One-year outcome after neurosurgery for intracranial tumor in elderly patients

Abstract

Background: The number of elderly patients proposed for brain tumor removal is increasing. Only few data on long-term functional prognosis after intracranial surgery are available.

Materials and methods: Prospective, observational study of all patients greater than 70 year of age operated for intracranial tumors. Two scales for health status evaluation were used: Karnofsky Performance Scale (KPS) and Activities of Daily Living (ADL) score. Data were expressed as medians (first to third quartiles). The primary endpoint was the probability to remain nondependant (ADL>3 and KPS≥70%) after 1 year.

Results: Between 2003 and 2007, 90 patients were included: 46 (51.1%) meningioma, 17 (18.9%) high-grade glioma, and 11 (12.2%) metastasis. At hospital admission, age was 73.50 years (71.25-76.00), American Society of Anesthesiology score 2 (2 to 3), KPS 80% (70-90), ADL 5.5 (4.5 to 6.0). Two patients died during the first 28 days, 3 others during the first year. Both KPS and ADL decreased after 1 year: KPS 80% (70 to 90; mean: 80%) at hospital admission versus 80% (60 to 90) at 1 year (mean: 70%), P=0.003; ADL 5.5 (4.5 to 6.0) at hospital admission versus 5.0 (3.25 to 5.50) at 1 year, P=0.001. In multivariate analysis, 2 preoperative parameters were associated with autonomy at 1 year: the ADL at hospital admission and meningioma as histologic type.

Conclusions: In this series of elderly patients, intracranial tumor surgery was associated with low 1-year mortality. Meningioma was associated with a better postoperative functional outcome. Preoperative ADL score was a predictive of functional evolution 1 year after the surgery.