Acta Neurochirurgica

, 153:1501 | Cite as

The Geriatric Scoring System (GSS) in meningioma patients—validation

  • Or Cohen-InbarEmail author
  • Gil E. Sviri
  • Jean F. Soustiel
  • Menashe Zaaroor
Clinical Article



Meningiomas are the most common primary brain tumor, the incidence of which rises with age. The Geriatric Scoring System (GSS) was constructed in an attempt to answer which elderly subpopulation will benefit from a surgical intervention in terms of their overall physical and functional state of health. The GSS incorporates different prognostic indicators, both clinical and radiological, for risk stratification.


The purpose of the study was to validate the previously defined GSS for the evaluation and risk stratification of elderly patients suffering from intracranial meningioma.


One hundred and twenty patients aged over 65 years admitted to the RAMBAM Medical Center with meningiomas during the years 2005–2010 were characterized, forming an independent cohort. We report the presenting symptoms, chronic illness and radiological features, as well as perioperative and long-term follow-up results up to 5 years after the surgery.


Nine outcome parameters were tested against the GSS score on admission. Survival, Barthel Index, Karnofsky Performance Scale (KPS), consciousness expressed by the Glasgow Coma Scale (GCS) [14] score 5 years after surgery, recurrence within and beyond 12 months of surgery, the length of hospitalization both overall and in a neurosurgical intensive care unit. A GSS score higher than 16 was associated with a significantly more favorable outcome.


The present results suggest that common experience-based considerations may be optimized and implemented into a simple scoring system that in turn may allow for outcome prediction and evidence-based decision making.


