Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France.
Department of Neurology, Sainte Anne Military Hospital, Toulon, France.
Br J Neurosurg. 2021 Aug;35(4):470-475. doi: 10.1080/02688697.2021.1875397. Epub 2021 Jan 20.
Elderly patients with symptomatic benign intracranial tumours such as meningioma pose particular problems in decision making. We report on the outcome, morbidity and mortality in patients aged over 80 years after undergoing cranial surgery for meningiomas.
In this retrospective study, 37 patients aged more than 80 years underwent surgery at our neurosurgery department. The Karnofsky Performance Scale (KPS) was used to assess functional status. The American Society of Anesthesiologists (ASA) classification system, the Geriatric Scoring System, the Clinical-Radiological Grading System and the Sex, Karnofsky, ASA, Location and Edema score were used to define clinical status and tumour characteristics. The Charlson Comorbidity Index and Clavien-Dindo classification scores reflected therapeutic morbidity.
Preoperative KPS scores were generally higher than 60 ( = 32). Of the 37 patients, 24 (64.8%) were in ASA class I or II, and 27 (73.0%) had one or more comorbidities. The median length of follow-up was 80.0 months (range: 1-96 months). The 1-year mortality rate was 2.7% ( = 1). Tumour control was achieved in 33 patients. At discharge, KPS scores were improved in 21 patients (with an average gain of +18.1 ± 8.7), stable in 10 patients and poorer in 6 patients. KPS scores improved or were stable in patients with shorter lengths of hospital stay (15.5 ± 17.9 days vs 51.4 ± 25.4 days; < 0.01), those with Clavien-Dindo scores lower than 2 ( < 0.01) and those with less favourable preoperative KPS scores (69.4 ± 10.9 vs 82.0 ± 11.0; = 0.04).
Historically, surgery for intracranial meningiomas in patients aged >80 years has been feasible; this series demonstrated decreasing rates of postoperative mortality. Functional benefit should be the main goal of surgery. Perioperative morbidity should be better assessed and predicted because it significantly influences functional outcomes.
有症状的良性颅内肿瘤（如脑膜瘤）的老年患者在决策时会带来特殊的问题。我们报告了在我们神经外科部门接受颅部手术治疗脑膜瘤的 80 岁以上患者的结果、发病率和死亡率。
在这项回顾性研究中，37 名 80 岁以上的患者在我们的神经外科部门接受了手术。卡诺夫斯基表现量表（KPS）用于评估功能状态。美国麻醉师协会（ASA）分类系统、老年评分系统、临床-放射学分级系统以及性别、卡诺夫斯基、ASA、位置和水肿评分用于定义临床状况和肿瘤特征。Charlson 合并症指数和 Clavien-Dindo 分类评分反映了治疗的发病率。
术前 KPS 评分一般高于 60（ = 32）。37 例患者中，24 例（64.8%）为 ASA Ⅰ或Ⅱ级，27 例（73.0%）有一个或多个合并症。中位随访时间为 80.0 个月（范围：1-96 个月）。1 年死亡率为 2.7%（ = 1）。33 例患者肿瘤得到控制。出院时，21 例患者 KPS 评分改善（平均增加+18.1±8.7），10 例患者稳定，6 例患者恶化。住院时间较短（15.5±17.9 天比 51.4±25.4 天； < 0.01）、Clavien-Dindo 评分较低（ < 0.01）和术前 KPS 评分较差的患者（69.4±10.9 比 82.0±11.0； = 0.04）的 KPS 评分改善或稳定。
从历史上看，对 80 岁以上患者颅内脑膜瘤进行手术是可行的；本系列研究显示术后死亡率呈下降趋势。功能获益应该是手术的主要目标。围手术期发病率应得到更好的评估和预测，因为它会显著影响功能结局。
