title: Surgical Outcomes and Predictors of Recurrence in Elderly Patients with Meningiomas.
abstract: BACKGROUND
  Meningiomas are more prevalent with increasing age, and there is no general consensus of surgical management for this group of tumors. The role of resection and the predictors of recurrence of meningiomas in elderly patients have not been well established. The authors reviewed their experience of surgical resection of these tumors in elderly patients and determined the factors for recurrence.
  
  
  METHODS
  Clinical and radiologic information of 81 elderly patients with meningiomas was retrospectively reviewed. Simpson grading scales were used to evaluate the extent of surgical resection. Statistical analysis was conducted using Kaplan-Meier curves and Cox proportional hazards regression.
  
  
  RESULTS
  In this study, the recurrence rate in the grades I-II resection group was 10%, whereas in the grades III-IV resection group, the recurrence rate was 46% (P < 0.001). In Cox regression analysis, Simpson grades I-II/complete resection was revealed as a significant predictor of recurrence-free survival (P = 0.002). The hazard ratio for recurrence after grades III-IV resection was 5 times higher than after grades I-II resection. Location, size of the tumor, medical comorbidities, Karnofsky Performance Status, Geriatric Scoring System (GSS) score >16, and repeated resection were identified as predictors of recurrence-free survival after resection of meningiomas.
  
  
  CONCLUSIONS
  Elderly patients with meningiomas having a GSS score >16 and undergoing Simpson grades I-II/gross total resection have low operative morbidity, mortality, and recurrence rates and are less likely to continue on antiepileptic medications. Although complete tumor resection is the goal, the surgical approach should be tailored to each patient depending on the patient's GSS score.
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Shyamal C
authors.initials: SC
authors.lastname: Bir
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Subhas
authors.initials: S
authors.lastname: Konar
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Tanmoy K
authors.initials: TK
authors.lastname: Maiti
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors.forename: Bharat
authors.initials: B
authors.lastname: Guthikonda
authors.affiliation: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA. Electronic address: ananda@lsuhsc.edu.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality* / Q000601:surgery*; D008579:Meningioma / Q000401:mortality* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Geriatric; Meningioma; Outcomes; Predictors; Resection