Surgery for intracranial meningiomas in the elderly: a clinical-radiological grading system as a predictor of outcome

Object. A grading system, called the Clinical–Radiological Grading System (CRGS), has been developed to standardize
surgical indications in elderly patients harboring intracranial meningiomas. Patients with a score lower than 10 had a
bad prognosis regardless of surgical treatment, those with a score between 10 and 12 had a prognosis positively influenced
by surgery, and those with a score higher than 12 had a good prognosis regardless of surgical treatment. The authors performed
a prospective cross-sectional study to validate further the use of the CRGS as a clinical tool to orientate surgical
decision making in elderly patients and to explore prognostic factors of survival.
Methods. From 1990 to 2000 the authors consecutively recruited and surgically treated 90 patients 70 years of age or
older with neuroimaging findings of intracranial meningiomas and a preoperative evaluation based on the CRGS.
The surgical mortality rate, which covers deaths within 3 months after surgical intervention, was 7.8%, and the 1-year
mortality rate was 15.6%.
Female sex and a higher CRGS score were associated with a higher probability of survival. Among the different subset
items of the CRGS score, no peritumoral edema for surgical survival and no concomitant diseases for 1-year survival provide
the strongest predictive contribution, even if not at a statistically significant level.
Conclusions. The CRGS score is a useful and practical tool for the selection of elderly patients affected by intracranial
meningiomas as surgical candidates. A CRGS score higher than 10 and female sex are good prognostic factors of survival,
whereas age is not a contraindication to surgery.