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Meningioma surgery in the very old—validating prognostic scoring systems

  • Clinical Article - Brain Tumors
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Abstract

Background

Several studies acknowledge a higher risk of morbidity and mortality following intracranial meningioma surgery in the elderly, yet there is no consensus with regards to risk factors. Four prognostic scoring systems have been proposed. To evaluate their usefulness, we assess the very old meningioma patients in our neuro-oncological database according to the four methods, and correlate the findings with mortality and morbidity.

Methods

We retrospectively calculated scores according to the Clinical-Radiological Grading System (CRGS), the Sex, Karnofsky Performance Scale, American Society of Anesthesiology Class, Location of Tumor, and Peritumoral Edema grading system (SKALE), the Geriatric Scoring System (GSS) and the Charlson Comorbidity Index (CCI) from all patients aged 80–90 years who had primary surgery for intracranial meningiomas 2003–2013 (n = 51), and related our findings to morbidity and mortality.

Results

The mortality rates were 3.9 %, 5.9 % and 15.7 % at 30-days, 3-months and 1-year post-surgery. The rate of complications requiring surgery was 13.7 %, 5.9 % had evacuation of intracerebral hematomas and two patients (3.9 %) had surgery for intracranial infection/osteitis. 15.7 % of the patients were neurologically worsened on discharge. The patients with SKALE scores ≤ 8 had significantly increased mortality rates. The GSS, the CRGS and the CCI were not found to correlate with mortality.

Conclusions

Retrospectively evaluating four proposed scoring systems, we find that the SKALE score reflects the mortality at 1 month and 1 year following primary surgery for intracranial meningiomas in our very old patients. It may represent a helpful adjunct to their preoperative assessment.

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Acknowledgments

We thank Elisabeth Elgesem for her kind assistance, and for her work with organizing and maintaining our neuro-oncological database. We also thank Are Hugo Pripp at the Department of Biostatistics, Epidemiology and Health Economy, OUS, for his kind advice.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Rikshospitalet, Oslo University Hospital, P. O. Box 4950, Nydalen, 0424, Oslo, Norway

    Ane Konglund, Siril G. Rogne, Eirik Helseth & Torstein R. Meling

  2. Faculty of Medicine, University of Oslo, Oslo, Norway

    Eirik Helseth

Authors
  1. Ane Konglund
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  2. Siril G. Rogne
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  3. Eirik Helseth
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  4. Torstein R. Meling
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Corresponding author

Correspondence to Ane Konglund.

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Comment

The modified SKALE score for evaluating very elderly patients for meningioma surgery may prove of use to surgeons attempting risky procedures at the extremes of age, in order to inform their patients and relatives.

Michael Powell

London, UK

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Konglund, A., Rogne, S.G., Helseth, E. et al. Meningioma surgery in the very old—validating prognostic scoring systems. Acta Neurochir 155, 2263–2271 (2013). https://doi.org/10.1007/s00701-013-1872-0

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  • DOI: https://doi.org/10.1007/s00701-013-1872-0

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