Risks and neurological benefits of meningioma surgery in elderly patients compared to young patients

Ahmeti, Hajrullah; Borzikowsky, Christoph; Hollander, Dieter; Röcken, Christoph; Jansen, Olav; Synowitz, Michael; Mehdorn, Maximilian

doi:10.1007/s11060-021-03832-5

Cited by 16 publications

(5 citation statements)

References 32 publications

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Section: Managementmentioning

confidence: 99%

“…Elderly patients are at higher risk of peri- and postoperative adverse events, 18 , 53 , 62 , 64–67 and the majority of these complications appear to be medical. 64 , 67 Postoperative complications significantly influence survival and functional course in the elderly. 66 , 71 , 72 , 88 It is important to note that comorbidities, frailty, and poor baseline performance status may be stronger predictors of adverse events than age, 73 , 74 and age alone is often not associated with complications in multivariable models adjusted for these factors.…”

Section: Managementmentioning

confidence: 99%

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Meningioma in the elderly

Amoo

Henry

Farrell

et al. 2023

Neuro-Oncology Advances

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Meningiomas are the most common primary intracranial neoplasm, accounting for approximately 40% of all primary brain tumors. The incidence of meningioma increases with age to 50 per 100,000 in patients older than 85. As the population ages, an increasing proportion of meningioma patients are elderly. Much of this increase is accounted for by an increase in incidental, asymptomatic diagnoses, which have a low risk of progression in the elderly. The first-line treatment of symptomatic disease is resection. Fractionated radiotherapy (RT) or stereotactic radiosurgery (SRS) can be considered as primary treatment where surgery is not feasible, or as adjuvant therapy in cases of subtotal resection or high grade histopathology. The role of RT/SRS, particularly following gross total resection of atypical meningioma, is unclear and requires further evaluation. There is an increased risk of perioperative and postoperative morbidity in the elderly and therefore management decisions must be tailored to individual circumstances. Good functional outcomes can be achieved in selected patients and age alone is not a contraindication to intervention. The immediate postoperative course is an important determinant of prognosis. Therefore, careful preoperative evaluation and avoidance of complications are necessary to optimize outcomes.

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Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Meningioma in the elderly

Amoo

Henry

Farrell

et al. 2023

Neuro-Oncology Advances

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“…We use it especially for asymptomatic (incidental) meningiomas in patients older than 70 years with numerous internal comorbidities. If tumour size progresses, we consider a radiosurgical procedure; surgery is the last resort [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Neurosurgical treatment and outcome patterns in patients with meningioma in South Moravian region—a population-based study

Duba,

Mrlian,

Rošková

et al. 2023

Neurol Sci

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Introduction Meningiomas are usually slow-growing tumours, constituting about one third of all primary intracranial tumours. They occur more frequently in women. Clinical manifestation of meningiomas depends on their location, tumour size and growth rate. In most cases, surgical treatment is the procedure of choice. The success of this treatment is, however, associated with the radicality of the resection. Radiotherapy represents an additional or alternative treatment modality. Gamma knife surgery is another notable treatment method, especially in small and/or slow-growing tumours in eloquent areas or in elderly patients. Material and methods Authors describe their experience with the diagnosis, treatment and outcome of the patients with meningioma (n = 857). Furthermore, they also assess the postoperative morbidity/mortality and recurrence rate. Results and conclusions In view of the benign histology of meningiomas, the success of the treatment largely depends (besides the tumour grading) on the radicality of the resection. The emphasis is also put on appropriate follow-up of the patients. In certain patients, the watch and wait strategy should be also considered as a suitable treatment method.

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“…In our opinion, the reason surgery in the elderly is still to be considered higher risk lies in the broadest possible consideration of all the other possible factors that influence the outcome. Different works [ 24 , 25 , 26 , 27 ] have previously attempted to identify and define prognostic factors for surgical outcomes in elderly patients, but information about patient selection for surgical treatment is limited by different study designs and indications for surgery across neurosurgical centers, showing conflicting, and often incomplete, data.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Meningioma in Elderly Patients. Retrospective Multicentric Risk and Surgical Factors Study of Morbidity and Mortality

et al. 2022

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With the increasing life expectancy, a large number of intracranial meningiomas (IM) have been identified in elderly patients. There is no general consensus regarding the management for IMs nor studies regarding the outcome of older patients undergoing meningioma surgery. We aimed to determine whether preoperative variables and postoperative clinical outcomes differ between age groups after meningioma surgery. We analyzed data from all patients who had undergone IM surgery from our departments. The final cohort consisted of 340 patients affected by IM with ASA class I-II: 188 in the young group (<65) and 152 in the elderly. The two subgroups did not present significant differences concerning biological characteristics of tumor, localization, diameters, lesion and edema volumes and surgical radicality. Despite these comparable data, elderly presented with a significantly lower Karnofsky Performance status value on admission and remained consistently lower during the follow-up. We establish instead that there is no intrinsic correlation to the presence of IM and no significant increased risk of complications or recurrence in elderly patients, but rather only an increased risk of reduced performance status with mortality related to the comorbidity of the patient, primarily cardiovascular disease, and an intrinsic frailty of the aged population.

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Risks and neurological benefits of meningioma surgery in elderly patients compared to young patients

Cited by 16 publications

References 32 publications

Meningioma in the elderly

Meningioma in the elderly

Neurosurgical treatment and outcome patterns in patients with meningioma in South Moravian region—a population-based study

Intracranial Meningioma in Elderly Patients. Retrospective Multicentric Risk and Surgical Factors Study of Morbidity and Mortality

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