The Geriatric Scoring System (GSS) for Risk Stratification in Meningioma Patients as a Predictor of Outcome in Patients Treated with Radiosurgery Or Cohen-Inbar 1 , Cheng-chia Lee 2,3 , David Schlesinger 1 , Zhiyuan Xu 1 , Jason P. Sheehan 1 - INTRODUCTION: Meningiomas are the most common primary benign brain tumor. Radiosurgery (primary or adjuvant) allows excellent local control. The Geriatric Scoring System (GSS) for preoperative risk stratification and outcome prediction of patients with meningiomas has been reported previously. The GSS incorporates 8 tumor and patient parameters on admission. A GSS score greater than 16 was reported previously to be associated with a more favorable outcome. We assessed the validity of the GSS score and its influence on outcome in patients treated with Gamma-Knife radiosurgery (GKRS). - PATIENTS AND METHODS: Patients treated with single- session GKRS for World Health Organization grade I menin- gioma during 1989e2013 at the University of Virginia were reviewed. The cohort comprised 323 patients, 50.2% (n [ 162) male. Median age was 56 years (29e84 years), and median follow-up was 53.6 months (6e235 months). Median tumor volume was 4.5 cm 3 (0.2e23). Median margin and maximal doses were 15 Gy (8e36) and 32.3 Gy (20e65), respectively. - RESULTS: Tumor volume control was achieved in 87% (n [ 281), and post-GKRS clinical neurologic improvement was reported in 66.3% (n [ 214). The median change in KPS was D10 (range L30 to D40). The most common compli- cation was intermittent headaches (34.1%, n [ 110) and cranial nerve deficits (14.2%, n [ 46). The GSS (calculated and grouped as GSS > 16 and GSS £ 16) was found to correlate with different post-GKRS functional status (P < 0.0001) and tumor control (P [ 0.028). - CONCLUSION: The GSS, used for risk stratification and outcome prediction in patients with meningiomas, seems valid for patients undergoing single-session GRKS. A GSS score greater than 16 is associated with a better long-term functional status and tumor control. INTRODUCTION M eningiomas are the most common primary benign brain tumor and account for approximately 12%e20% of all primary intracranial tumors. 1 The risk of developing meningioma increases with age, dramatically so after the age of 65 years. 1 Surgical resection traditionally has been referred to as the primary treatment option. Despite a dramatic decrease in surgical morbidity for meningiomas reported during the last 2 decades, a complete resection while preserving neurologic function is not always feasible. Incomplete resection can lead to lower local rates of control and increased risk of tumor progression or recurrence. 2,3 Patients harboring an incompletely resected meningioma often require multiple treatments, leading to increased morbidity and even mortality. 2-4 In patients with meningioma who are treated with resection, the use of the Geriatric Scoring System (GSS) for preoperative risk stratification and outcome prediction has been reported (Table 1). 5,6 The GSS incorporates 8 independent tumor- and patient-related parameters on admission, each assigned a value ranging from 1 to 3 points. Tumor size and location, peritumoral edema, neurologic deficits, and Karnofsky Performance Status (KPS), 7 as well as patient’s diabetes, hypertension, or the presence of lung disease and medical control thereof comprise the GSS. Seven different surgical and functional outcome parameters were tested via use of the scoring system. A GSS score greater than 16 was reported previously to be associated with a significantly more favorable outcome in patients undergoing a resection. 5,6 Key words - Gamma knife - GSS score - Meningioma - Outcome prediction Abbreviations and Acronyms GKRS: Gamma-Knife radiosurgery GSS: Geriatric Scoring System KPS: Karnofsky Performance Status SRS: Stereotactic radiosurgery WHO: World Health Organization From the 1 Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA; 2 Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan; and 3 National Yang-Ming University, Taipei, Taiwan To whom correspondence should be addressed: Or Cohen-Inbar, M.D., Ph.D. [E-mail: oc2f@virginia.edu] Citation: World Neurosurg. (2016) 87:431-438. http://dx.doi.org/10.1016/j.wneu.2015.10.081 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2016 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY 87: 431-438, MARCH 2016 www.WORLDNEUROSURGERY.org 431 Original Article