Elderly Patients with Intracranial Meningioma: Surgical Considerations in 228 Patients with a Comprehensive Analysis of the Literature

Ekşi, Murat Şakir; Canbolat, Çağrı; Akbaş, Ahmet; Özmen, Berk Barış; Akpınar, Ebubekir; Usseli, Murat İmre; Güngör, Abuzer; Güdük, Mustafa; Hacıhanefioğlu, Mehmet; Danyeli, Ayça Erşen; Özduman, Koray; Pamir, M. Necmettin

doi:10.1016/j.wneu.2019.08.150

Cited by 33 publications

(32 citation statements)

References 63 publications

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“…The rate of tumor recurrence was also similar in elderly and non-elderly patients, which could indicate the similar biological behavior of most (low-grade) meningiomas. This is further supported by the fact that there was no significant difference in histopathological grading (MIB1-index or WHO grade) between the two groups, and it is consistent with previous studies on age-related features of spinal meningiomas [49], but it differs from intracranial meningiomas where MIB1-index values are generally higher in elderly patients [50]. In line with previously published data, the elderly cohort also had a higher degree of preoperative neurological impairment compared to the non-elderly [29].…”

Section: Discussionsupporting

confidence: 91%

Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Pettersson-Segerlind

Fletcher‐Sandersjöö

Tatter

et al. 2021

Cancers

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Spinal meningiomas are the most common adult primary spinal tumor, constituting 24–45% of spinal intradural tumors and 2% of all meningiomas. The aim of this study was to assess postoperative complications, long-term outcomes, predictors of functional improvement and differences between elderly (≥70 years) and non-elderly (18–69 years) patients surgically treated for spinal meningiomas. Variables were retrospectively collected from patient charts and magnetic resonance images. Baseline comparisons, paired testing and regression analyses were used. In conclusion, 129 patients were included, with a median follow-up time of 8.2 years. Motor deficit was the most common presenting symptom (66%). The median time between diagnosis and surgery was 1.3 months. A postoperative complication occurred in 10 (7.8%) and tumor growth or recurrence in 6 (4.7%) patients. Surgery was associated with significant improvement of motor and sensory deficit, gait disturbance, bladder dysfunction and pain. Time to surgery, tumor area and the degree of spinal cord compression significantly predicted postoperative improvement in a modified McCormick scale (mMCs) in the univariable regression analysis, and spinal cord compression showed independent risk association in multivariable analysis. There was no difference in improvement, complications or tumor control between elderly and non-elderly patients. We concluded that surgery of spinal meningiomas was associated with significant long-term neurological improvement, which could be predicted by time to surgery, tumor size and spinal cord compression.

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Section: Discussionsupporting

confidence: 91%

Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Pettersson-Segerlind

Fletcher‐Sandersjöö

Tatter

et al. 2021

Cancers

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“…The PR expression of meningiomas in the different age groups is scarcely focused in the literature. Two recent reviews of reported studies on elderly patients do not include data on the PR expression (41,42). We have found significantly higher rate of PR expression ≥80% in patients aged <70 years (p = 0.032), whereas lower PR values are not correlated.…”

Section: Progesterone Receptor Expression and Patient Age And Sexcontrasting

confidence: 72%

Progesterone Receptor Expression in Meningiomas: Pathological and Prognostic Implications

Maiuri¹,

Mariniello²,

Esposito³

et al. 2021

Front. Oncol.

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BackgroundThe progesterone receptor (PR) is variably expressed in most meningiomas and was found to have prognostic significance. However, the correlation with patient age, tumor location, time to recurrence, and pattern of regrowth has scarcely been discussed.MethodsA surgical series of 300 patients with meningiomas is reviewed. The PR expression was classified as: 0. absent; 1. low (<15%); 2. moderately low (16–50%); 3. moderately high (51–79%); 4. high (≥80%). The PR values were correlated with the patient age and sex, meningioma location, WHO grade, Ki-67 MIB1, recurrence rate, pattern of recurrence (local-peripheral versus multicentric diffuse), and time to recurrence.ResultsThe PR expression has shown lower rate of high expression in the elderly group (p = 0.032) and no sex difference (including premenopausal versus postmenopausal women), higher expression in medial skull base and spinal versus other locations (p = 0.0036), inverse correlation with WHO grade and Ki67-MIB1 (p < 0.0001). Meningiomas which recurred showed at initial surgery higher rates of low or moderately low PR expression than the non-recurrent ones (p = 0.0004), whereas the pattern of regrowth was not significant. Higher rates of PR values ≥80% were found in cases with time to recurrence >5 years (p = 0.036).ConclusionThe higher PR expression in medial skull base meningiomas, the significant correlation with the time to recurrence, the lack of difference of PR expression between premenopausal and postmenopausal women and between local-peripheral versus multicentric-diffuse recurrences are the most relevant unreported findings of this study. The rate of PR expression must be included in the routine pathological diagnosis of meningiomas because of its prognostic significance.

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“…A recent review of meningioma surgery in elderly patients [38] often found that postoperative mortality is most commonly associated with co-morbidities. Eksi et al [39] also found in their meta-analysis that co-morbidities are a strong predictor of postsurgical neurologic complications.…”

Section: Toxicitymentioning

confidence: 94%

Stereotactic radiosurgery of benign brain tumors in elderly patients: evaluation of outcome and toxicity

et al. 2020

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Background Stereotactic radiosurgery (SRS) is widely accepted as a therapeutic option for meningiomas (M) and vestibular schwannomas (VS). However, data on outcome and toxicity in the elderly population have rarely been reported in detail. Methods All patients aged ≥ 65 years with M or VS who underwent single fraction SRS were included. Patient data were analyzed in terms of clinical tumor control and incidence of early and late treatment related complications, which were graded according to the Common Terminology Criteria for Adverse Events (CTCAE), Results We identified 245 patients with benign brain tumors (129 M and 116 VS, median tumor volume 2.9 ml, range 0.1–28). The median age was 71 years (range 65–86) and the mean follow-up times were 42 months (range 2–181). Tumors were irradiated with a median dose of 12.4 Gy. Actuarial clinical and radiological tumor control rates at 2, 5, and 10 years after SRS were 98%, 93%, and 88%, respectively. Recurrent tumors after previous treatment had a higher probability of post-radiosurgical progression (p < 0.001). Permanent toxicity (CTCAE I/II) were noted in 5.7%. No severe adverse events were observed during early and late follow up, although patients > 70 years had a slightly higher risk for toxicity (p = 0.027). The presence and extent of co-morbidities had no significant influence on local tumor control or toxicity. Conclusion SRS provides favorable tumor control with low risk for treatment-related severe complications. Thus, SRS should always be considered as treatment option for benign intracranial tumors (meningiomas, schwannomas), especially in the group of elderly patients.

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Elderly Patients with Intracranial Meningioma: Surgical Considerations in 228 Patients with a Comprehensive Analysis of the Literature

Cited by 33 publications

References 63 publications

Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Progesterone Receptor Expression in Meningiomas: Pathological and Prognostic Implications

Stereotactic radiosurgery of benign brain tumors in elderly patients: evaluation of outcome and toxicity

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