Department of Neurosurgery, Rambam Medical Center, Haifa 31096, Israel.
Acta Neurochir (Wien). 2010 Jan;152(1):87-97; discussion 97. doi: 10.1007/s00701-009-0552-6.
The purpose of the study was to define and identify prognostic indicators within an elderly population of patients suffering from intracranial meningiomas. The clinical presentation of the patient with meningioma is diverse, manifesting as a different clinical entity in the elderly patient compared to a similar type of tumor in a young patient.
Two hundred fifty patients aged over 65 years admitted to RAMBAM Medical Center with meningiomas from 1995-2005 were characterized. We report the presenting symptoms, chronic illnesses, perioperative and longterm follow-up results for a 5-year period.
Based on univariate and multivariate analysis,significant prognostic indicators were identified and were implemented into a new geriatric scoring system (GSS)including tumor size and location, peritumoral edema,neurological deficits, Karnofsky score (Clancey J Neurosci Nurs 27:220, 1995; Crooks et al. J Gerontol 46:M139-M144, 1991), and associated diabetes, hypertension or lung disease. Seven outcome parameters were retrospectively tested using the scoring system, namely mortality,Barthel Index score (Mahoney and Barthel Md State Med J 14:61-65, 1965), Karnofsky score and consciousness expressed by the Glasgow Coma Scale score (Jennett and Bond Lancet 1:480-484, 1975) 5 years after surgery, as well as recurrence within and beyond 12 months. Age proved to inversely correlate with outcome. Morbidity and mortality were significantly lower in women. The extent of surgical resection (Simpson J Neurol Neurosurg Psychiatry 20:22-39, 1957) had no influence on functional outcome, although radical resection was associated with significantly lower mortality. Generally, a GSS score higher than 14 was associated with a significantly more favorable outcome.
The present results suggest that common experience-based considerations may be optimized and implemented into a simple scoring system that in turn may allow for outcome prediction and evidence-based decision making
本研究旨在确定并识别颅内脑膜瘤老年患者的预后指标。脑膜瘤患者的临床表现多种多样，与年轻患者的类似类型肿瘤相比，老年患者的临床表现呈现出不同的临床实体。
我们对 1995 年至 2005 年间在 RAMBAM 医疗中心就诊的 250 名年龄超过 65 岁的脑膜瘤患者进行了特征描述。我们报告了 5 年的发病症状、慢性疾病、围手术期和长期随访结果。
基于单变量和多变量分析，确定了显著的预后指标，并将其纳入一个新的老年评分系统（GSS）中，包括肿瘤大小和位置、瘤周水肿、神经功能缺损、卡诺夫斯基评分（Clancey J Neurosci Nurs 27:220, 1995; Crooks 等人，J Gerontol 46:M139-M144, 1991）以及相关的糖尿病、高血压或肺部疾病。使用评分系统对 7 个预后参数进行了回顾性测试，即死亡率、巴塞尔指数评分（Mahoney 和 Barthel Md State Med J 14:61-65, 1965）、卡诺夫斯基评分和格拉斯哥昏迷量表评分（Jennett 和 Bond Lancet 1:480-484, 1975）术后 5 年，以及 12 个月内和 12 个月后的复发。年龄与预后呈负相关。女性的发病率和死亡率明显较低。手术切除范围（Simpson J Neurol Neurosurg Psychiatry 20:22-39, 1957）对功能预后没有影响，尽管根治性切除与死亡率显著降低有关。一般来说，GSS 评分高于 14 与预后显著改善相关。
目前的结果表明，常见的基于经验的考虑因素可以得到优化，并纳入一个简单的评分系统，从而可以进行预后预测和基于证据的决策。
