The role of scoring systems in treatment indication of meningiomas in elderly patients


Authors: I. Rošková;  A. Mrlian;  M. Smrčka;  M. Duba;  V. Juráň
Authors‘ workplace: Neurochirurgická klinika LF MU a FN Brno
Published in: Cesk Slov Neurol N 2022; 85(6): 471-476
Category: Original Paper
doi: 10.48095/cccsnn2022471

Overview

Introduction: The incidence of meningiomas increases exponentially after the age of 65. However, this age is characterized by a higher incidence of comorbidities and the benefit of the surgery may not always exceed its risk. Treatment optimization should therefore be objectively assessed using scoring systems as well. Materials and methods: A retrospective analysis evaluated the group of patients treated at the Brno University Hospital between 2013–2018 (N = 108). Patients were older than 65 years of age. Three procedures were considered in the treatment: watch and wait strategy, surgery and stereotactic radiosurgery. The groups of patients were evaluated in terms of the incidence of comorbidities and the outcome of the patients with regard to the choice of treatment modality. Scoring systems were used in the indication for individual types of treatment. Furthermore, short-term and long-term morbidity and mortality were evaluated in individual groups. Results: Significant dependence in the analysis of annual mortality in the SKALE system has been proved. No statistically significant relationship was found between mortality and sex, collateral oedema, and tumour location. In contrast, age, tumour size, and Karnofsky score before treatment were significant predictors of prognosis. Conclusion: Individualized patient analysis and neurosurgeon experience continue to be important factors in treatment selection in elderly patients with a dia­gnosis of meningioma. However, the scoring systems used to select a treatment modality in elderly patients make it possible to significantly optimize the treatment process and, ultimately, the prognosis of the disease.

Keywords:

geriatric patient – Meningioma – scoring systems


Sources

1. Buerki RA, Horbinski CM, Kruser T et al. An overview of meningiomas. Future Oncol 2018; 14 (21): 2161–2177. doi: 10.2217/fon-2018-0006.

2. Apra C, Peyre M, Kalamarides M. Current treatment options for meningioma. Expert Rev Neurother 2018; 18 (3): 241–249. doi: 10.1080/14737175.2018.1429920.

3. Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol 2010; 99 (3): 307–314. doi: 10.1007/s11060-010-0386-3.

4. Ekaireb RI, Edwards CS, Ali MS et al. Meningioma surgical outcomes and complications in patients aged 75 years and older. J Clin Neurosci 2021; 88: 88–94. doi: 10.1016/j.jocn.2021.03.032.

5. Ikawa F, Kinoshita Y, Takeda M et al. Review of current evidence regarding surgery in elderly patients with meningioma. Neurol Med Chir (Tokyo) 2017; 57 (10): 521–533. doi: 10.2176/nmc.ra.2017-0011.

6. Eseonu C, Vivas-Buitrago T, Quiñones-Hinojosa A. Meningiomas in the elderly. Handb Clin Neurol 2020; 169: 261–271. doi: 10.1016/B978-0-12-804280-9.00017-2.

7. Ahmeti H, Borzikowsky C, Hollander D et al. Risks and neurological benefits of meningioma surgery in elderly patients compared to young patients. J Neurooncol 2021; 154 (3): 335–344. doi: 10.1007/s11060-021-038 32-5.

8. Amano T, Nakamizo A, Michiwaki Y et al. Surgical outcome in elderly patients with intracranial meningioma. J Clin Neurosci 2018; 56: 63–66. doi: 10.1016/ j.jocn.2018.07.009.

9. Kim YJ, Kang J, Kim MJ et al. Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study. Korean Shock Society (KoSS) Investigators.BMC Med 2020; 18 (1): 390. doi: 10.1186/s12916-020-01875-5.

10. Monden D, Raimann FJ, Neef V et al. Meningioma surgery in patients – 70 years of age: clinical outcome and validation of the SKALE score. J Clin Med 2021; 10: 1820. doi: 10.3390/jcm10091820.

11. Zhao X, Zhao D, Wu Y et al. Meningioma in the elderly: characteristics, prognostic factors, and surgical strategy. J Clin Neurosci 2018; 56: 143–149. doi: 10.1016/ j.jocn.2018.06.011.

12. Charlson Comorbidity Index. [online]. Available from: https: //www.mdcalc.com/calc/3917/charlson-comorbidity-index-cci.

13. Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957; 20 (1): 22–39. doi: 10.1136/jnnp.20.1.22.

14. Brusselaers N, Lagergren J. The Charlson comorbidity index in registry-based research. Methods Inf Med 2017; 56 (5): 401–406. doi: 10.3414/ME17-01-0051.

15. Rafiq R, Katiyar V, Garg K et al. Comparison of outcomes of surgery for intracranial meningioma in elderly and young patients – a systematic review and meta-analysis. Clin Neurol Neurosurg 2021; 207: 106772. doi: 10.1016/j.clineuro.2021.106772.

16. Goldbrunner R, Stavrinou P, Jenkinson MD et al. EANO guideline on the dia­gnosis and management of meningiomas. Neuro Oncol 2021; 23 (11): 1821–1834. doi: 10.1093/neuonc/noab150.PMID: 34181733.

17. Troya Castilla M, Chocrón Gonzalez Y, Márquez Rivas FJ. Complications and outcomes in the elderly with intracranial meningioma. Rev Esp Geriatr Gerontol 2016; 51 (2): 82–87. doi: 10.1016/j.regg.2015.06.004.

18. Czernicki T. Surgical Management of intracranial meningiomas in the elderly: early and long-term outcomes. Clin Interv Aging 2020; 15 (4): 2439–2451. doi: 10.2147/CIA.S283678.

