Intracranial meningiomas in the elderly (over 70 years old)

Abstract

The decision to operate on a patient older than 70 years for an intracranial meningioma is always difficult. Therefore a series of meningiomas treated surgically in 30 cases older than 70 years has been reconsidered and studied according to the following parameters: Karnofsky's rating scale, physiological status of the patient (A.S.A. criteria), perifocal oedema and mass effect. The locations of the meningiomas were: convexity 13, parasagittal 6, falx 2, pterion (sphenoid ridge) 5, orbito-cranial 3, jugum sphenoidale 1, tentorium (occipital) 1. Postoperative survival at day 30 shows a mortality rate of 23% which increases to 37% at day 90 including causes like decubitus ulcers and 3 cases of fatal pulmonary embolism. In a comparable series of 31 cases from 60 to 70 years, mortality rate was only 16% at day 90. Two parameters seem essential for quantifying surgical risk: clinical status, oedema and mass effect, evaluated by CT scan. The best conditions seem combined when Karnofsky rating scale is higher than or equal to 50 with no or only limited perifocal hypodensity and without mass effect. Although meningiomas may remain dormant for many years or can be kept under control medically for some time, their development is unpredictable. We think therefore that a reasonable surgical risk can be taken on patients with good physical status and favourable parameters at the time of diagnosis, particularly if the meningioma is located at the convexity where the risk of recurrence is minimal. On the other hand, patients with unfavourable parameters are not recommended for surgery.

Single Dose versus Fractionated Stereotactic Radiotherapy for Meningiomas

“…8,9,11,13,20 However, patients with exceptional surgical risk factors such as advanced age, poor functional status, and strategic tumor locations are considered poor candidates for surgery which aims for complete tumor resection. 12,14,15 Subtotal resection, which carries significant morbidity and mortality for poor risk patients, offers much worse LC, which was on the order of 40% at five years. 3,8,9 Mirimanoff et al 11 reported a 10-year progressionfree survival of 80% for patients who had a complete resection for benign meningioma compared to only 45% for those who had subtotal resection in a series of 225 patients.…”

“…[9][10][11] However, meningiomas may recur after surgery and curative resection can result in significant morbidity because of strategic tumor location and old age. [12][13][14][15] Stereotactic radiosurgery (SRS) can deliver a single high dose of radiation to a localized area in the brain for the treatment of meningiomas that are unresectable, recurrent or residual after surgery. However, large tumors and tumors adjacent to vital ABSTRACT: Objective: To evaluate the safety and efficacy of stereotactic radiosurgery (SRS) compared to fractionated stereotactic radiation therapy (FSRT) for meningiomas treated over a seven year period.…”

Factors influencing visual and clinical outcome in Nigerian patients with cranial meningioma

“…Our 6-month mortality rate (20%) is higher than most reported rates (7-19.3%). [5][6][7][8]10,11,18 Four of the deaths recorded in the present study were due to brain swelling and rostro-caudal herniation during the first 1-2 weeks of surgery. All the patients presented after 3 years of onset (considered as late presentation) with signs and symptoms of raised intracranial pressure and, on CT, large tumours (>50 mm) bordered by grade 3 peritumoural oedema.…”

“…Of age, sex, tumour size, location, vascularity, oedema and histology, Alaywan and Sindou 8 found severity of preoperative neurological conditions and tumour size to be the only predictors of adverse outcome, including morbidity and mortality, and stressed the additional role of vascular supply from the pia mater. 9 Djindjian et al 10 also found that preoperative clinical status (including a Karnofsky rating of less than 50), peritumoural oedema and mass effect are essential parameters for quantifying surgical risk, while in the series of Meixensberger et al, 11 age, poor preoperative clinical condition (ASA [American Society of Anesthetists] score), intra-and postoperative bleeding and cerebrospinal fluid disturbances were significantly associated with a subsequent decrease of quality of life.…”

Dose-Volume Effect in Gamma Knife Radiosurgery of Meningiomas

“…Though most meningiomas can be operated successfully, morbidity and mortality remain considerably high in some critical locations, and the recurrence rate may exceed expectation in some subgroups [2][3][4][5]. Gamma knife radiosurgery provides an excellent method for treatment of intracranial meningiomas, with a total tumor control rate between 92 and 100% in some reports, with tumor regression in 24-74%.…”