Predictors of Early Functional Dependence Following Skull Base Meningioma Resection: A Multivariable Model of Preoperative Risk Factors

Abstract Early functional recovery following skull base meningioma resection remains difficult to predict despite its importance for patient counseling, perioperative planning, and postoperative rehabilitation. We sought to identify preoperative predictors of 6-week functional dependence and develop a clinically applicable prediction model. Adult patients undergoing skull base meningioma resection between January 2008 and July 2024 were retrospectively identified. The primary outcome was functional dependence at 6 weeks, defined as a modified Rankin Scale score > 2. Candidate predictors included demographic, clinical, radiographic, and surgical variables. Missing data were addressed using multiple imputation, and multivariable Firth penalized logistic regression was performed. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). A total of 283 patients were included, of whom 69 (24.4%) remained functionally dependent at 6 weeks. Patients with functional dependence were older (median: 65.0 vs. 56.9 years), had lower preoperative Karnofsky Performance Status (KPS), greater comorbidity burden, larger tumors (43 vs. 31 mm), and were more likely to harbor posterior cranial fossa tumors. In multivariable analysis, older age (adjusted odds ratio [OR]: 1.03 per year, 95% confidence interval [CI]: 1.01–1.06; p = 0.018), lower preoperative KPS (adjusted OR: 0.75 per 10-point increase, 95% CI: 0.60–0.93; p = 0.010), larger tumor diameter (adjusted OR: 1.03 per mm, 95% CI: 1.01–1.05; p = 0.004), and morbid obesity (body mass index ≥ 40 kg/m2; adjusted OR: 3.06, 95% CI: 1.07–8.76; p = 0.037) independently predicted functional dependence. The final model demonstrated good discrimination with a mean AUC of 0.796 (95% CI: 0.737–0.855). Older age, lower preoperative KPS, larger tumor size, and morbid obesity independently predict early functional dependence following skull base meningioma resection. These findings may facilitate individualized preoperative counseling, perioperative planning, and future clinical risk stratification.