19. Di Cristofori A, Zarino B, Bertani G et al. Surgery in elderly patients with intracranial meningioma: neuropsychological functioning during a long-term follow-up. J Neurooncol 2018; 137 (3): 611–619. doi: 10.1007/s11060-018-2754-3.

20. Brokinkel B, Holling M, Spille DC et al. Surgery for meningioma in the elderly and long-term survival: comparison with an age – and sex-matched general population and with younger patients. J Neurosurg 2017; 126 (4): 1201–1211. doi: 10.3171/2016.2. JNS152611.

21. Díaz J, Carballares J, Zabalo G et al. Comparison of intracranial meningioma outcome scales in operated patients older than 65 years old. Our experience between 2002–2012 and a literature review. Neucir 2016; 27 (1): 2–9. doi: 10.1016/j.neucir.2015.04.003.

22. Zoia C, Bongetta D, Guerrini F et al. Outcome of elderly patients undergoing intracranial meningioma resection: a single-center experience. J Neurosurg Sci 2021; 65 (5): 513–517. doi: 10.23736/S0390-5616.18.04333-3.

23. Chen ZY, Zheng CH, Tang Li et al. Intracranial meningioma surgery in the elderly (over 65 years): prognostic factors and outcome. Acta Neurochir (Wien) 2015; 157 (9): 1549–1557. doi: 10.1007/s00701-015-2502-9.

24. Joubert C, Sellier A, Sahuc P et al. Neurosurgery for intracranial meningioma in patients aged more than 80 years: benefits and rationale. Br J Neurosurg 2021; 35 (4): 470–475. doi: 10.1080/02688697.2021.1875397.

25. Caroli M, Locatelli M, Prada F et al. Surgery for intracranial meningiomas in the elderly: a clinical-radiological grading system as a predictor of outcome. J Neurosurg 2005; 102 (2): 290–294. doi: 10.3171/jns.2005.102.2.0290.

26. Kim L. A narrative review of targeted therapies in meningioma. Chin Clin Oncol 2020; 9 (6): 76. doi: 10.21037/cco-2020-mbt-01.

27. Behling F, Fodi C, Hoffmann E et al. The role of Simpson grading in meningiomas after integration of the updated WHO classification and adjuvant radiotherapy. Neurosurg Rev 2021; 44 (4): 2329–2336. doi: 10.1007/s10143-020-01428-7.

28. Delgado-Fernández J, García-Pallero MA, Gil-Simoes R et al. Validation of grading scores and outcome prognostic factors in intracranial meningiomas in elderly patients. World Neurosurg 2018; 114: e1057–e1065. doi: 10.1016/j.wneu.2018.03.146.

29. Konglund A, Rogne SG, Helseth E et al. Meningioma surgery in the very old-validating prognostic scoring systems. Acta Neurochir (Wien) 2013; 155 (12): 2263–2271. doi: 10.1007/s00701-013-1872-0.

30. Brokinkel B, Spille DC, Brokinkel C et al. The Simpson grading: defining the optimal threshold for gross total resection in meningioma surgery. Neurosurg Rev 2021; 44 (3): 1713–1720. doi: 10.1007/s10143-020-01369-1.

31. Horvath B, Kloesel B, Todd MM et al. The evolution, current value, and future of the American Society of Anesthesiologists Physical Status Classification System. Anesthesiology 2021; 135 (5): 904–919. doi: 10.1097/ALN. 0000000000003947.

32. Kan HJ, Kharrazi H, Leff B et al. Defining and assessing geriatric risk factors and associated health care utilization among older adults using claims and electronic health records. Med Care 2018; 56 (3): 233–239. doi: 10.1097/MLR.0000000000000865.

33. Brastianos PK, Galanis E, Butowski N et al. Advances in multidisciplinary therapy for meningiomas. Neuro Oncol 2019; 21 (Suppl 1): i18–i31. doi: 10.1093/neuonc/noy136.

34. Goldbrunner R, Stavrinou P, Jenkinson MD et al. EANO guideline on the dia­gnosis and management of meningiomas. Neuro Oncol 2021; 23 (11): 1821–1834. doi: 10.1093/neuonc/noab150.

35. Ikawa F, Isobe N, Michihata N et al. In-hospital complications after surgery in elderly patients with asymptomatic or minor symptom meningioma: a nationwide registry study. World Neurosurg 2021; 148: e459–e470. doi: 10.1016/j.wneu.2021.01.001.

36. Black P, Kathiresan S, Chung W. Meningioma surgery in the elderly: a case-control study assessing morbidity and mortality. Acta Neurochir (Wien) 1998; 140 (10): 1013–1017. doi: 10.1007/s007010050209.

37. Ekşi MŞ, Canbolat Ç, Akbaş A et al. Elderly patients with intracranial meningioma: surgical considerations in 228 patients with a comprehensive analysis of the literature. World Neurosurg 2019; 132: e350–e365. doi: 10.1016/j.wneu.2019.08.150.

38. Schul DB, Wolf S, Krammer MJ et al. Meningioma surgery in the elderly: outcome and validation of 2 proposed grading score systems. Neurosurgery 2012; 70 (3): 555–565. doi: 10.1227/NEU.0b013e318233a 99a.

39. Cohen-Inbar O. Geriatric brain tumor management part I: Meningioma. J Clin Neurosci 2019; 67: 5–9. doi: 10.1016/j.jocn.2019.05.063.

40. Pamir MN, Özduman K. Current decision-making in meningiomas. Handb Clin Neurol 2020; 169: 229–252. doi: 10.1016/B978-0-12-804280-9.00015-9.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 6

2022 Issue 6

Most read in this issue
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account