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Validation of grading scores and outcome prognostic factors in intracranial meningiomas in elderly patients.

Validation of grading scores and outcome prognostic factors in intracranial meningiomas in elderly patients.
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Delgado-Fernández J, García-Pallero MA, Gil-Simoes R, Blasco G, Frade-Porto N, Pulido P, Sola RG,


Delgado-Fernández J, García-Pallero MA, Gil-Simoes R, Blasco G, Frade-Porto N, Pulido P, Sola RG, (click to view)

Delgado-Fernández J, García-Pallero MA, Gil-Simoes R, Blasco G, Frade-Porto N, Pulido P, Sola RG,

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World neurosurgery 2018 03 29() pii S1878-8750(18)30628-4
Abstract
OBJECT
Meningiomas are the most frequent benign intracranial tumors and they are becoming more frequent due to the aging population and advances in diagnostics and neurosurgical treatment. Therefore, there will be an increase of this disease in the coming years.

METHODS
We performed a retrospective analysis of patients over 70 years old who underwent surgery for intracranial meningiomas, and established risk factors related to outcome, morbidity and mortality. Finally, we compared three previously described scores (GSS, CRGS and SKALE).

RESULTS
We identified one-hundred-ten patients over 70 years old. In the univariate analysis postoperative KPS was related to the presence of edema (p = .036), tumor size (p = .043), previous neurological impairment (p = .012), and preoperative ASA (p = .029). In the multivariable logistic regression model, ASA (OR .324; p = .04) and preoperative KPS (OR 1.042 p = 0.05) were also statistically significant. In all cases better survival curves in the Kaplan-Meier survival test appear in patients with lower scores (CRGS p = .015; GSS p = .014; SKALE p < .001). Also, morbidity measured as postoperative KPS correlated with these scores (CRGS p< .001; SKALE p< .001; GSS p<.001). However, only SKALE correlated with perioperative morbidity, mortality and one-year mortality. CONCLUSIONS
Meningioma resection in patients older than 70 years is safe, with an acceptable rate of mortality and morbidity. Selection of patients who should undergo surgery must be done in relation to their comorbidities, such as ASA or preoperative KPS. However, SKALE could be a useful tool as an initial approach.

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