Surgery for intracranial meningiomas in the elderly: a clinical—radiological grading system as a predictor of outcome

Caroli, Manuela; Locatelli, Marco; Prada, Francesco; Beretta, Federica; Boneschi, Filippo Martinelli; Campanella, Rolando; Arienta, Cesare

doi:10.3171/jns.2005.102.2.0290

Cited by 71 publications

(45 citation statements)

References 10 publications

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“…Previous studies have reported that the 30 day postoperative mortality rate is 0-10.8% in elderly meningioma patients (10,15,17,38). A recent prospective study of surgical resection of intracranial meningiomas reported that elderly patients (>70 years) exhibited significantly higher 30-day postoperative mortality rates (12.0%) than younger patients (4.6%) (6).…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study, age was not an independent factor for predicting surgical outcome (7,10,15); in the present study it was demonstrated that age was not associated with increased surgical risk in elderly patients with intracranial meningioma, which was consistent with previous studies (7,10,15). Several studies have assessed predictors for surgical outcome in elderly meningioma patients using CRGS, GSS and SKALE scoring systems that include tumor size, gender, KPS score, ASA score, tumor location, peritumoral edema and concomitant disease (9,10,16).…”

Section: Discussionmentioning

confidence: 99%

“…Tumor resection rate was determined according to the Simpson grade (18) and tumors were pathologically graded according to the World Health Organization (WHO) classification (19). In addition, proposed grading scoring systems, including CRGS, GSS, and SKALE, were used to calculate scores for each patient using admission data, according to previous studies (9,15,17) and the correlation between these scores and surgical outcomes was assessed.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies demonstrated that a poor outcome following surgical treatment for intracranial meningiomas in the elderly was associated with a score ≤9, ≤15 and ≤7 for the CRGS, GSS and SKALE, respectively (15)(16)(17). The cut-off point for postoperative complications was ≤9, ≤15, and ≤7 for CRGS, GSS, and SKALE, respectively (9,15,17). Multivariate logistic regression analysis revealed no significant associations between patient age (≥75 years), lower CRGS (≤9), GSS (≤15), and SKALE scores (≤7) and surgical complications (P= 0.0992, P= 0.7935, P= 0.1414 and P= 0.6441, respectively) (Table IV).…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

“…Thus, patient selection and optimal treatment strategies for intracranial meningiomas in the elderly, which must consider patient lifestyle, survival benefits vs. side effects and the potential complications of surgery, including neurological deficits, continue to be debated (6,7,10,15). To standardize the surgical indications for intracranial meningiomas in the elderly, a number of studies have proposed grading systems, which include the clinical-radiological grading system (CRGS) (15), the geriatric scoring system (GSS) (16), Karnofsky performance scale (KPS) score, the American Society of Anesthesiology (ASA) score and the Location of Tumor and Peritumoral Edema grading system (SKALE) (17).…”

Section: Introductionmentioning

confidence: 99%

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Clinical features and surgical management of intracranial meningiomas in the elderly

et al. 2017

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Abstract. Meningioma accounts for ~25% of all primary intracranial neoplasms and the incidence increases with age. Prvios population-based studies demonstrated that the annual incidence of intracranial meningiomas was 1.2-3.1/100,000 population. In particular, the incidence of this disease among the elderly is high. Recently, increased life expectancy and greater use of diagnostic radiological imaging led to an increased incidence in the diagnosis of intracranial meningiomas, both symptomatic and asymptomatic, in the elderly. Thus, neurosurgeons may be increasingly confronted with the management of intracranial meningiomas in the elderly. In practice, it is often difficult for physicians to determine whether traditional surgical resection is the optimal management strategy for intracranial meningiomas in the elderly. However, reported clinical studies about the outcome of surgical resection of intracranial meningiomas in the elderly are limited. Increased risk of mortality and morbidity associated with surgical treatment for intracranial meningiomas in the elderly compared with younger patients have been controversial. In the present study, the clinical features of intracranial meningiomas in 70 consecutive intracranial meningioma patients that underwent surgical treatment at the affiliated hospital of University of Occupational and Environmental Health between 2007 and 2013 were assessed. In addition, patient selection and surgical management of intracranial meningioma in elderly patients was discussed. Preoperative factors, including symptoms, tumor location, tumor size, Karnofsky Performance Scale (KPS) score and American Society of Anesthesiology (ASA) score, and postoperative factors, including pathological diagnosis, tumor proliferation index (Ki-67), resection rate (Simpson grade), length of hospital stay and discharge destination were retrospectively analyzed in patients aged ≥75 years (n=16; elderly group) and <75 years (n=54; younger group). Outcomes were assessed 6 months after surgery. Multivariate logistic regression revealed that tumor resection rate (Simpson grade III-V) was an important predictor of surgical complications (odds ratio, 5.662; 95% confidence interval, 1.323-24.236; P= 0.0194). Perioperative morbidity was not correlated with age (>75 years), tumor location, tumor size, KPS score or ASA score. Thus, the present study indicated that age is not associated with surgical outcome in elderly meningioma patients. Regardless of patient age, the decision to perform surgical resection should be made on an individual basis wherein tumor characteristics and the general health of the patient are considered.

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Section: Discussionmentioning

confidence: 99%