TY - JOUR
T1 - Surgical Outcome of Patients with Supratentorial Meningiomas Aged 80 Years or Older-Retrospective International Multicenter Study
AU - Schwartz, Christoph
AU - Rautalin, Ilari
AU - Grauvogel, Jürgen
AU - Bissolo, Marco
AU - Masalha, Waseem
AU - Steiert, Christine
AU - Schnell, Oliver
AU - Beck, Jürgen
AU - Ebel, Florian
AU - Bervini, David
AU - Raabe, Andreas
AU - Eibl, Thomas
AU - Steiner, Hans Herbert
AU - Shlobin, Nathan A.
AU - Nandoliya, Khizar R.
AU - Youngblood, Mark W.
AU - Chandler, James P.
AU - Romagna, Alexander
AU - Lehmberg, Jens
AU - Fuetsch, Manuel
AU - Spears, Julian
AU - Rezai, Arwin
AU - Ladisich, Barbara
AU - Demetz, Matthias
AU - Griessenauer, Christoph J.
AU - Niemelä, Mika
AU - Korja, Miikka
N1 - Publisher Copyright:
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - BACKGROUND AND OBJECTIVES: Demographic changes will lead to an increase in old patients, a population with significant risk of postoperative morbidity and mortality, requiring neurosurgery for meningiomas. This multicenter study aims to report neurofunctional status after resection of patients with supratentorial meningioma aged 80 years or older, to identify factors associated with outcome, and to validate a previously proposed decision support tool. METHODS: Neurofunctional status was assessed by the Karnofsky Performance Scale (KPS). Patients were categorized in poor (KPS ≤40), intermediate (KPS 50-70), and good (KPS ≥80) preoperative subgroups. Volumetric analyses of tumor and peritumoral brain edema (PTBE) were performed; volumes were scored as small (<10 cm 3), medium (10-50 cm 3), and large (>50 cm 3). RESULTS: The study population consisted of 262 patients, and the median age at surgery was 83.0 years. The median preoperative KPS was 70; 117 (44.7%) patients were allotted to the good, 113 (43.1%) to the intermediate, and 32 (12.2%) to the poor subgroup. The median tumor and PTBE volumes were 30.2 cm 3 and 27.3 cm 3; large PTBE volume correlated with poor preoperative KPS status (P =.008). The 90-day and 1-year mortality rates were 9.0% and 13.2%, respectively. Within the first postoperative year, 101 (38.5%) patients improved, 87 (33.2%) were unchanged, and 74 (28.2%) were functionally worse (including deaths). Each year increase of age associated with 44% (23%-70%) increased risk of 90-day and 1-year mortality. In total, 111 (42.4%) patients suffered from surgery-associated complications. Maximum tumor diameter ≥5 cm (odds ratio 1.87 [1.12-3.13]) and large tumor volume (odds ratio 2.35 [1.01-5.50]) associated with increased risk of complications. Among patients with poor preoperative status and large PTBE, most (58.3%) benefited from surgery. CONCLUSION: Patients with poor preoperative neurofunctional status and large PTBE most often showed postoperative improvements. The decision support tool may be of help in identifying cases that most likely benefit from surgery.
AB - BACKGROUND AND OBJECTIVES: Demographic changes will lead to an increase in old patients, a population with significant risk of postoperative morbidity and mortality, requiring neurosurgery for meningiomas. This multicenter study aims to report neurofunctional status after resection of patients with supratentorial meningioma aged 80 years or older, to identify factors associated with outcome, and to validate a previously proposed decision support tool. METHODS: Neurofunctional status was assessed by the Karnofsky Performance Scale (KPS). Patients were categorized in poor (KPS ≤40), intermediate (KPS 50-70), and good (KPS ≥80) preoperative subgroups. Volumetric analyses of tumor and peritumoral brain edema (PTBE) were performed; volumes were scored as small (<10 cm 3), medium (10-50 cm 3), and large (>50 cm 3). RESULTS: The study population consisted of 262 patients, and the median age at surgery was 83.0 years. The median preoperative KPS was 70; 117 (44.7%) patients were allotted to the good, 113 (43.1%) to the intermediate, and 32 (12.2%) to the poor subgroup. The median tumor and PTBE volumes were 30.2 cm 3 and 27.3 cm 3; large PTBE volume correlated with poor preoperative KPS status (P =.008). The 90-day and 1-year mortality rates were 9.0% and 13.2%, respectively. Within the first postoperative year, 101 (38.5%) patients improved, 87 (33.2%) were unchanged, and 74 (28.2%) were functionally worse (including deaths). Each year increase of age associated with 44% (23%-70%) increased risk of 90-day and 1-year mortality. In total, 111 (42.4%) patients suffered from surgery-associated complications. Maximum tumor diameter ≥5 cm (odds ratio 1.87 [1.12-3.13]) and large tumor volume (odds ratio 2.35 [1.01-5.50]) associated with increased risk of complications. Among patients with poor preoperative status and large PTBE, most (58.3%) benefited from surgery. CONCLUSION: Patients with poor preoperative neurofunctional status and large PTBE most often showed postoperative improvements. The decision support tool may be of help in identifying cases that most likely benefit from surgery.
KW - Age
KW - Complications
KW - Decision support tool
KW - Functional outcome
KW - Morbidity and mortality
KW - Supratentorial meningioma
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U2 - 10.1227/neu.0000000000002673
DO - 10.1227/neu.0000000000002673
M3 - Article
C2 - 37847034
AN - SCOPUS:85182725676
SN - 0148-396X
VL - 94
SP - 399
EP - 412
JO - Neurosurgery
JF - Neurosurgery
IS - 2
ER -