Validation of Grading Scores and Outcome Prognostic Factors in Intracranial Meningiomas in Elderly Patients

Abstract

Objective: Meningiomas are the most frequent benign intracranial tumors and they are becoming more frequent because of the aging population and advances in diagnostics and neurosurgical treatment. Therefore, there will be an increase of this disease in the coming years.

Methods: We performed a retrospective analysis of patients older than 70 years who underwent surgery for intracranial meningiomas, and we established risk factors related to outcome, morbidity, and mortality. We compared 3 previously described scores (Geriatric Scoring System [GSS], Clinico-Radiological Grading System [CRGS], and Sex, Karnofsky, ASA, Location and Edema [SKALE] score).

Results: We identified 110 patients older than 70 years. In the univariate analysis, postoperative Karnofsky Performance Status (KPS) was related to the presence of edema (P = 0.036), tumor size (P = 0.043), previous neurologic impairment (P = 0.012), and preoperative American Society of Anesthesiologists (ASA) physical status classification (P = 0.029). In the multivariable logistic regression model, ASA classification (odds ratio, 0.324; P = 0.04) and preoperative KPS (odds ratio, 1.042; P = 0.05) were also statistically significant. In all cases, better survival curves in the Kaplan-Meier survival test appear in patients with lower scores (CRGS, P = 0.015; GSS, P = 0.014; SKALE, P < 0.001). Also, morbidity measured as postoperative KPS correlated with these scores (CRGS, P < 0.001; SKALE, P < 0.001; GSS, P < 0.001). However, only SKALE correlated with perioperative morbidity, mortality, and 1-year mortality.

Conclusions: Meningioma resection in patients older than 70 years is safe, with an acceptable rate of mortality and morbidity. Patients who should undergo surgery must be selected in relation to their comorbidities, such as ASA classification or preoperative KPS. However, SKALE could be a useful tool as an initial approach.

Keywords: Clinico-Radiological Grading System; Elderly meningioma; Geriatric Scoring System; Intracranial meningioma; Prognostic factors; SKALE.