Effects of surgery on cognitive functioning of elderly patients with intracranial meningioma

Tucha, Oliver; Smely, Christian; Lange, Klaus W.

doi:10.1080/02688690151127608

Cited by 45 publications

(27 citation statements)

References 26 publications

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“…Other studies have reported significant cognitive impairment in meningioma patients either pre- or post- surgery [9, 10], although the average tumor size in both of these studies was much greater than the average size of tumor in our study. Those looking at patients both before and after surgery show mixed findings based on factors such as type of intervention, meningioma size, and patient characteristics [7, 8, 19, 20]. Previous authors have suggested the cognitive impairment could be due to mass effect, edema, and even extra-tumor factors such as seizures and anti-seizure medications.…”

Section: Discussionmentioning

confidence: 99%

“…Studies available on cognitive functioning in meningioma have identified cognitive impairment in subjects who are being followed clinically (e.g., as part of a “wait and scan” approach [6], during pre-surgical evaluation [7, 8], or following surgical intervention [9, 10]). Recently, van Nieuwenhuizen et al studied a sample of 21 individuals with radiologically confirmed WHO Grade I supratentorial meningiomas who were followed with a “wait and scan” approach.…”

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confidence: 99%

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Neurocognition in individuals with incidentally-identified meningioma

et al. 2017

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Meningiomas are primary intracranial tumors that are often asymptomatic. To our knowledge, no study has attempted to describe neurocognitive function in patients with incidentally-discovered meningioma. We utilized the Mayo Clinic Study of Aging (MCSA), which is a population-based sample of Olmsted County, Minnesota residents that includes neuropsychological testing and brain MRI approximately every 15 months. Using a text search of radiologists’ notes of 2,402 MCSA individuals (mean age 77 years, scanned between 2004 and 2014) we identified 48 eligible subjects (2%) who had at least one meningioma. Most meningiomas were small (90% < 3cm). We matched each of the 48 subjects to five non-demented MCSA controls (n = 240) on age, sex, and education. Cognitive domains assessed included memory, attention-executive function, language, and visuospatial. More women (67%) had a meningioma than men (33%). Groups did not differ on prevalence of Mild Cognitive Impairment (Meningioma = 19%, Controls = 13%). Across cognitive domains, we observed similar performance for the two groups (p’s ≥ 0.21). Subtle differences emerged in memory and language domains (p = 0.05 and p = 0.11) when we divided the Meningioma group by tumor location, wherein the small group with an infratentorial tumor performed more poorly than controls globally as well as on select memory and language measures. Our findings suggest that small meningiomas are generally cognitively benign, but that may change as the tumor evolves, and might be impacted by other factors such as meningioma location.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Neurocognition in individuals with incidentally-identified meningioma

et al. 2017

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“…With regard to toxicity outcomes, our results indicate the safety of this treatment modality for the older population, who is at risk of higher treatment-related complications due to lower performance indices and comorbidities. Reports of several surgical series in older adults have found that the incidence of associated morbidity ranges from 9% to 54% in this population [ 19 – 22 ]. The largest surgical series that examined outcome in 258 older patients with meningioma indicated morbidity rates of 29.8% [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Elderly Patients with Meningioma after Image-Guided Stereotactic Radiotherapy: A Study of 100 Cases

Kaul

Budach

Graaf

et al. 2015

BioMed Research International

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Introduction. Incidence of meningioma increases with age. Surgery has been the mainstay treatment. Elderly patients, however, are at risk of severe morbidity. Therefore, we conducted this study to analyze long-term outcomes of linac-based fractionated stereotactic radiotherapy (FSRT) for older adults (aged ≥65 years) with meningioma and determine prognostic factors. Materials and Methods. Between October 1998 and March 2009, 100 patients (≥65, median age, 71 years) were treated with FSRT for meningioma. Two patients were lost to follow-up. Eight patients each had grade I and grade II meningiomas, and five patients had grade III meningiomas. The histology was unknown in 77 cases (grade 0). Results. The median follow-up was 37 months, and 3-year, 5-year, and 10-year progression-free survival (PFS) rates were 93.7%, 91.1%, and 82%. Patients with grade 0/I meningioma showed 3- and 5-year PFS rates of 98.4% and 95.6%. Patients with grade II or III meningiomas showed 3-year PFS rates of 36%. 93.8% of patients showed local tumor control. Multivariate analysis did not indicate any significant prognostic factors. Conclusion. FSRT may play an important role as a noninvasive and safe method in the clinical management of older patients with meningioma.

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“…The smallest category of two papers 18,19) defined elderly as aged over 60 years old and included 87 patients; skull base-related location rate of 44.5%, tumor size rate over 4 cm of 78.8%, KPS score over 80 of 88.9%, in-hospital mortality rate of 5.6%, deterioration rate of 31.5%, and brain and general complication rates of 33.5% and 11.2%, respectively. One study 18) evaluated preoperative assessments, KPS, the mini-mental state examination, 20) ASA, and SKALE scores, and concluded that meningioma surgery carries higher risks of mortality and morbidity in elderly patients, compared with intracranial tumor surgery in the general population. However, the authors noted that survivors exhibited improved cognitive function and acceptable quality of life (QOL), and the proportion of independent patients (according to KPS) did not decrease significantly.…”

Section: Introductionmentioning

confidence: 99%

“…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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Effects of surgery on cognitive functioning of elderly patients with intracranial meningioma

Cited by 45 publications

References 26 publications

Neurocognition in individuals with incidentally-identified meningioma

Neurocognition in individuals with incidentally-identified meningioma

Outcome of Elderly Patients with Meningioma after Image-Guided Stereotactic Radiotherapy: A Study of 100 Cases

Review of Current Evidence Regarding Surgery in Elderly Patients with Meningioma

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