Dear Colleagues, We are thankful for your careful reading and remarks regarding our paper entitled “The Geriatric Scoring System (GSS) in meningioma patients—validation” Acta Neurochir (2011) 153:1501–1508 [3]. The advances made in medicine and the increase in life expectancy has led to an increase in the incidental finding of meningioma. Meningiomas comprise approximately 21% of all primary intracranial tumors, and when data from autopsies are included, this figure rises to above 40%, thus showing that many remain clinically silent, never coming to clinical attention [5, 6, 8, 11]. The elderly patient poses a medical challenge in all aspects of medicine and for any surgical intervention. Roser and coworkers [10, 11] defined meningioma in the elderly patient as a separate clinical entity in comparison to that in the young, since cellular proliferation, vascularity, and intra-tumoral hormonal profiles change with age. A question arises concerning the benefit of surgery for those elderly patients for whom surgical resection is possible; namely, when there is no technical limitation to surgery. In other words, what elderly subpopulation will benefit from surgical intervention in terms of their overall physical and functional states of health? Previous work done by our group reported the presenting symptoms, chronic illnesses and their impact, and the perioperative and long-term follow-up results of 250 patients admitted to our institute during a 10-year period (1995–2005) [2]. Based on univariant and multivariate analysis, significant prognostic indicators were identified and were implemented into a Geriatric Scoring System (GSS). The GSS incorporates essential independent considerations and patient factors on admission, including tumor size and location, peritumoral edema, neurological deficits, Karnofsky score [1, 4], and associated diabetes, hypertension, or lung disease. Each of the parameters is assigned a score ranging from 1 to 3; thus, the total score ranges from 8 to 24. Seven outcome parameters were retrospectively tested using the scoring system; namely, mortality, Barthel index score [9], Karnofsky score, and consciousness expressed by the Glasgow Coma Scale (GCS) score [7] 5 years after surgery, as well as recurrence within and beyond 12 months. A GSS score higher than 16 was found to be associated with a significantly more favorable outcome. In this follow-up study, we reported the presenting symptoms, chronic illnesses and their impact, perioperative and long-term follow-up results of 120 patients admitted to our institute during a 5-year period (2005–2010), forming an independent cohort. The GSS score, proposed previously by our group, was challenged again in this second paper. Nine outcome parameters were tested against the GSS score: survival (3 months after surgery and overall), Barthel index, Karnofsky score, and GCS score 5 years after operation, and tumor recurrence (within and beyond 12 months of operation), admission time (both in nICU and overall). It was shown with statistical significance, for all outcome parameters tested, that a patient presenting with a score of 16 or higher may benefit from a surgical intervention and has a favorable prognosis thereafter. O. Cohen-Inbar (*) Department of Neurosurgery, Rambam Maimondes Health Care Campus, Haifa Israel Faculty of Medicine, Technion Israel Institute of Technology, PO Box 9602, Haifa 31096, Israel e-mail: orcoheninbar@gmail.com