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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Meningiomas in patients ≥ 75 years of age – clinical outcome and validation of the SKALE score

Meningeome bei ≥ 75 Jahre alten Patienten – klinischer Verlauf und Validierung des SKALE-Scores

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  • presenting/speaker Daniel Monden - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Florian Raimann - Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Anästhesiologie, Frankfurt am Main, Deutschland
  • Patrick N. Harter - Johann Wolfgang Goethe-Universität Frankfurt am Main, Edinger Institut, Neuropathologie, Frankfurt am Main, Deutschland
  • Fee Keil - Universitätsklinikum Frankfurt am Main, Neuroradiologie, Frankfurt am Main, Deutschland
  • Thomas Freiman - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Volker Seifert - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Christian Senft - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland
  • Peter Baumgarten - Universitätsklinikum Frankfurt am Main, Klinik und Poliklinik für Neurochirurgie, Frankfurt am Main, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV225

doi: 10.3205/20dgnc222, urn:nbn:de:0183-20dgnc2222

Published: June 26, 2020

© 2020 Monden et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Average life expectancy has increased and with it the number of very elderly meningioma patients. Patients at age of ≥75 years show increased morbidity and mortality when undergoing intracranial surgery. Our aim was to evaluate whether very elderly meningioma patients benefit from surgery and to validate the SKALE score, which was designed for decision-making for these patients.

Methods: A total of 570 patients underwent meningioma resection between 2009 and 2016. Data of recurrent tumors reaching back to 1979 for primary resection were included as well. At primary resection, 46 patients were ≥75 years of age. We compared WHO grade, Karnofsky Performance Scale (KPS) change, intensive care unit (ICU) stay, Simpson score, progression free survival (PFS) and overall survival (OAS). Preoperative SKALE score (Sex, KPS, ASA, location and edema) was determined for elderly patients. SKALE ≥8 was set for dichotomization according to the first description.

Results: In 43 very elderly patients (male/female 21/22) all data were available. At first resection WHO grade ≥II was found more frequently in elderly patients (57% vs 43%). Intended ICU stay of 1 day was only achieved in half of the patients, median stay was 2 days (range 1-46 days). Perioperative deterioration of KPS was more common in elderly patients (p=0.0008). Mean OAS was shorter in patients ≥75 years (75 vs. 269 months, p<0.0001). Analyses of the Kaplan Meier curves revealed differences in 1-year (0.88% vs. 25%) and 5-year mortality (4% vs. 50%) for very elderly patients. Multivariate analysis showed a significant survival benefit for patients with SKALE score ≥8 (p=0.0166) and for low Simpson grade (p=0.0342).

Conclusion: Very elderly meningioma patients face higher postoperative morbidity but have an increased risk for having higher WHO grade tumors. According to our data, even aggressive resection is reasonable. The SKALE score is a useful instrument regarding surgical indication.