Intracranial Meningiomas in the 9th Decade of Life

Mastronardi, Luciano; Ferrante, Luigi; Qasho, R.; Ferrari, Vincenzo; Tatarelli, Roberto; Fortuna, Aldo

doi:10.1227/00006123-199502000-00005

Cited by 58 publications

(21 citation statements)

References 12 publications

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“…Several recent large studies have suggested increasing age as a prognostic risk factor in patients indicated for intracranial meningioma surgery, 13,14,16,32,52) but clinical and functional status 13–16,18,32,34,53–55) and radiological features 13,17,25,32,53,54,56,57) are still more frequently recognized as risk factors. Moreover, female sex has been associated with better prognosis.…”

Section: Introductionmentioning

confidence: 99%

Review of Current Evidence Regarding Surgery in Elderly Patients with Meningioma

Ikawa

Kinoshita

Takeda

et al. 2017

Neurol. Med. Chir.(Tokyo)

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The Japanese population features the highest rate of elderly individuals worldwide. Moreover, Japan has the highest number of computed tomography/magnetic resonance imaging devices in the world, which has led to an increase in the incidental detection of meningioma in healthy elderly patients. Many previous papers have discussed the risks and indications for surgery in this patient population, but available information remains insufficient, and the definition of “elderly” has not been standardized. This review tried to clarify the published evidence and challenges associated with elderly meningioma based on a search of the PubMed database using the terms “meningioma,” “elderly,” and “surgery” for English-language clinical studies and collected related papers published from 2000 to 2016. Twenty-four papers were reviewed and classified by definition of elderly age: over 60, 65, 70, and 80 years old. Six of seven papers that defined the elderly cutoff as over 65 years old were published after 2010, which suggested the consensus definition. Four preoperative grading scoring systems were described and associated with mortality. The 1-year and 5-year mortality rates ranged from 0% to 16.7% and from 7% to 27%, which were comparable with unselected cohorts. Review of risk factor analysis emphasized the importance of considering the preoperative status, presence of comorbidities, and optimum surgical timing during patient selection. Careful choice of patients can also lead to better quality of life. A prospective randomized study considering patient frailty should address the causes and prevention of complications.

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Section: Introductionmentioning

confidence: 99%

Review of Current Evidence Regarding Surgery in Elderly Patients with Meningioma

Ikawa

Kinoshita

Takeda

et al. 2017

Neurol. Med. Chir.(Tokyo)

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“…1. From a total of 1039 articles, seven fulfilled the inclusion criteria [5,6,14,15,19,20,23]. All seven studies were retrospective, conducted between 1995 and 2018.…”

Section: Resultsmentioning

confidence: 99%

“…All seven studies were retrospective, conducted between 1995 and 2018. Three of the studies were performed in Italy [5,6,15], two in France [19,20], one in Norway [14], and one in the USA [23]. The latter [23] was based on a large national register (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Preoperative status and morbidity All seven studies [5,6,14,15,19,20,23] used the American Society of Anesthesiology (ASA) scale [7] to assess preoperative physical status, which varied considerably among studies. Four studies [5,6,15,19] included mostly healthy patients or patients with mild comorbidities (ASA classes I-II), whereas in three studies [14,20,23], most patients had severe systemic comorbidities (ASA classes III-V). In addition, six studies [5,6,14,15,19,20] used the Karnofsky Performance Scale (KPS) [4] to describe IM patients' preoperative functional status.…”

Section: Preoperative Characteristicsmentioning

confidence: 99%

“…Four studies [5,6,15,19] included mostly healthy patients or patients with mild comorbidities (ASA classes I-II), whereas in three studies [14,20,23], most patients had severe systemic comorbidities (ASA classes III-V). In addition, six studies [5,6,14,15,19,20] used the Karnofsky Performance Scale (KPS) [4] to describe IM patients' preoperative functional status. In these studies, there was an equal representation of dependent (KPS 0-60) and independent (KPS 70-100) IM patients ( Table 2).…”

Section: Preoperative Characteristicsmentioning

confidence: 99%

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Is surgery justified for 80-year-old or older intracranial meningioma patients? A systematic review

2020

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Since the number of elderly people with intracranial meningiomas (IM) continues to rise, surgical treatment has increasingly become a considerable treatment option, even in very old (≥ 80 years old) meningioma patients. Since little is known about whether meningioma surgery in this age group is safe and justified, we conducted a systematic review to summarize the results of surgical outcomes in very old meningioma patients. We performed a systematic literature search in Pubmed, Cochrane Library, and Scopus databases. Primarily, we extracted 1-month and 1-year survival rates, and 1-year morbidity rates, as well as information about preoperative morbidity, operative complications, meningioma size, location, histology, and peritumoral edema. Quality of the included studies was evaluated by Cochrane Collaboration Handbook and Critical Appraisal Skills Program. From the 1039 reviewed articles, seven retrospective studies fulfilled our eligibility criteria. Motor deficits (27-65%) and mental changes (51-59%) were the most common indications for surgery. One-month and 1-year mortality rates varied between 0-23.5% and 9.4-27.3%, respectively. Most of the operated IM patients (41.2-86.5%) improved their performance during postoperative follow-up. Impaired preoperative performance and comorbidities were most commonly related to higher postoperative mortality. None of the studies fulfilled the criteria of high quality. Based on the evidence currently available, surgical treatment of very old IM patients seems to improve the performance of highly selected individuals. Given the rapid increase of the aging population, more detailed retrospective studies as well as prospective studies are needed to prove the outcome benefits of surgery in this patient group.

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Frequency and risk factors for meningioma in clinically healthy 75‐year‐old patients

Krampla

Newrkla

Pfisterer

et al. 2004

Cancer

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BACKGROUNDThe prevalence of clinically silent intracranial tumors in specific populations is poorly researched. It is known that, in advanced age groups, the number of clinically manifest meningiomas constitute a small proportion of the actual number of cases. The goals of the current study were to determine the frequency of asymptomatic patients with meningioma in advanced age and to identify risk factors for meningiomas in this population.METHODSBetween May 2000 and November 2002, 532 probands from a specifically defined geographic area of Vienna who were age 75 years underwent a magnetic resonance imaging scan of the brain and were evaluated for the presence of a space‐occupying mass. All probands were examined clinically and neurologically as well as by a neuropsychiatrist. The patients' medical histories were carefully documented with regard to previous diseases, medication, and lifestyle, as were their laboratory reports. The collected data were correlated and similarities among subjects with meningioma were determined.RESULTSNine meningiomas that were unknown until the time of investigation were observed among the 318 women included in the trial (corresponding to a calculated prevalence of 2800/100,000 clinically silent meningiomas in 75‐year‐old women). No tumors were found among men. Associated clinical changes or deficits were not observed in any subject. Apart from advanced age and female gender, no other accepted or well known risk factors were observed in the tumor patients.CONCLUSIONSClinically quiescent meningiomas in the elderly female population were more common than was believed to be the case to date. Known and influenceable risk factors were found to be less important than age and gender. The high frequency of this lesion should be considered when deciding on the treatment of patients with incidentally discovered, clinically quiescent meningiomas. Cancer 2004. © 2004 American Cancer Society.

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Intracranial Meningiomas in the 9th Decade of Life

Cited by 58 publications

References 12 publications

Review of Current Evidence Regarding Surgery in Elderly Patients with Meningioma

Review of Current Evidence Regarding Surgery in Elderly Patients with Meningioma

Is surgery justified for 80-year-old or older intracranial meningioma patients? A systematic review

Frequency and risk factors for meningioma in clinically healthy 75‐year‐old patients

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