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鞍上脑膜瘤切除术后的视觉预后:一项回顾性队列研究及基于机器学习的预测模型

Visual Outcomes after Suprasellar Meningioma Resection: A Retrospective Cohort Study and a Machine Learning-Based Predictive Model.

作者信息

Iranmehr Arad, Chavoshi Mohammadreza, Zeinalizadeh Mehdi

机构信息

Department of Neurosurgery, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex (IKHC), Tehran, Iran.

Department of Radiology, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.

出版信息

J Neurol Surg B Skull Base. 2024 Feb 23;86(1):58-65. doi: 10.1055/s-0044-1779671. eCollection 2025 Feb.

Abstract

In this research, the authors provide a retrospective cohort study of 82 patients with suprasellar meningiomas to identify predictors of the visual outcome following surgery. We also conducted a matched retrospective case-control analysis.  This retrospective cohort study included all patients who underwent craniotomy for surgical excision of suprasellar meningiomas at our institution between January 2016 and March 2022. We designed a matched case-control study for patients with and without early intradural optic canal decompression (IOCD). We also developed a machine learning model to have the best possible sensitivity for the prediction of visual recovery after surgery.  The visual acuity score (VAS) improved in 46.3% of our cases and decreased in 7.4% of the 82 included cases postoperatively. The VAS did not change in 46.3% of the patients after surgery. Statistically, visual complaints, optic atrophy, tuberculum sella involvement, and olfactory groove involvement were associated with lower preoperative VAS and visual field index (VFI). Only intracavernous sinus (ICS) extension and intraoperative vascular involvement were significantly associated with lower postoperative mean VAS correction. The outcome analysis revealed that the improvement in VAS and VFI after surgery was not statistically different between the groups with and without early IOCD ( -value = 1).  ICS extension was the only location-related factor associated with increased tumor recurrence or regrowth, which makes postoperative radiotherapy more valuable in patients with cavernous sinus extension. Our study results did not support the efficacy of early IOCD in increasing postoperative VAS and VFI.

摘要

在本研究中,作者对82例鞍上脑膜瘤患者进行了回顾性队列研究,以确定手术后视力预后的预测因素。我们还进行了匹配的回顾性病例对照分析。

这项回顾性队列研究纳入了2016年1月至2022年3月期间在我们机构接受开颅手术切除鞍上脑膜瘤的所有患者。我们为有和没有早期硬膜内视神经管减压(IOCD)的患者设计了一项匹配的病例对照研究。我们还开发了一种机器学习模型,以对术后视力恢复进行预测时具有尽可能高的敏感性。

在我们纳入的82例病例中,46.3%的患者视力评分(VAS)术后改善,7.4%的患者下降。46.3%的患者术后VAS未改变。从统计学上看,视觉主诉、视神经萎缩、鞍结节受累和嗅沟受累与术前较低的VAS和视野指数(VFI)相关。只有海绵窦(ICS)扩展和术中血管受累与术后平均VAS矫正值较低显著相关。结果分析显示,早期IOCD组和非早期IOCD组术后VAS和VFI的改善在统计学上无差异(P值 = 1)。

ICS扩展是与肿瘤复发或再生长增加相关的唯一位置相关因素,这使得术后放疗对海绵窦扩展患者更有价值。我们的研究结果不支持早期IOCD在提高术后VAS和VFI方面的疗效。

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