• Christoph Schwartz, Ilari Rautalin, Jürgen Grauvogel, Marco Bissolo, Waseem Masalha, Christine Steiert, Oliver Schnell, Jürgen Beck, Florian Ebel, David Bervini, Andreas Raabe, Thomas Eibl, Hans-Herbert Steiner, Nathan A Shlobin, Khizar R Nandoliya, Mark W Youngblood, James P Chandler, Stephen T Magill, Alexander Romagna, Jens Lehmberg, Manuel Fuetsch, Julian Spears, Arwin Rezai, Barbara Ladisich, Matthias Demetz, Christoph J Griessenauer, Mika Niemelä, and Miikka Korja.
• Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland.
• Neurosurgery. 2024 Feb 1; 94 (2): 399412399-412.

Background And ObjectivesDemographic 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.MethodsNeurofunctional 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 ).ResultsThe 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.ConclusionPatients 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.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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