title: Meningioma surgery in the very old-validating prognostic scoring systems.
abstract: BACKGROUND
  Several studies acknowledge a higher risk of morbidity and mortality following intracranial meningioma surgery in the elderly, yet there is no consensus with regards to risk factors. Four prognostic scoring systems have been proposed. To evaluate their usefulness, we assess the very old meningioma patients in our neuro-oncological database according to the four methods, and correlate the findings with mortality and morbidity.
  
  
  METHODS
  We retrospectively calculated scores according to the Clinical-Radiological Grading System (CRGS), the Sex, Karnofsky Performance Scale, American Society of Anesthesiology Class, Location of Tumor, and Peritumoral Edema grading system (SKALE), the Geriatric Scoring System (GSS) and the Charlson Comorbidity Index (CCI) from all patients aged 80-90 years who had primary surgery for intracranial meningiomas 2003-2013 (n = 51), and related our findings to morbidity and mortality.
  
  
  RESULTS
  The mortality rates were 3.9 %, 5.9 % and 15.7 % at 30-days, 3-months and 1-year post-surgery. The rate of complications requiring surgery was 13.7 %, 5.9 % had evacuation of intracerebral hematomas and two patients (3.9 %) had surgery for intracranial infection/osteitis. 15.7 % of the patients were neurologically worsened on discharge. The patients with SKALE scores ≤ 8 had significantly increased mortality rates. The GSS, the CRGS and the CCI were not found to correlate with mortality.
  
  
  CONCLUSIONS
  Retrospectively evaluating four proposed scoring systems, we find that the SKALE score reflects the mortality at 1 month and 1 year following primary surgery for intracranial meningiomas in our very old patients. It may represent a helpful adjunct to their preoperative assessment.
authors.affiliation: Department of Neurosurgery, Rikshospitalet, Oslo University Hospital, P. O. Box 4950, Nydalen, 0424, Oslo, Norway, anekonglund@gmail.com.
authors.forename: Ane
authors.initials: A
authors.lastname: Konglund
authors.forename: Siril G
authors.initials: SG
authors.lastname: Rogne
authors.forename: Eirik
authors.initials: E
authors.lastname: Helseth
authors.forename: Torstein R
authors.initials: TR
authors.lastname: Meling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D009017:Morbidity; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors