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Intracranial meningioma surgery in the elderly (over 65 years): prognostic factors and outcome

  • Clinical Article - Brain Tumors
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Abstract

Background

Meningiomas are more prevalent in elderly individuals; however, the surgical outcome and prognostic factors in this age group are unclear. This retrospective study aimed to identify the prognostic factors of elderly patients with intracranial meningiomas who underwent surgical resection.

Methods

Eighty-six patients (aged ≥65) diagnosed with an intracranial meningioma were surgically treated at our department. The clinical, radiological, and follow-up data were retrospectively reviewed. Univariate and multivariate logistic analyses were performed to identify relationships between factors [age, sex, neurological condition, concomitant disease, American Society of Anesthesiology (ASA) classification, preoperative Karnofsky Performance Scale (KPS) score, tumor location and size, peritumoral edema, and Simpson resection grade] and outcome.

Results

One patient (1.2 %) died within 30 days of surgery. The morbidity rate was 37.2 %. Postoperative morbidities occurred more frequently in the patients with preoperative neurological deficits than in those without (p = 0.049). Univariate analysis identified significant relationships between a low KPS score (≤70) at discharge and preoperative neurological deficits, low preoperative KPS score (≤70), and critical tumor location (p < 0.001, p < 0.001, and p = 0.04, respectively). In the multivariate logistic analysis, only the preoperative KPS score remained significant for the KPS score at discharge (p = 0.005); there was no significant association with the most recent KPS score.

Conclusion

The outcome of intracranial meningioma resection in elderly individuals is favorable if the preoperative KPS score is >70 and no neurological deficits are present. Treatment decisions should be patient-specific, and additional factors should be considered when operations are performed in patients with a low preoperative KPS score or neurological deficits.

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Acknowledgments

We would like to thank the neurosurgeons and staff of The First Affiliated Hospital of Guangxi Medical University for their excellent work. We thank Medjaden Bioscience, Ltd., for assisting in the preparation of this manuscript.

Patient consent

The patients or their relatives consented to study participation and the use of their data for research purposes.

Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, Guangxi, 530021, China

    Zhi-Yi Chen, Chuan-Hua Zheng,  Tang Li, Xiao-Yan Su, Gui-Hua Lu, Chao-Yuan Zhang, Shao-Wen Xiao & Yuan-Fu Tan

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Comments

Our Chinese colleaques retrospectively analyzed prognostic factors for the outcome in 86 elderly (≥65 years) patients after a microsurgical removal of an intracranial meningioma. But their task was impossible—only one variable in the cohort was rather constant, i.e., modern microneurosurgery in advanced services, but two were highly variable, i.e., intracranial meningiomas (size/site/adherence to adjacent structures) and elderly patients (neurological deficits/concomitant diseases and medications/previous neurocardiovascular events)—at least in unselected population-based services.

Let's try an Individual Risk Calculator of Operative 12-month Mortality and Morbidity of Intracranial Meningiomas in the Elderly based on the authors’ multivariate analysis data. What would the risk of operative 1- or 12-month mortality be for this 70-year-old female, a retired cardiologist, with treated hypertension and anticoagulation because of atrial fibrillation, now presenting with a suprasellar meningioma and rapidly reduced visual acuity not allowing an independent life any more? This is not possible because there are only seven tuberculum sellae meningiomas in their series, etc. The individual risk calculator would require 8600 rather than 86 patients. The authors conclude that ‘prospective and large sample studies must be performed to identify prognostic factors and surgical selection criteria for elderly patients with intracranial meningioma.’ I don't think so because that effort would exceed our combined capacity. But I totally agree that ‘treatment decisions should be patient-specific.’

Who then is elderly? My official retirement age is 68 years. If I then had a 5-cm falcine meningioma with focal seizures in the left foot, what would my neurosurgeon, orginally trained by me, tell me, and in what tone, about my possible outcome and complications?—Professor, considering your age, I am sorry to tell that your left foot will most probably remain weaker than it is now and the risk of venous infarctions from occlusion of bridging veins…

Juha E Jääskeläinen

Kuopio Finland

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Chen, ZY., Zheng, CH., Tang Li et al. Intracranial meningioma surgery in the elderly (over 65 years): prognostic factors and outcome. Acta Neurochir 157, 1549–1557 (2015). https://doi.org/10.1007/s00701-015-2502-9

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