Sarcopenia as a Predictor of Functional Outcome in Patients With Intracranial Aneurysms

Background: Radiological markers in head computed tomography (CT) scan have emerged as tools to evaluate sarcopenia. They can be easily obtained by standardized measurements in preoperative image assessment of patients with brain aneurysms. Methodologies are emerging to measuring sarcopenia using the sectional area and thickness of the temporal muscle using head CT. We aimed to evaluate the association between sarcopenia and functional outcomes of intracranial aneurysms (IA). Methods: We report a prospective observational cohort study performed in patients who underwent microsurgery or embolization for ruptured or unruptured intracranial aneurysm, admitted in a tertiary referral hospital between January 2018 and December 2019, with a 6-months follow-up. Patients with no head CT in the preoperative period and incomplete data with less than 3 months of follow-up were excluded. Preoperative CT scans were analyzed to measure temporal muscle thickness and area using tools native standard from the Radiological Department of HCFMUSP. The goal was to analyze the relationship between sarcopenia and the postoperative functional outcome assessed using the modified Rankin Scale (mRS). Values > 2 were considered unfavorable, whereas mRS£2 were considered favorable. Findings: A total of 361 patients were included, of whom 199 (55.1%) had ruptured and 162 (44.9%) had unruptured lesions. TMA was not different between patients with ruptured and unruptured aneurysms (P=.79). Larger TMA significantly predicted better functional outcomes at discharge, with each extra 10mm2 being associated with an OR of 0.97 (95%CI 0.93–0.99). TMT was associated with functional outcomes at both discharge (OR 0.76, 95%CI 0.60–0.95) and 6 months (OR 0.78, 95%CI 0.60–0.98), adjusted for rupture and hypertension. There were no significant interactions between covariates. Maximizing the sum sensitivity-specificity, an optimal TMT cutoff of 6.25mm can predict unfavorable outcomes. Maximizing the product Positive Predictive Value X Negative Predictive Value, the cutpoint of 3.55mm was very specific (99%) but not sensitive (11.1%). Interpretation: Sarcopenia, represented by temporal muscle thickness and area, is significantly associated with poorer functional results at discharge and 6 months follow-up after IA management. TMT below 6.25mm was associated with unfavorable functional outcomes. TMT below 3.55 had 99% sensitivity for unfavorable functional outcomes. These easily obtainable measurements may improve the decision-making process for patients with IAs. Funding: None Declaration of Interest: None Ethical Approval: The local Ethics Committee approved this study.