E-ISSN: 1019-5157
ISSN: 2651-5024
Research
PREDICTION OF DIFFICULT INTUBATION IN CRANIOTOMY PATIENTS: A COMPARATIVE ANALYSIS OF MRI AND RADIOGRAPHIC PARAMETERS WITH TRADITIONAL TESTS
Burak Cemil BALIK ,
Berna KAYA UGUR ,
Feyza GELEBEK✉ ,
Ali Nehir ,
Ahmet Şenol Uyar ,
Abidin Murat GEYİK
Anesthesiology and Reanimation, Gaziantep City Hospital; Anesthesiology and Reanimation, Gaziantep Üniversitesi; Department of Radiology, Gaziantep Üniversitesi; Department of Neurosurgery, Gaziantep University Faculty of Medicine; Neurosurgery, Gaziantep Üniversitesi
DOI: 10.5137/1019-5149.JTN.51935-26.2
Accepted: 26/09/2026
Article in Press
Corresponding Author:
Feyza GELEBEK (feyzagelebek@gmail.com)
Abstract
Aim
This study aims to compare the predictive success rates of novel radiological markers for difficult intubation with traditional tests, including the Modified Mallampati score (MMS), Cormack-Lehane classification (CLS), thyromental distance (TMD), and sternomental distance (SMD). The new markers include skin-vallecular distance (SVD), skin-epiglottic distance (SED), skin-glottic distance (SGD), tongue length and height (TL-TH), and epiglottis length and angle (EL-EA), as measured on preoperative magnetic resonance imaging (MRI) and plain radiographs that have already been performed for routine neurosurgical purposes.
Material and Methods
Setting, participants: Patients in the ASA I-IV group, who were prepared for elective cranial surgery under general anesthesia by the department and would routinely undergo MRI and plain radiography in the preoperative period.
Main outcome measures: Intubation time in seconds of cranial surgery patients that would routinely undergo MRI and plain radiography in the preoperative period.
Results
Seventeen of 70 patients (24.3%) met the difficult intubation criteria. MMS ≥3, shorter SMD and TMD, limited neck movement, a large tongue, and facial/oral dysmorphism were associated with difficult intubation. The AUCs were 0.841 for MMS, 0.866 for SMD, and 0.823 for TMD. Among the MRI-derived markers, SGD had the highest AUC (0.658; 95% CI 0.510–0.805), whereas the remaining MRI AUCs ranged from 0.506 to 0.608. MMS ≥3 yielded 82.4% sensitivity and 75.5% specificity; SMD ≤130 mm yielded 70.6% sensitivity and 92.5% specificity; and TMD ≤55 mm yielded 70.6% sensitivity and 88.7% specificity.
Conclusion
reoperative clinical assessments showed good discrimination, whereas MRI-derived measurements showed poor-to-modest standalone discrimination. In this small cohort, routine MRI measurements did not provide convincing evidence of superior predictive performance. Larger studies should assess whether selected MRI markers provide incremental value beyond clinical airway assessment.
This study aims to compare the predictive success rates of novel radiological markers for difficult intubation with traditional tests, including the Modified Mallampati score (MMS), Cormack-Lehane classification (CLS), thyromental distance (TMD), and sternomental distance (SMD). The new markers include skin-vallecular distance (SVD), skin-epiglottic distance (SED), skin-glottic distance (SGD), tongue length and height (TL-TH), and epiglottis length and angle (EL-EA), as measured on preoperative magnetic resonance imaging (MRI) and plain radiographs that have already been performed for routine neurosurgical purposes.
Material and Methods
Setting, participants: Patients in the ASA I-IV group, who were prepared for elective cranial surgery under general anesthesia by the department and would routinely undergo MRI and plain radiography in the preoperative period.
Main outcome measures: Intubation time in seconds of cranial surgery patients that would routinely undergo MRI and plain radiography in the preoperative period.
Results
Seventeen of 70 patients (24.3%) met the difficult intubation criteria. MMS ≥3, shorter SMD and TMD, limited neck movement, a large tongue, and facial/oral dysmorphism were associated with difficult intubation. The AUCs were 0.841 for MMS, 0.866 for SMD, and 0.823 for TMD. Among the MRI-derived markers, SGD had the highest AUC (0.658; 95% CI 0.510–0.805), whereas the remaining MRI AUCs ranged from 0.506 to 0.608. MMS ≥3 yielded 82.4% sensitivity and 75.5% specificity; SMD ≤130 mm yielded 70.6% sensitivity and 92.5% specificity; and TMD ≤55 mm yielded 70.6% sensitivity and 88.7% specificity.
Conclusion
reoperative clinical assessments showed good discrimination, whereas MRI-derived measurements showed poor-to-modest standalone discrimination. In this small cohort, routine MRI measurements did not provide convincing evidence of superior predictive performance. Larger studies should assess whether selected MRI markers provide incremental value beyond clinical airway assessment.
Keywords
Neuroanesthesia
difficult intubation
craniotomy
mallampati score
MRI
radiographic measurements
Cormack- Lehane