Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
Clin Interv Aging. 2020 Dec 30;15:2439-2451. doi: 10.2147/CIA.S283678. eCollection 2020.
In view of the risk associated with the surgical treatment of intracranial meningiomas in the elderly population due to the physiology of aging and multiple comorbidities, an attempt was made to identify factors influencing outcomes and to define the subgroup of patients who should not be operated on due to poor results.
A retrospective analysis of 58 patients over 70 years old with assessment of short-term and long-term outcomes. Scores by previously described CRGS, SKALE, and GSS grading systems were also calculated for our patients.
Neurological morbidity was only associated with a critical location according to the SKALE grading system (=0.02). Six patients (10.3%) died. Mortality was associated with the Karnofsky Performance Scale score (KPS ≤60 vs KPS ≥70; =0.0162), the American Society of Anesthesiologists scale status (ASA 1 or 2 vs ASA 3; =0.0022) and the WHO grade of meningiomas (=0.012). Risk factors for tumor recurrence (six patients) were WHO grade (=0.00048) and Simpson grade of resection (=0.0437). At follow-up, excluding patients who died due to surgery or recurrence (15.5%), most patients improved (50%) or remained unchanged (25.9%) in relation to the preoperative KPS status.
Postoperative neurological deterioration was only associated with a critical tumor location (skull base, eloquent area, large vessels involvement by the tumor). Due to a significantly higher risk of death, careful consideration should be taken for surgery in patients in a poor functional condition (KPS ≤60) or in a poor physical condition (ASA 3 status). An improvement or at least nonworsening of the neurological status in relation to the preoperative condition was observed in the majority of patients during follow-up.
鉴于老年人颅内脑膜瘤手术治疗存在与衰老生理和多种合并症相关的风险，本研究试图确定影响手术结果的因素，并确定由于手术效果不佳而不应进行手术的患者亚组。
回顾性分析了 58 名 70 岁以上的患者，评估了他们的短期和长期预后。我们还为患者计算了先前描述的 CRGS、SKALE 和 GSS 分级系统的评分。
根据 SKALE 分级系统，仅神经功能障碍与关键部位有关（=0.02）。有 6 名患者（10.3%）死亡。死亡率与 Karnofsky 表现量表评分（KPS≤60 与 KPS≥70；=0.0162）、美国麻醉医师协会（ASA）分级状态（ASA 1 或 2 与 ASA 3；=0.0022）和世界卫生组织（WHO）脑膜瘤分级有关（=0.012）。肿瘤复发的危险因素为 WHO 分级（=0.00048）和 Simpson 切除分级（=0.0437）。在随访中，排除因手术或复发而死亡的患者（15.5%），大多数患者的 KPS 状态与术前相比有所改善（50%）或保持不变（25.9%）。
术后神经功能恶化仅与肿瘤的关键部位（颅底、语言功能区、大血管受肿瘤累及）有关。由于死亡风险显著增加，对于功能状态差（KPS≤60）或身体状况差（ASA 3 级）的患者，应慎重考虑手术。在随访期间，大多数患者的神经功能状况与术前相比有所改善或至少无恶化。