Elderly Evidence based medicine GSS score Meningioma Prognosis 


Conflicts of interest



  1. 1.
    CBTRUS (Central Brain Tumor Registry of the United States) Statistical Report (2009–2010). Primary (malignant and non-malignant) brain and CNS tumor age-specific incidence rates by major histology groupings, histology and age at diagnosis, CBTRUS 2002–2006.
  2. 2.
    Clancey JK (1995) Karnofsky performance scale. J Neurosci Nurs 27:220PubMedGoogle Scholar
  3. 3.
    Claus EB, Black PM, Bondy ML, Calvocoressi L, Schildkraut JM, Wiemels JL, Wrensch M (2007) Exogenous hormone use and meningioma risk: what do we tell our patients? Cancer 110:471–476PubMedCrossRefGoogle Scholar
  4. 4.
    Cohen-Inbar O, Soustiel JF, Zaaroor M (2010) Meningiomas in the elderly, the surgical benefit and a new scoring system. Acta Neurochir (Wien) 87:87–97CrossRefGoogle Scholar
  5. 5.
    Crooks V, Waller S, Smith T, Hahn TJ (1991) The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. J Gerontol 46:M139–M144PubMedGoogle Scholar
  6. 6.
    Cushing H (1922) The meningiomas (dural endotheliomas): their source and favoured sets of origin. Brain 45:282–306Google Scholar
  7. 7.
    Cushing H Eisenhardt H (1938) Meningiomas: their classification, regional behavior, life history and surgical end results. Charles C. Thomas, SpringfieldGoogle Scholar
  8. 8.
    D’Andrea G, Roperto R, Caroli E, Crispo F, Ferrante L (2005) Thirty-seven cases of intracranial meningiomas in the ninth decade of life: our experience and review of the literature. Neurosurgery 56:956–961PubMedGoogle Scholar
  9. 9.
    Drummond KJ, Zhu JJ, Black PM (2004) Meningiomas: updating basic science, management, and outcome. Neurologist 10:113–130PubMedCrossRefGoogle Scholar
  10. 10.
    Hadded GF, OA-MSIA (2009) Extrinsic tumors, meningiomas. In: Youmans JR (ed) Youmans neurological surgery. Saunders, PhiledelphiaGoogle Scholar
  11. 11.
    Godfrey JB, Caird FI (1984) Intracranial tumours in the elderly: diagnosis and treatment. Age Ageing 13:152–158PubMedCrossRefGoogle Scholar
  12. 12.
    Hijiya N, Hudson MM, Lensing S, Zacher M, Onciu M, Behm FG, Razzouk BI, Ribeiro RC, Rubnitz JE, Sandlund JT, Rivera GK, Evans WE, Relling MV, Pui CH (2007) Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia. JAMA 297:1207–1215PubMedCrossRefGoogle Scholar
  13. 13.
    Inskip PD, Tarone RE, Hatch EE, Wilcosky TC, Shapiro WR, Selker RG, Fine HA, Black PM, Loeffler JS, Linet MS (2001) Cellular-telephone use and brain tumors. N Engl J Med 344:79–86PubMedCrossRefGoogle Scholar
  14. 14.
    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484PubMedCrossRefGoogle Scholar
  15. 15.
    Johansen C, Boice J Jr, McLaughlin J, Olsen J (2001) Cellular telephones and cancer–a nationwide cohort study in Denmark. J Natl Cancer Inst 93:203–207PubMedCrossRefGoogle Scholar
  16. 16.
    Lee JH, Sade B (2009) The novel “CLASS” algorithmic scale for patient selection in meningioma surgery. In: Lee JH (ed) Meningiomas: diagnosis, treatment, and outcome. Springer, London, pp 217–223Google Scholar
  17. 17.
    Krampla W, Newrkla S, Pfisterer W, Jungwirth S, Fischer P, Leitha T, Hruby W, Tragl KH (2004) Frequency and risk factors for meningioma in clinically healthy 75-year-old patients: results of the Transdanube Ageing Study (VITA). Cancer 100:1208–1212PubMedCrossRefGoogle Scholar
  18. 18.
    Kurland LT, Schoenberg BS, Annegers JF, Okazaki H, Molgaard CA (1935–1977) The incidence of primary intracranial neoplasms in Rochester, Minnesota. Ann N Y Acad Sci 381:6–16CrossRefGoogle Scholar
  19. 19.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the barthel index. Md State Med J 14:61–65PubMedGoogle Scholar
  20. 20.
    Mawrin C, Perry A (2010) Pathological classification and molecular genetics of meningiomas. J Neurooncol 99:379–391PubMedCrossRefGoogle Scholar
  21. 21.
    Muscat JE, Malkin MG, Thompson S, Shore RE, Stellman SD, McRee D, Neugut AI, Wynder EL (2000) Handheld cellular telephone use and risk of brain cancer. JAMA 284:3001–3007PubMedCrossRefGoogle Scholar
  22. 22.
    Patil CG, Veeravagu A, Lad SP, Boakye M (2010) Craniotomy for resection of meningioma in the elderly: a multicentre, prospective analysis from the National Surgical Quality Improvement Program. J Neurol Neurosurg Psychiatry 81:502–505PubMedCrossRefGoogle Scholar
  23. 23.
    Pompili A, Cacciani L, Cattani F, Caroli F, Crecco M, Mastrostefano R, Mazzitelli MR, Raus L (1997) Intracranial meningiomas in the elderly. Minerva Med 88:229–236PubMedGoogle Scholar
  24. 24.
    Preston DL, Ron E, Yonehara S, Kobuke T, Fujii H, Kishikawa M, Tokunaga M, Tokuoka S, Mabuchi K (2002) Tumors of the nervous system and pituitary gland associated with atomic bomb radiation exposure. J Natl Cancer Inst 94:1555–1563PubMedGoogle Scholar
  25. 25.
    Rengachary SS, Suskind DL (1991) Meningiomas in the elderly and asymptomatic meningiomas. In: Al-Mefty O (ed) Meningiomas. Raven Press, New-York, pp 153–159Google Scholar
  26. 26.
    Ron E, Modan B, Boice JD Jr, Alfandary E, Stovall M, Chetrit A, Katz L (1988) Tumors of the brain and nervous system after radiotherapy in childhood. N Engl J Med 319:1033–1039PubMedCrossRefGoogle Scholar
  27. 27.
    Roser F, Ebner FH, Ritz R, Samii M, Tatagiba MS, Nakamura M (2007) Management of skull based meningiomas in the elderly patient. J Clin Neurosci 14:224–228PubMedCrossRefGoogle Scholar
  28. 28.
    Sacko O, Sesay M, Roux FE, Riem T, Grenier B, Liguoro D, Loiseau H (2007) Intracranial meningioma surgery in the ninth decade of life. Neurosurgery 61:950–954PubMedCrossRefGoogle Scholar
  29. 29.
    Sadetzki S, Flint-Richter P, Starinsky S, Novikov I, Lerman Y, Goldman B, Friedman E (2005) Genotyping of patients with sporadic and radiation-associated meningiomas. Cancer Epidemiol Biomark Prev 14:969–976CrossRefGoogle Scholar
  30. 30.
    Sutherland GR, Florell R, Louw D, Choi NW, Sima AA (1987) Epidemiology of primary intracranial neoplasms in Manitoba, Canada. Can J Neurol Sci 14:586–592PubMedGoogle Scholar
  31. 31.
    Vadivelu S, Sharer L, Schulder M (2010) Regression of multiple intracranial meningiomas after cessation of long-term progesterone agonist therapy. J Neurosurg 112:920–924PubMedCrossRefGoogle Scholar
  32. 32.
    Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A (2007) Incidental findings on brain MRI in the general population. N Engl J Med 357:1821–1828PubMedCrossRefGoogle Scholar
  33. 33.
    Wiemels J, Wrensch M, Claus EB (2010) Epidemiology and etiology of meningioma. J Neurooncol 99:307–314PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Or Cohen-Inbar
    • 1
    • 2
    • 3
    • 4
    Email author
  • Gil E. Sviri
    • 1
    • 2
  • Jean F. Soustiel
    • 1
    • 2
  • Menashe Zaaroor
    • 1
    • 2
  1. 1.Department of Neurosurgery, Rambam Maimondes Health Care CampusHaifaIsrael
  2. 2.Faculty of Medicine, Technion Israel Institute of TechnologyHaifaIsrael
  3. 3.Neurosurgical DepartmentRambam Health Care CampusHaifaIsrael
  4. 4.Molecular Immunology LaboratoryTechnion Institute of TechnologyHaifaIsrael

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