학술논문
Surgical Outcome of Patients With Supratentorial Meningiomas Aged 80 Years or Older-Retrospective International Multicenter Study.
Document Type
Academic Journal
Author
Schwartz C; Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland.; Current Affiliations: Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria.; Rautalin I; Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland.; The National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland , New Zealand.; Grauvogel J; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany.; Bissolo M; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany.; Masalha W; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany.; Steiert C; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany.; Schnell O; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany.; Beck J; Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany.; Ebel F; Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland.; Department of Neurosurgery, University of Basel, Basel , Switzerland.; Bervini D; Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland.; Raabe A; Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland.; Eibl T; Department of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg , Germany.; Steiner HH; Department of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg , Germany.; Shlobin NA; Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA.; Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA.; Nandoliya KR; Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA.; Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA.; Youngblood MW; Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA.; Chandler JP; Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA.; Magill ST; Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA.; Romagna A; Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria.; Department of Neurosurgery, München Klinik Bogenhausen, Munich , Germany.; Lehmberg J; Department of Neurosurgery, München Klinik Bogenhausen, Munich , Germany.; Fuetsch M; Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , ON , Canada.; Department of Spine and Scoliosis Surgery, Artemed Klinikum München Süd, Munich , Germany.; Spears J; Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , ON , Canada.; Rezai A; Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria.; Ladisich B; Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria.; Department of Neurosurgery, University Hospital St. Pölten, St. Pölten , Austria.; Demetz M; Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria.; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck , Austria.; Griessenauer CJ; Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria.; Niemelä M; Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland.; Korja M; Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland.
Source
Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 7802914 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4040 (Electronic) Linking ISSN: 0148396X NLM ISO Abbreviation: Neurosurgery Subsets: MEDLINE
Subject
Language
English
Abstract
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.
(Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
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.
(Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)