Sarcopenia as a Predictor of the Functional Outcome in Patients with Intracranial Aneurysms

Abstract

<b><i>Introduction:</i></b> Radiological indicators in head computed tomography (CT) scan have emerged as tools to evaluate sarcopenia using the sectional area and thickness of the temporal muscle. They can be obtained by standardized measurements in preoperative image assessment of patients with brain aneurysms. We aimed to evaluate the association between functional outcomes after interventions for intracranial aneurysms (IAs) and temporal muscle thickness (TMT) and area (TMA), as surrogates of sarcopenia. <b><i>Methods:</i></b> This is a prospective observational cohort study in patients who underwent microsurgery or embolization for ruptured or unruptured IA between January 2018 and December 2019, with a 6-month follow-up. Preoperative CT scans were analyzed to measure TMT and TMA. The functional outcome was assessed by the modified Rankin Scale (mRS). The main outcome was the relationship between sarcopenia and the postoperative functional outcome. <b><i>Results:</i></b> A total of 361 patients were included, of whom 199 (55.1%) had ruptured and 162 (44.9%) had unruptured lesions. Larger TMA significantly predicted better functional outcomes at discharge. TMT was associated with functional outcomes at both discharge and 6 months, adjusted for rupture and hypertension. Maximizing the sum sensitivity-specificity, an optimal TMT cutoff of 6.25 mm can predict unfavorable outcomes. Maximizing the positive predictive value × negative predictive value of a product, the cutpoint was 3.55 mm. <b><i>Conclusions:</i></b> Sarcopenia, represented by TMT and TMA, is associated with poorer functional results at discharge and 6-month follow-up in IA surgery. TMT below 6.25 mm was associated with unfavorable functional outcomes. These easily obtainable measurements may improve the decision-making process for patients with IAs.

Initial Temporal Muscle Thickness and Area: Poor Predictors of Neurological Outcome in Aneurysmal Subarachnoid Hemorrhage in a Central European Patient Cohort

“…A significant correlation between the temporalis muscle and the mRS was found in 49 elderly aSAH patients (>75 years) as well as in 298 aSAH patients who received endovascular coiling [ 25 , 26 ]. Rodrigues et al found a significant correlation between TMT/TMA and mRS at discharge/after 6 months in a study including 361 patients with intracranial aneurysms (199 ruptured, 162 unruptured) [ 19 ]. In contrast to these findings, our patient cohort showed no significant prognostic benefit for either TMT or TMA.…”

“…Recent studies have suggested that skeletal muscle mass may be a useful prognostic marker in critically ill patients. The loss of muscle mass, known as sarcopenia, is associated with poor outcomes in various medical and surgical conditions, including brain metastasis, head and neck carcinoma, chronic subdural hemorrhage, intracranial aneurysm, stroke, and glioblastoma [ 16 , 17 , 18 , 19 , 20 , 21 ]. However, clinical diagnosis of sarcopenia, including measuring walking speed or hand strength, can be challenging to implement in aSAH patients with neurological deficits or impaired vigilance [ 22 ].…”