42&#44;9&#37; &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and the probability of reaching 70 points in the Karnofsky&#39;scale was only 60&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</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&#46; In applying this predictive system we will be able to reduce surgical morbidity&#44; 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&#46;</p>"
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                      "titulo" => "Meningiomas&#58; Their classification&#44; regional behaviour life history and surgical end results"
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                    0 => array:2 [
                      "titulo" => "Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery"
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                          "autores" => array:5 [
                            0 => "C&#46;M&#46; Duma"
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Vol. 16. Núm. 6.
Páginas 477-485 (enero 2004)
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Vol. 16. Núm. 6.
Páginas 477-485 (enero 2004)
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
Visitas
1314
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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Resumen
Objetivo

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.

Métodos

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).

Resultados

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= 0.001) y b) la afectación de pares craneales (p<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:

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.

En ellos las posibilidades de extirpación total se encuentran en un 98,3% (p<0.0001) y las perspectivas de alcanzar 70 puntos en la escala de Karnofsky son de un 96,5%.

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<0.0001) y las perspectivas de alcanzar 70 puntos en la escala de Karnofsky descienden a un 70,6%.

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<0.0001) con las perspectivas de alcanzar los 70 puntos en la escala de Karnofsky en sólo el 60%.

Conclusiones

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.

Palabras clave:
Meningiomas
Base de cráneo
Gradación extirpación quirúrgica
Summary
Objective

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.

Method

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.

Results

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:

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<0.0001) and the perspective to reach 70 points in the Karnofsky'scale was of 96,5% (p=0.001).

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<0.0001) and the probability to reach 70 points in the Karnofsky'scale was 70,6% (p=0.001).

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<0.0001) and the probability of reaching 70 points in the Karnofsky'scale was only 60% (p=0.001).

Conclusions

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.

Key words:
Skull base
Meningiomas
Grading predicting system
Outcome

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