Surgery on giant meningiomas in very old patients entails frequent postoperative intracranial hemorrhages and atypical histopathology

Abstract

Purpose Surgical resection of intracranial meningiomas in patients that are 80 years old and older, i.e. very old patients, is increasingly considered. Meningiomas with a largest diameter of at least 5 cm—‘giant meningiomas’—form a distinct entity, and their surgical resection is considered more difficult and prone to complications. Here, we evaluated functional outcome, morbidity and mortality, and the prognostic value of tumor size in very old patients who underwent resection of giant supratentorial meningiomas. Methods We retrospectively reviewed clinical and radiological data, functional performance (Karnofsky Performance Score), histopathological diagnosis and complications of very old patients who underwent surgery of a supratentorial meningioma at the Helsinki University Hospital between 2010 and 2018. Results We identified 76 very old patients, including 28 with a giant meningioma. Patients with a giant meningioma suffered from major complications more commonly than those with a non-giant meningioma (36% vs. 17%, p = 0.06), particularly from postoperative intracranial hemorrhages (ICH). At the 1-year follow-up, functional performance and mortality rate were comparable between patients with giant meningiomas and those with non-giant meningiomas. An exceptionally high rate of giant meningiomas were diagnosed as atypical meningiomas (WHO II) at an (11 out of 28 cases). Conclusions Giant meningioma surgery entails a high complication rate in frail, very old patients. The prevention of postoperative ICH in this specific patient group is of utmost importance. An atypical histopathology was notably frequent among very old patients with a giant meningioma, which should be taken into account when planning the surgical strategy.

The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie

“…Although the most intuitive hypothesis would be that a larger meningioma with a higher growth velocity and more frequently higher grade would result in a higher proportion of edema with related symptomatology (therefore, tumors associated with extensive PBE are commonly suspected to be pathologically malignant [17]), this does not occur. Further, although there is a correlation between grading with survival and recurrence rates [3,24,25], we did not find a correlation between PBE and grading.…”

“…Medium/large meningiomas were considered as one group for this study because they have similar prognostic features and are often variably defined in many studies [ 1 , 3 , 14 , 15 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ].…”

“…In defining the size of meningiomas, we referred to the traditional classification of Russell et al [23] which reports small meningiomas as those less than 2 cm in diameter, medium as 2 to 4 cm, and large up to 4.9 cm. Medium/large meningiomas were considered as one group for this study because they have similar prognostic features and are often variably defined in many studies [1,3,14,15,[24][25][26][27][28][29][30][31].…”

Mortality of surgically treated 80-year-old or older intracranial meningioma patients in comparison to matched general population

“…In addition to the current study evaluating the overall rationality of operating very old meningioma patients, we have previously used the same patient cohort to assess the effect of peritumoral edema 8 , size 12 and surgeon’s experience 11 on surgical outcomes. Based on our studies, surgical removal of IMs with larger peritumoral edema associates with more favorable outcome 8 , whereas surgical treatment of giant (diameter ≥ 5 cm) IMs entails a high complication rate 12 . Moreover, surgical results did not depend on the surgeon’s experience 11 .…”

“…The study cohort has been described previously 8 , 11 , 12 . By utilizing a hospital-based electronic Centricity™ Opera (GE Healthcare) software, which is an operating theatre management solution, we identified all very old (≥ 80-year-old) patients who underwent their first-ever elective IM surgery at HUH.…”