One-year outcome after neurosurgery for intracranial tumor in elderly patients.
BACKGROUND
The number of elderly patients proposed for brain tumor removal is increasing. Only few data on long-term functional prognosis after intracranial surgery are available.


METHODS
Prospective, observational study of all patients greater than 70 year of age operated for intracranial tumors. Two scales for health status evaluation were used: Karnofsky Performance Scale (KPS) and Activities of Daily Living (ADL) score. Data were expressed as medians (first to third quartiles). The primary endpoint was the probability to remain nondependant (ADL>3 and KPS≥70%) after 1 year.


RESULTS
Between 2003 and 2007, 90 patients were included: 46 (51.1%) meningioma, 17 (18.9%) high-grade glioma, and 11 (12.2%) metastasis. At hospital admission, age was 73.50 years (71.25-76.00), American Society of Anesthesiology score 2 (2 to 3), KPS 80% (70-90), ADL 5.5 (4.5 to 6.0). Two patients died during the first 28 days, 3 others during the first year. Both KPS and ADL decreased after 1 year: KPS 80% (70 to 90; mean: 80%) at hospital admission versus 80% (60 to 90) at 1 year (mean: 70%), P=0.003; ADL 5.5 (4.5 to 6.0) at hospital admission versus 5.0 (3.25 to 5.50) at 1 year, P=0.001. In multivariate analysis, 2 preoperative parameters were associated with autonomy at 1 year: the ADL at hospital admission and meningioma as histologic type.


CONCLUSIONS
In this series of elderly patients, intracranial tumor surgery was associated with low 1-year mortality. Meningioma was associated with a better postoperative functional outcome. Preoperative ADL score was a predictive of functional evolution 1 year after the surgery.
Pirracchio
Romain
R
Department of Anesthesiology, Critical Care and SAMU, Lariboisiére Hospital, Paris, France. romain.pirracchio@lrb.aphp.fr
Resche-Rigon
Matthieu
M
Bresson
Damien
D
Basta
Benedetta
B
Welschbillig
Stéphane
S
Heyer
Laurent
L
Kechiche
Hakim
H
Madadaki
Catarina
C
Chollet
Alain
A
Lukaszewicz
Anne Claire
AC
Mebazaa
Alexandre
A
George
Bernard
B
Payen
Didier
D
D000203:Activities of Daily Living; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005544:Forecasting; D005910:Glioma / Q000601:surgery; D006801:Humans; D057187:Independent Living; D017567:Karnofsky Performance Status; D008137:Longitudinal Studies; D008297:Male; D008579:Meningioma / Q000601:surgery; D009362:Neoplasm Metastasis; D019635:Neurosurgical Procedures; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome