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Objective:The apparent increase in the incidence of the intracranial meningiomas in the elderly is due in part to improved diagnostic tools and improved span of life. The authors carried out a retrospective study to validate the use of the Clinical-Radiological Grading System (CRGS) as a clinical tool to orientate surgical decision making in elderly patients and to explore prognostic factors of survival. Methods : From January 1997 to January 2006, the authors consecutively recruited and surgically treated 20 patients older than 65 years of age with radiologic findings of intracranial meningiomas and a preoperative evaluation based on the CRGS. Results : High CRGS score was associated with a higher probability of good outcome (p=0.004) and a lower probability of postoperative complications (p=0.049). Among the different subset items of the CRGS score, larger maximum tumor diameters (D&Igrave;4cm) and the presence of a severe peritumoral edema were associated with incidence rate of postoperative poor outcome and complications (p<0.05). Additionally, the critical location of the tumor was also correlated with poor outcome (p<0.05). Conclusion : A CRGS score higher than 13 is a good prognostic indication of survival. The CRGS score is a useful and practical tool for the selection of elderly patients affected by intracranial meningiomas as surgical candidates.