Vascular Encasement Score as a Prognostic Tool for Outcome in Skull Base Tumor Resection

Involvement of major cerebral arteries in skull-base tumors poses a significant surgical challenge and is associated with increased peri- and postoperative complication rates. The aim of the current study is to introduce a vascular encasement score (VES) to assess intraoperative risk and predict patient outcomes.

Patients undergoing surgery for skull base tumors involving at least one major cerebral artery between April 2019 and March 2022 were included. Tumor-vessel contact was assessed on preoperative magnetic resonance imaging, evaluating both the longitudinal and circumferential encasement of arteries. Each parameter was graded from 1 to 5. The VES was calculated by multiplying the summed grades of both dimensions. Neurological outcomes were dichotomized into "good" and "poor" and correlated with VES.

Forty-eight patients were enrolled, most diagnosed with meningioma (79.17%). The mean resection rate was 77.23%, and the median VES was 32.5. Sixteen patients (33.3%) had poor outcomes. Higher VES scores were significantly associated with poor outcomes (P = 0.019). A receiver operating characteristic-derived threshold of 75 defined high-risk cases. Logistic regression confirmed that high VES (>75) predicted worse outcomes (P = 0.018). All patients with low VES had favorable outcomes and resection rates >90%. In contrast, 62.5% of patients with high VES had poor outcomes, influenced by a lower extent of resection (P < 0.001).

The magnetic resonance imaging-based VES provides a practical method to quantify vascular involvement in skull base tumors. It may support risk-adapted surgical planning and serve as a foundation for Artificial Intelligence-based tools enabling automated preoperative risk assessment.