Intracranial Meningioma Surgery in the Ninth Decade of Life

Sacko, Oumar; Sesay, Musa; Roux, Franck‐Emmanuel; Riem, Tanguy; Grenier, B.; Liguoro, Dominique; Loiseau, Hugues

doi:10.1227/01.neu.0000303190.80049.7d

Cited by 104 publications

(105 citation statements)

References 15 publications

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“…Whether there is an increased surgical risk for meningioma in elderly patients remains controversial (6,7,10,11,17). In the present study, the 1-year postoperative mortality rate of meningioma patients was 0% and the rate of postoperative complications in elderly patients was 7.7%.…”

Section: Discussionmentioning

confidence: 46%

“…The maximum tumor size was measured on a contrast-enhanced T1-weighted image prior to surgery. Peritumoral brain edema was measured on preoperative T2-weight images, as described previously (17). Briefly, severe brain edema was defined when the ratio of maximum diameter of edema to the maximum diameter of the tumor was >1.…”

Section: Methodsmentioning

confidence: 99%

“…Tumor resection rate was determined according to the Simpson grade (18) and tumors were pathologically graded according to the World Health Organization (WHO) classification (19). In addition, proposed grading scoring systems, including CRGS, GSS, and SKALE, were used to calculate scores for each patient using admission data, according to previous studies (9,15,17) and the correlation between these scores and surgical outcomes was assessed.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies demonstrated that a poor outcome following surgical treatment for intracranial meningiomas in the elderly was associated with a score ≤9, ≤15 and ≤7 for the CRGS, GSS and SKALE, respectively (15)(16)(17). The cut-off point for postoperative complications was ≤9, ≤15, and ≤7 for CRGS, GSS, and SKALE, respectively (9,15,17). Multivariate logistic regression analysis revealed no significant associations between patient age (≥75 years), lower CRGS (≤9), GSS (≤15), and SKALE scores (≤7) and surgical complications (P= 0.0992, P= 0.7935, P= 0.1414 and P= 0.6441, respectively) (Table IV).…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

“…Thus, patient selection and optimal treatment strategies for intracranial meningiomas in the elderly, which must consider patient lifestyle, survival benefits vs. side effects and the potential complications of surgery, including neurological deficits, continue to be debated (6,7,10,15). To standardize the surgical indications for intracranial meningiomas in the elderly, a number of studies have proposed grading systems, which include the clinical-radiological grading system (CRGS) (15), the geriatric scoring system (GSS) (16), Karnofsky performance scale (KPS) score, the American Society of Anesthesiology (ASA) score and the Location of Tumor and Peritumoral Edema grading system (SKALE) (17).…”

Section: Introductionmentioning

confidence: 99%

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Clinical features and surgical management of intracranial meningiomas in the elderly

et al. 2017

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Abstract. Meningioma accounts for ~25% of all primary intracranial neoplasms and the incidence increases with age. Prvios population-based studies demonstrated that the annual incidence of intracranial meningiomas was 1.2-3.1/100,000 population. In particular, the incidence of this disease among the elderly is high. Recently, increased life expectancy and greater use of diagnostic radiological imaging led to an increased incidence in the diagnosis of intracranial meningiomas, both symptomatic and asymptomatic, in the elderly. Thus, neurosurgeons may be increasingly confronted with the management of intracranial meningiomas in the elderly. In practice, it is often difficult for physicians to determine whether traditional surgical resection is the optimal management strategy for intracranial meningiomas in the elderly. However, reported clinical studies about the outcome of surgical resection of intracranial meningiomas in the elderly are limited. Increased risk of mortality and morbidity associated with surgical treatment for intracranial meningiomas in the elderly compared with younger patients have been controversial. In the present study, the clinical features of intracranial meningiomas in 70 consecutive intracranial meningioma patients that underwent surgical treatment at the affiliated hospital of University of Occupational and Environmental Health between 2007 and 2013 were assessed. In addition, patient selection and surgical management of intracranial meningioma in elderly patients was discussed. Preoperative factors, including symptoms, tumor location, tumor size, Karnofsky Performance Scale (KPS) score and American Society of Anesthesiology (ASA) score, and postoperative factors, including pathological diagnosis, tumor proliferation index (Ki-67), resection rate (Simpson grade), length of hospital stay and discharge destination were retrospectively analyzed in patients aged ≥75 years (n=16; elderly group) and <75 years (n=54; younger group). Outcomes were assessed 6 months after surgery. Multivariate logistic regression revealed that tumor resection rate (Simpson grade III-V) was an important predictor of surgical complications (odds ratio, 5.662; 95% confidence interval, 1.323-24.236; P= 0.0194). Perioperative morbidity was not correlated with age (>75 years), tumor location, tumor size, KPS score or ASA score. Thus, the present study indicated that age is not associated with surgical outcome in elderly meningioma patients. Regardless of patient age, the decision to perform surgical resection should be made on an individual basis wherein tumor characteristics and the general health of the patient are considered.

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