Key result
Awake craniotomy was successfully performed in a 92-year-old patient with a brain tumor, guided by a low frailty score (RAI-C 30), resulting in immediate intraoperative speech improvement.
Why the study?
Geriatric patients are often viewed as poor candidates for awake craniotomy due to age and medical comorbidities, though frailty assessments can gauge physiological reserve for preoperative decision-making.
Does frailty scoring predict successful awake craniotomy in a 92-year-old patient?
Case Report (n=1)
Does frailty scoring predict successful awake craniotomy in a 92-year-old patient?
This case demonstrates that nonfrail patients over 90 years of age may tolerate awake craniotomy, highlighting the utility of frailty scoring for preoperative risk assessment.
Answers are grounded in this paper and cite their sources.
Nonfrail nonagenarians may tolerate awake craniotomy; frailty scoring utility remains hypothesis-generating pending validation.
Background: The awake craniotomy (AC) procedure allows for safe and maximal resection of brain tumors from highly eloquent regions. However, geriatric patients are often viewed as poor candidates for AC due to age and medical comorbidities. Frailty assessments gauge physiological reserve for surgery and are valuable tools for preoperative decision-making. Here, we present a novel case illustrating how frailty scoring enabled an elderly but otherwise healthy female to undergo successful AC for tumor resection. Case Description: A 92-year-old right-handed female with history of hypertension and basal cell skin cancer presented with a 1-month history of progressive aphasia and was found to have a ring-enhancing left frontoparietal mass abutting the rolandic cortex concerning for malignant neoplasm. Frailty scoring with the recalibrated risk analysis index (RAI-C) tool revealed a score of 30 (of 81) indicating low surgical risk. The patient and family were counseled appropriately that, despite advanced chronological age, a low frailty score predicts favorable surgical outcomes. The patient underwent left-sided AC for resection of tumor and experienced immediate improvement of speech intraoperatively. After surgery, the patient was neurologically intact and had an unremarkable postoperative course with significant improvements from preoperatively baseline at follow-up. Conclusion: To the best of our knowledge, this case represents the oldest patient to undergo successful AC for brain tumor resection. Nonfrail patients over 90 years of age with the proper indications may tolerate cranial surgery. Frailty scoring is a powerful tool for preoperative risk assessment in the geriatric neurosurgery population.
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Cole et al. (2022) conducted a case report in Brain tumor (n=1). Awake craniotomy guided by frailty scoring (RAI-C) was evaluated on Surgical outcome and neurological status. Awake craniotomy was successfully performed in a 92-year-old patient with a brain tumor, guided by a low frailty score (RAI-C 30), resulting in immediate intraoperative speech improvement.
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