Meningioma surgery in the very old-validating prognostic scoring systems

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Oncology

Background:

• Elderly patients face increased risks from intracranial meningioma surgery.
• Existing prognostic scoring systems lack consensus for this demographic.
• Identifying reliable risk factors is crucial for optimizing patient care.

Purpose of the Study:

• To evaluate the predictive accuracy of four established scoring systems for mortality and morbidity in very elderly patients (80-90 years) undergoing intracranial meningioma surgery.
• To determine if any system can reliably identify high-risk individuals for improved preoperative assessment.

Main Methods:

• Retrospective analysis of 51 patients aged 80-90 years who underwent primary intracranial meningioma surgery (2003-2013).
• Calculation of scores using the Clinical-Radiological Grading System (CRGS), Sex, Karnofsky Performance Scale, American Society of Anesthesiology Class, Location of Tumor, and Peritumoral Edema grading system (SKALE), Geriatric Scoring System (GSS), and Charlson Comorbidity Index (CCI).
• Correlation of calculated scores with 30-day, 3-month, and 1-year mortality and morbidity outcomes.

Main Results:

• Overall mortality rates were 3.9% (30-day), 5.9% (3-month), and 15.7% (1-year).
• Complications included surgical interventions for hematomas (5.9%) and infections (3.9%).
• Patients with SKALE scores ≤ 8 demonstrated significantly higher mortality rates, while GSS, CRGS, and CCI did not correlate with mortality.

Conclusions:

• The SKALE score is a valuable tool for predicting mortality in very elderly patients after intracranial meningioma surgery.
• The SKALE score may serve as a useful adjunct for preoperative risk stratification in this vulnerable population.