ABSTRACT
BACKGROUND: Surgical management of symptomatic meningioma in elderly is still a high-risk surgery due to increased incidence of complication rate. Many scoring systems have been proposed to expect the surgical risk and the outcome.The study tries to assess cranial meningioma surgery in elderly using the Ibañez grade for complication rate and the Geriatric Scoring System (GSS) for the surgical outcome (GSS). METHODS: A clinical and radiological data were studied retrospectively in 42 patients with a primary intracranial meningioma at or above the age of 65. Complication rate, surgical risk, and outcome were statistically analyzed. RESULTS: The mean Geriatric Scoring System (GSS) score on admission was 15.4 ± 2.6. Ibañez grade of severe complication or death (grades III-IV) were experienced in 26.2% of patients. It was more common in male and in emergency cases, but it was significant in relation to the comorbidities (P < 0.004). Most patients had World Health Organization (WHO) grades I lesions, accounted for 85.7% of patients. MRI evidence of post-surgical residual was 14.4%, and 83.3% of patients had recurrence-free survival (RFS). The GSS score >16 were more frequent in the patient with RFS than those of < 16, and it was statistically significant (P < 0.06). Patient with Karnofsky performance status (KPS) < 70, the mean GSS was 14.5 and KPS > 70, the mean GSS was 18.9, and it was statistically significant (P < 0.002). CONCLUSION: The surgical technique for resection of elderly meningioma still had numbered cases of morbidity and mortality. The complication rate is related to preoperative co-morbidity and frequently associated with male and urgent surgery. Karnofsky score > 70, and RFS are favorable prognosis and related to GSS > 16 scores. The recurrence rate is usually attributed to high tumor grade and skull base tumor. Such scoring systems are valuable for elderly meningioma.
ABSTRACT
PURPOSE: To evaluate the benefit of fluoroscopy-guided lumbar spine interventional procedures in treatment of low back pain. METHODS: This prospective descriptive study was performed on 60 patients with back/radicular pain after showing no improvement with conservative treatment. RESULTS: One hundred and two injection sessions were done (average 1.7 injection per patient). Caudal and lumbar transforaminal injections were effective in 55.9% and 78.5%, respectively. Facet and sacroiliac interventions were effective in 28.3% and 10%, respectively. Complications occurred in 20% of the procedures. CONCLUSION: Lumbar injections improved pain/disability related to discogenic lumbar spinal diseases. Efficacy of facet and sacroiliac injections is limited.
