Elderly Patients with Frontobasal and Suprasellar Meningiomas: Safety and Efficacy of Tumor Removal via Frontolateral Approach

Guo, Shunyu; Gerganov, Venelin; Giordano, Mario; Samii, Amir; Samii, Madjid

doi:10.1016/j.wneu.2019.12.029

Cited by 5 publications

(8 citation statements)

References 24 publications

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“…Importantly, studies that did not report specific outcomes for OGM/TSM and approach combination were excluded from the final meta-analysis. These studies were considered for qualitative analysis if the relevant the tumour (TSM or OGM) and approach (mTCA, EEA, or eSKA) combination of interest was > 50% of the study population [9,48,98,105,111]. Similarly, articles that grouped TSM cases with planum sphenoidale meningiomas [3,92] were considered for qualitative review only (owing to the similarity of these tumour groups) but not included in the final meta-analysis.…”

Section: Data Extractionmentioning

confidence: 99%

The endoscope-assisted supraorbital “keyhole” approach for anterior skull base meningiomas: an updated meta-analysis

et al. 2020

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Introduction The gold-standard treatment for symptomatic anterior skull base meningiomas is surgical resection. The endoscope-assisted supraorbital "keyhole" approach (eSKA) is a promising technique for surgical resection of olfactory groove (OGM) and tuberculum sellae meningioma (TSM) but has yet to be compared with the microscopic transcranial (mTCA) and the expanded endoscopic endonasal approach (EEA) in the context of existing literature. Methods An updated study-level meta-analysis on surgical outcomes and complications of OGM and TSM operated with the eSKA, mTCA, and EEA was conducted using random-effect models. Results A total of 2285 articles were screened, yielding 96 studies (2191 TSM and 1510 OGM patients). In terms of effectiveness, gross total resection incidence was highest in mTCA (89.6% TSM, 91.1% OGM), followed by eSKA (85.2% TSM, 84.9% OGM) and EEA (83.9% TSM, 82.8% OGM). Additionally, the EEA group had the highest incidence of visual improvement (81.9% TSM, 54.6% OGM), followed by eSKA (65.9% TSM, 52.9% OGM) and mTCA (63.9% TSM, 45.7% OGM). However, in terms of safety, the EEA possessed the highest cerebrospinal fluid leak incidence (9.2% TSM, 14.5% OGM), compared with eSKA (2.1% TSM, 1.6% OGM) and mTCA (1.6% TSM, 6.5% OGM). Finally, mortality and intraoperative arterial injury were 1% or lower across all subgroups. Conclusions In the context of diverse study populations, the eSKA appeared not to be associated with increased adverse outcomes when compared with mTCA and EEA and offered comparable effectiveness. Case-selection is paramount in establishing a role for the eSKA in anterior skull base tumours.

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Section: Data Extractionmentioning

confidence: 99%

The endoscope-assisted supraorbital “keyhole” approach for anterior skull base meningiomas: an updated meta-analysis

et al. 2020

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“…Several other factors were predictive of outcome, including patient factors, male sex, neurological conditions, general health indicators such as KPS score, and tumor parameters [ 12 ], such as the size and location, presence, and severity of edema radiological features, extension, grading [ 4 , 13 , 28 , 29 , 30 ], and operative approach [ 31 ].…”

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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“…Most of these studies focused only on elderly patients without including control groups of young patients [16][17][18]. On the other hand, the series presented in the literature comparing meningioma surgery in elderly and young patients contains small numbers of elderly patients, most of whom included fewer than one hundred elderly patients [7,[19][20][21][22]. Bateman et al presented the largest series of patients with intracranial meningiomas in 2304 elderly and 6557 young patients from a nationwide inpatient sample database [6].…”

Section: Discussionmentioning

confidence: 99%

“…Despite differences such as age, number of pre-existing diseases and ASA score, even in elderly patients, high total resection rates were achieved in 79–88.6% of elderly patients compared to 62.9–90.3% of young patients [ 7 , 18 , 22 , 23 ]. Li et al reported a series of 70 patients over 65 years and 80 patients younger than 65 years with significantly low total resection rates of 50 and 68%, respectively [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the higher rate of postoperative morbidities in elderly patients, many studies have shown an improvement in neurological status postoperatively [ 22 , 24 ]. Zhao et al demonstrated in their series of 115 elderly patients a significantly lower postoperative KPS (mean KPS of 79.6) than in 413 young patients (mean KPS 88.81) [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Introduction While surgery is the primary treatment choice for intracranial meningiomas in young patients, surgery in elderly patients, especially those with pre-existing comorbidities, has been the subject of repeated discussion. This study investigated the postoperative risks and neurological benefits of meningioma surgery in elderly patients compared to young patients. Methods In total, 768 patients were included and divided into two main groups: group I (age: ≤ 64 years; 484 young patients) and group II (age: ≥ 65 years; 284 elderly patients). Group II was subdivided into: IIa (age: 65–69 years), IIb (age: 70–79 years); and IIc (age: ≥ 80 years). Results The total tumor resection rate was higher in the elderly cohort than in the young cohort (84.5 and 76.2%, respectively). 154 young patients (31.8%) and 132 elderly patients (46.5%) developed postoperative morbidities, with the three most common being bleeding (12.9%), cranial nerve disorder (10%) and CSF fistula (8.1%). Postoperative bleeding, palsy, speech disorder, pneumonia and renal insufficiency were dependent on age (r = 0.123, p = 0.001; r = 0.089, p = 0.014; r = 0.100, p = 0.006; r = 0.098, p = 0.007 and r = 0.084, p = 0.020) and presented more often in elderly patients. 6 young and 15 elderly patients died during the 17.4-year observation period. Most patients showed a significant improvement in postoperative KPS (p < 0.001), except those over 80 years old (p = 0.753). The KPS at the last follow-up was significantly improved in all patients (p < 0.001). Conclusion Meningioma surgery is associated with a higher rate of postoperative complications in elderly patients than in young patients. Most elderly patients, similar to young patients, show a significant improvement in neurological status postoperatively.

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Elderly Patients with Frontobasal and Suprasellar Meningiomas: Safety and Efficacy of Tumor Removal via Frontolateral Approach

Cited by 5 publications

References 24 publications

The endoscope-assisted supraorbital “keyhole” approach for anterior skull base meningiomas: an updated meta-analysis

The endoscope-assisted supraorbital “keyhole” approach for anterior skull base meningiomas: an updated meta-analysis

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

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

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