title: Outcome of elderly patients undergoing awake-craniotomy for tumor resection.
abstract: BACKGROUND
  Awake-craniotomy allows maximal tumor resection, which has been associated with extended survival. The feasibility and safety of awake-craniotomy and the effect of extent of resection on survival in the elderly population has not been established. The aim of this study was to compare surgical outcome of elderly patients undergoing awake-craniotomy to that of younger patients.
  
  
  METHODS
  Outcomes of consecutive patients younger and older than 65 years who underwent awake-craniotomy at a single institution between 2003 and 2010 were retrospectively reviewed. The groups were compared for clinical variables and surgical outcome parameters, as well as overall survival.
  
  
  RESULTS
  A total of 334 young (45.4 ± 13.2 years, mean ± SD) and 90 elderly (71.7 ± 5.1 years) patients were studied. Distribution of gender, mannitol treatment, hemodynamic stability, and extent of tumor resection were similar. Significantly more younger patients had a better preoperative Karnofsky Performance Scale score (>70) than elderly patients (P = 0.0012). Older patients harbored significantly more high-grade gliomas (HGG) and brain metastases, and fewer low-grade gliomas (P < 0.0001). No significantly higher rate of mortality, or complications were observed in the elderly group. Age was associated with increased length of stay (4.9 ± 6.3 vs. 6.6 ± 7.5 days, P = 0.01). Maximal extent of tumor resection in patients with HGG was associated with prolonged survival in the elderly patients.
  
  
  CONCLUSIONS
  Awake-craniotomy is a well-tolerated and safe procedure, even in elderly patients. Gross total tumor resection in elderly patients with HGG was associated with prolonged survival. The data suggest that favorable prognostic factors for patients with malignant brain tumors are also valid in elderly patients.
authors.affiliation: Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Grossman
authors.forename: Erez
authors.initials: E
authors.lastname: Nossek
authors.forename: Razi
authors.initials: R
authors.lastname: Sitt
authors.forename: Daniel
authors.initials: D
authors.lastname: Hayat
authors.forename: Tal
authors.initials: T
authors.lastname: Shahar
authors.forename: Ori
authors.initials: O
authors.lastname: Barzilai
authors.forename: Tal
authors.initials: T
authors.lastname: Gonen
authors.forename: Akiva
authors.initials: A
authors.lastname: Korn
authors.forename: Gal
authors.initials: G
authors.lastname: Sela
authors.forename: Zvi
authors.initials: Z
authors.lastname: Ram
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D003243:Consciousness; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome