Intracranial Meningiomas in the 9th Decade of Life

Mastronardi, Luciano; Ferrante, Luigi; Qasho, R.; Ferrari, Vincenzo; Tatarelli, Roberto; Fortuna, Aldo

doi:10.1097/00006123-199502000-00005

Cited by 9 publications

(11 citation statements)

References 12 publications

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“…Nevertheless, several groups have found that meningioma resection can be performed safely in wellselected elderly individuals. 9,16,27 None of the patients in our own series that presented with asymptomatic meningiomas required treatment.…”

Section: Discussionmentioning

confidence: 77%

Incidental findings on cranial imaging in nonagenarians

Al-Holou

Khan²,

Wilson³

et al. 2011

FOC

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Object The aim of this article was to report on the nature and prevalence of incidental imaging findings in a consecutive series of patients older than 90 years of age who underwent intracranial imaging for any reason. Methods The authors retrospectively reviewed the electronic medical and imaging records of consecutive patients who underwent brain MR imaging at a single institution over a 153-month interval and were at least 90 but less than 100 years of age at the time of the imaging study. The prevalence of lesions by type in this consecutive series of MR imaging evaluations was calculated for all patients. The authors reviewed the medical record to evaluate whether a change in management was recommended based on MR imaging findings. They evaluated patient age at the time of death and the time interval between MR imaging and death. Results The authors identified 177 patients who met the study criteria. The group included 119 women (67%) and 58 (33%) men. Their mean age was 92.3 ± 1.8 years. Evidence of acute ischemic changes or cerebrovascular accident (CVA) was found in 36 patients (20%). Fifteen patients (8%) had an intracranial tumor. Intracranial aneurysms were incidentally identified in 6 patients (3%). Chronic subdural hematomas were found in 3 patients (2%). Overall, 25 patients (14%) had some change in medical management as a result of the MR imaging findings. The most common MR imaging finding that resulted in a change in medical management was an acute CVA (p < 0.0001). The mean time to death from date of MR imaging was 2.5 ± 2.3 years. Conclusions Intracranial imaging is rarely performed in patients older than 90 years. In cases of suspected stroke, MR imaging findings may influence treatment decisions. Brain MR imaging studies ordered for other indications in this age group rarely influence treatment decisions. Incidentally discovered lesions in this age group are generally not treated.

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Section: Discussionmentioning

confidence: 77%

Incidental findings on cranial imaging in nonagenarians

Al-Holou

Khan²,

Wilson³

et al. 2011

FOC

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“…5 Other studies focusing on mortality in very old (80 years or older) patients with meningioma indicated perioperative mortality rates ranging from 1.4% to 29.4%, which is significantly higher than the reported rates in younger patients. 7,10,11,[23][24][25] Thus, radiotherapy is a viable treatment option for very old patients with meningioma deemed unfit for neurosurgery. Fractionated external beam radiotherapy and radiosurgery are well-established treatment modalities leading to good tumor control with a positive risk-benefit profile.…”

Section: Complications and Mortalitymentioning

confidence: 99%

mentioning

confidence: 99%

“…Previously, we found that patients with poor preoperative status and large peritumoral edema (PTBE) most commonly benefit from surgery without suffering from increased surgery-associated morbidity as previously suggested. [6][7][8][9][10][11][12][13][14] Based on our pilot study's data, we suggested a decision support tool, based on preoperative neurofunctional status and PTBE volume, to identify those patients who most likely benefit from surgical resection (Table 1). 6 Given that single-center results on outcome of neurosurgically treated very old patients with supratentorial meningioma may be highly selective and biased, we collected data on surgical outcome of patients with supratentorial meningioma aged 80 years or older treated in European and North American centers.…”

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confidence: 99%

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Surgical Outcome of Patients With Supratentorial Meningiomas Aged 80 Years or Older—Retrospective International Multicenter Study

Schwartz,

Rautalin,

Grauvogel

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Demographic changes will lead to an increase in old patients, a population with significant risk of postoperative morbidity and mortality, requiring neurosurgery for meningiomas. This multicenter study aims to report neurofunctional status after resection of patients with supratentorial meningioma aged 80 years or older, to identify factors associated with outcome, and to validate a previously proposed decision support tool. METHODS: Neurofunctional status was assessed by the Karnofsky Performance Scale (KPS). Patients were categorized in poor (KPS ≤40), intermediate (KPS 50-70), and good (KPS ≥80) preoperative subgroups. Volumetric analyses of tumor and peritumoral brain edema (PTBE) were performed; volumes were scored as small (<10 cm3), medium (10-50 cm3), and large (>50 cm3). RESULTS: The study population consisted of 262 patients, and the median age at surgery was 83.0 years. The median preoperative KPS was 70; 117 (44.7%) patients were allotted to the good, 113 (43.1%) to the intermediate, and 32 (12.2%) to the poor subgroup. The median tumor and PTBE volumes were 30.2 cm3 and 27.3 cm3; large PTBE volume correlated with poor preoperative KPS status (P = .008). The 90-day and 1-year mortality rates were 9.0% and 13.2%, respectively. Within the first postoperative year, 101 (38.5%) patients improved, 87 (33.2%) were unchanged, and 74 (28.2%) were functionally worse (including deaths). Each year increase of age associated with 44% (23%-70%) increased risk of 90-day and 1-year mortality. In total, 111 (42.4%) patients suffered from surgery-associated complications. Maximum tumor diameter ≥5 cm (odds ratio 1.87 [1.12-3.13]) and large tumor volume (odds ratio 2.35 [1.01-5.50]) associated with increased risk of complications. Among patients with poor preoperative status and large PTBE, most (58.3%) benefited from surgery. CONCLUSION: Patients with poor preoperative neurofunctional status and large PTBE most often showed postoperative improvements. The decision support tool may be of help in identifying cases that most likely benefit from surgery.

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“…14 Furthermore, of the four studies that did specifically look at the octogenarian population, only a portion of their sample consisted of skull base meningiomas. [15][16][17][18] In an attempt to address this gap of data, this paper presents one institution's experience with treating skull base pathology in this age group, with a specific focus on rates of tracheostomy and gastrostomy tube placement in the postoperative period.…”

Section: Introductionmentioning

confidence: 99%

Case Series of Skull Base Meningioma Resection in the Octogenarian Population

Kusyk

Mao

Dabecco

et al. 2021

J Neurol Surg B Skull Base

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Introduction The geriatric population is the fastest growing segment of the American population, and octogenarians are increasingly seen by neurosurgeons for relatively common lesions such as meningiomas. Unfortunately, providers do not have clear data to guide decision-making regarding these lesions, particularly if they involve the skull base. Current research in outcomes among the elderly looks at a wide range of ages, often anyone older than 65. Previous studies in octogenarians report a wide-range of mortality rates and do not focus on skull base lesions. This paper strives to clarify the experiences and outcomes of octogenarians. Patients and Methods This retrospective series reviews skull base tumor surgeries performed at a single academic institution over the past 15 years in octogenarian patients. Primary endpoint was 30-day mortality; however, potential risk factors, perioperative morbidity, postdischarge disposition, and longer term follow-up were also captured. Multivariate logistic regression was performed to identify relevant perioperative and medical characteristics that increases the risk of adverse events. Results Fourteen patients underwent craniotomies for skull base procedures with an average age of 84.5, with a 14% 30-day mortality rate. One patient required a tracheostomy on discharge and approximately half were able to either go home or rehabilitation after their procedure. On statistical analysis, there were no noted characteristics that predisposed any of the patients to a poorer outcome. Conclusion Octogenarian patients were able to tolerate surgery for skull base meningiomas resection. This outcome data may be used to inform surgical decision and guide conversation with patients and their families.

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Intracranial Meningiomas in the 9th Decade of Life

Cited by 9 publications

References 12 publications

Incidental findings on cranial imaging in nonagenarians

Incidental findings on cranial imaging in nonagenarians

Surgical Outcome of Patients With Supratentorial Meningiomas Aged 80 Years or Older—Retrospective International Multicenter Study

Case Series of Skull Base Meningioma Resection in the Octogenarian Population

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