Functional Outcomes and Complications in Meningioma Surgery Across Various Age Groups Based on Preoperative Karnofsky Scoring: A Retrospective Cohort Study

https://doi.org/10.5281/zenodo.19491219

Abstract

Background

Meningiomas are the most common primary intracranial tumors, with an incidence increasing with age. Surgical resection is the treatment of first choice, though outcomes vary with age. Preoperative functional status is assessed by the Karnofsky Performance Status (KPS) score. KPS and age were stratified to evaluate functional outcomes and postoperative complications.

Methods

A single-center retrospective cohort study was done in 128 consecutive patients who underwent primary meningioma resection from January 1, 2021 to June 30, 2024. Inclusion criteria were age≥18 years, histologically confirmed meningioma (WHO grades 1-3) and a minimum follow-up of 12 months; exclusion criteria were previous cranial surgery, concurrent malignancies, or incomplete records. Out of the 128 patients, 105 (82%) had complete data. Age group stratification was as follows: <60 years (young) group; 60 to 74 years (elderly); ≥75 years (oldest). Preoperative KPS was classified as high (≥80), moderate (70) and low (≤60). The primary outcome measure was the change in KPS from baseline to 12 months. Secondary outcomes included the complication rate, mortality, recurrence-free survival time and quality of life using EQ-5D scale scores. Paired t-tests, chi-square tests and multifactorial logistic regression were carried out.

Results The mean age was 63.8 years ±13.5; 68% were women. The preoperative KPS averaged 76.2±14.8, with increasingly lower scores in older age groups (≥75 years: 69.1±11.8 vs.<60 years: 84.7 ±10.2; P<0.001). At 12 months, for the group as a whole the KPS increased to 82.5±14.3 (mean change + 6.3, 95% CI, 4.1 − 8.5; P<0.001), but in the oldest age group (+3.5) and low preoperative KPS group (≤60: +2.4) subgroups, recovery was smaller. Complication rate was 21.9% (n=23) with a 4.8% mortality. Multivariable analysis identified age≥75 (OR 2.6, 95% CI 1.4−4.9; P=0.003) and low preoperative KPS (OR 3.2, 95% CI 1.7−6.1; P<0.001) as predictors of complications.

Conclusions Meningioma surgery results in significant improvement of function. But its outcomes are determined by both age and preoperative KPS. Patients in the older old category must accept higher risks.Stratified preoperative counselling is recommended.