BACKGROUND: Although population age increases, published evidence on meningioma treatment in the elderly is scarce.
OBJECTIVE: In order to improve selection for surgery, we investigated our patients’ collective, using 2 proposed risk assessment systems; the Clinical-Radiological Grading System (CRGS) and the SKALE score (Sex, Karnofsky, ASA, Location, Edema).
METHODS: We retrospectively assessed morbidity and mortality in 164 patients aged >=65, operated on an intracranial meningioma. Medical and surgical records were reviewed and analyzed. CRGS and SKALE were calculated. The ability of both CRGS and SKALE and all single factors to predict death within 12 months was analyzed using multivariate logistic regression modeling.
RESULTS: 11 patients died (6.7%). Logistic regression for CRGS/SKALE showed a significant relationship with 12 months mortality. Age, Simpson’s resection-grade and Sex were not significant predictors when investigated alone. In multivariate logistic-regression, including all proposed factors, only concomitant disease and edema (CRGS) and ASA-score and preoperative KPS (SKALE) showed a significant relationship to mortality. After stepwise reduction of the full multivariate regression model to its significant terms, only concomitant disease and ASA remained significant for CRGS (p< 0.001) and SKALE (p=0.003), respectively.
CONCLUSION: Meningioma resection in the elderly is possible with some mortality. We were unable to reproduce the utility of two proposed grading system for mortality prediction when extending to younger patients. In single factors analysis, only concomitant disease and ASA-score remained significant. Decision whether to operate should be taken individually. Patients with severe concomitant disease or high ASA-score should be advised not to undergo surgical therapy independently from other factors.
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