title: Meningioma surgery in the elderly:  outcome and validation of 2 proposed grading score systems.
abstract: 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, American Society of Anesthesiology [ASA] score, location, edema).
  
  
  METHODS
  We retrospectively assessed morbidity and mortality in 164 patients aged ≥ 65, operated on for an intracranial meningioma. Medical and surgical records were reviewed and analyzed. CRGS and SKALE scores were calculated. The ability of both CRGS and SKALE and all single factors to predict death within 12 months was analyzed by the use of multivariate logistic regression modeling.
  
  
  RESULTS
  Eleven patients died (6.7%). Logistic regression for CRGS/SKALE showed a significant relationship with 12 months mortality. Age, Simpson 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) as well as ASA score and preoperative Karnofsky Performance Scale (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 < .001) and SKALE (P = .003), respectively.
  
  
  CONCLUSIONS
  Meningioma resection in the elderly is possible with some mortality. We were unable to reproduce the utility of 2 proposed grading systems for mortality prediction when extending to younger patients. In single-factor analysis, only concomitant disease and ASA score remained significant. The 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.
authors.affiliation: Department of Neurosurgery, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Munich, Germany. dudischul@me.com
authors.forename: David B
authors.initials: DB
authors.lastname: Schul
authors.forename: Stefan
authors.initials: S
authors.lastname: Wolf
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Krammer
authors.forename: Julia F
authors.initials: JF
authors.lastname: Landscheidt
authors.forename: Andre
authors.initials: A
authors.lastname: Tomasino
authors.forename: Christianto B
authors.initials: CB
authors.lastname: Lumenta
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015999:Multivariate Analysis; D018579:Patient Selection; D011300:Preoperative Care / Q000592:standards*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution