ABC Surgical Risk Scale for skull base meningioma

A new scoring system for predicting the extent of tumor removal and neurological outcome - Clinical article

Kazuhide Adachi, Takeshi Kawase, Kazunari Yoshida, Takahito Yazaki, Satoshi Onozuka

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Object. Surgery for skull base meningiomas (SBMs) can lead to complications because these lesions are difficult to approach and can involve cranial nerves and arteries. The authors propose a scoring system to evaluate the relative risks and benefits of surgical treatment of SBMs. Methods. The authors used a 2-step process to construct their scale. First, they derived significant predictive variables from retrospective data on 132 SBM cases treated surgically (primary surgeries only) between May 2000 and December 2005. Next, they validated the predictive accuracy of their scoring system in 60 consecutive cases treated surgically between January 1995 and April 2000, including both primary and repeated surgeries. Finally, they investigated the effect of the surgery on the patients' preoperative symptoms for consecutive cases treated surgically between January 1995 and December 2005, including both primary surgeries and retreatments. Results. Five items that predicted surgical risk were identified: 1) tumor attachment size; 2) arterial involvement; 3) brainstem contact; 4) central cavity location; and 5) cranial nerve group involvement. The authors named their scoring system the ABC Surgical Risk Scale, after the initial letters of these items. Each factor was assigned a score of 0-2 points, and an additional point was added for previous surgical treatment or for radiation, giving a possible total score of 12 points. On average, the scoring system allocated 2 points for gross-total resections, 6.1 points for near-total resections, and 9 points for subtotal resections, with significant differences between groups. For cases scoring ≥ 8 points, the percentage of cases showing neurological deterioration postoperatively exceeded the percentage showing improvement. Conclusions. The authors conclude that this scoring system can be used to predict the extent of tumor removal and that the scores reflect the surgical risk.

Original languageEnglish
Pages (from-to)1053-1061
Number of pages9
JournalJournal of Neurosurgery
Volume111
Issue number5
DOIs
Publication statusPublished - 2009

Fingerprint

Skull Base
Meningioma
Cranial Nerves
Neoplasms
Retreatment
Brain Stem
Arteries
Radiation
Therapeutics

Keywords

  • Grading system
  • Meningioma
  • Skull base
  • Surgical risk scale

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

ABC Surgical Risk Scale for skull base meningioma : A new scoring system for predicting the extent of tumor removal and neurological outcome - Clinical article. / Adachi, Kazuhide; Kawase, Takeshi; Yoshida, Kazunari; Yazaki, Takahito; Onozuka, Satoshi.

In: Journal of Neurosurgery, Vol. 111, No. 5, 2009, p. 1053-1061.

Research output: Contribution to journalArticle

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AB - Object. Surgery for skull base meningiomas (SBMs) can lead to complications because these lesions are difficult to approach and can involve cranial nerves and arteries. The authors propose a scoring system to evaluate the relative risks and benefits of surgical treatment of SBMs. Methods. The authors used a 2-step process to construct their scale. First, they derived significant predictive variables from retrospective data on 132 SBM cases treated surgically (primary surgeries only) between May 2000 and December 2005. Next, they validated the predictive accuracy of their scoring system in 60 consecutive cases treated surgically between January 1995 and April 2000, including both primary and repeated surgeries. Finally, they investigated the effect of the surgery on the patients' preoperative symptoms for consecutive cases treated surgically between January 1995 and December 2005, including both primary surgeries and retreatments. Results. Five items that predicted surgical risk were identified: 1) tumor attachment size; 2) arterial involvement; 3) brainstem contact; 4) central cavity location; and 5) cranial nerve group involvement. The authors named their scoring system the ABC Surgical Risk Scale, after the initial letters of these items. Each factor was assigned a score of 0-2 points, and an additional point was added for previous surgical treatment or for radiation, giving a possible total score of 12 points. On average, the scoring system allocated 2 points for gross-total resections, 6.1 points for near-total resections, and 9 points for subtotal resections, with significant differences between groups. For cases scoring ≥ 8 points, the percentage of cases showing neurological deterioration postoperatively exceeded the percentage showing improvement. Conclusions. The authors conclude that this scoring system can be used to predict the extent of tumor removal and that the scores reflect the surgical risk.

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