Intracranial meningioma surgery in the ninth decade of life.
OBJECTIVE
The aims of this study are to assess the surgical outcome of elderly patients aged 80 years or more, to analyze the factors influencing postoperative course, and to propose a grading system to standardize the surgical indication of intracranial meningioma in the elderly.


METHODS
Between 1990 and 2005, we surgically treated 74 consecutive patients aged 80 years or more for intracranial meningiomas (47 women, 27 men; mean age, 82 yr; age range, 80-90 yr). The median follow-up period was 94 months (range, 15-147 mo). We retrospectively analyzed the factors influencing surgical outcome and retained the significant factors to form the Sex, Karnofsky Performance Scale, American Society of Anesthesiology Class, Location of Tumor, and Peritumoral Edema (SKALE) grading system.


RESULTS
There was no perioperative mortality, and the 1-year mortality rate was 9.4%. Postoperative mortality was lower in women with a Karnofsky Performance Scale score of 60 or greater, an American Society of Anesthesiology Class of 1 or 2, a noncritical tumor location, and a moderate or absent peritumoral edema. Patients with a SKALE score of more than 8 had an excellent outcome, whereas those with a SKALE score of less than 8 had a poor outcome. The rate of postoperative complications was 9.4%. Large tumors, critical locations, severe peritumoral edema, and total surgical excision were associated with a higher risk of postoperative complications.


CONCLUSIONS
Surgery of intracranial meningioma in elderly patients is feasible when the SKALE score is 8 or greater. Prospective studies are required to validate this grading system.
Sacko
Oumar
O
Department of Neurosurgery, Pellegrin University Hospital, Bordeaux, France. oumarsacko36@yahoo.fr
Sesay
Musa
M
Roux
Franck-Emmanuel
FE
Riem
Tanguy
T
Grenier
Bruno
B
Liguoro
Dominique
D
Loiseau
Hugues
H
D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate