Is surgery justified for 80-year-old or older intracranial meningioma patients? A systematic review

Abstract

Since the number of elderly people with intracranial meningiomas (IM) continues to rise, surgical treatment has increasingly become a considerable treatment option, even in very old (≥ 80 years old) meningioma patients. Since little is known about whether meningioma surgery in this age group is safe and justified, we conducted a systematic review to summarize the results of surgical outcomes in very old meningioma patients. We performed a systematic literature search in Pubmed, Cochrane Library, and Scopus databases. Primarily, we extracted 1-month and 1-year survival rates, and 1-year morbidity rates, as well as information about preoperative morbidity, operative complications, meningioma size, location, histology, and peritumoral edema. Quality of the included studies was evaluated by Cochrane Collaboration Handbook and Critical Appraisal Skills Program. From the 1039 reviewed articles, seven retrospective studies fulfilled our eligibility criteria. Motor deficits (27-65%) and mental changes (51-59%) were the most common indications for surgery. One-month and 1-year mortality rates varied between 0-23.5% and 9.4-27.3%, respectively. Most of the operated IM patients (41.2-86.5%) improved their performance during postoperative follow-up. Impaired preoperative performance and comorbidities were most commonly related to higher postoperative mortality. None of the studies fulfilled the criteria of high quality. Based on the evidence currently available, surgical treatment of very old IM patients seems to improve the performance of highly selected individuals. Given the rapid increase of the aging population, more detailed retrospective studies as well as prospective studies are needed to prove the outcome benefits of surgery in this patient group.

Stereotactic radiosurgery of benign brain tumors in elderly patients: evaluation of outcome and toxicity

“…Finally, an important finding of our study is that patients' co-morbidities have no influence on the effectiveness and especially the toxicity of the treatment, whereas for surgery it is always an issue. A recent review of meningioma surgery in elderly patients [38] often found that postoperative mortality is most commonly associated with co-morbidities. Eksi et al [39] also found in their meta-analysis that co-morbidities are a strong predictor of postsurgical neurologic complications.…”

Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

“…Moreover, studies have suffered from factors such as limited sample size [2,13,[15][16][17][18][19]21,22] and short follow-up time [2,15,18,19]. In addition, even though the incidence of spinal meningiomas is highest in the elderly population, there may be a reluctance to operate on these patients due to an expected higher risk of adverse events and poor outcomes [1,[22][23][24][25][26][27][28]. Available studies on this topic have been limited by low patient numbers and lack of a younger control group [21,22,29] (Table S1).…”

Surgery on giant meningiomas in very old patients entails frequent postoperative intracranial hemorrhages and atypical histopathology

“…Due to the population's increasing life expectancy, the finding of intracranial meningiomas in very old patients, i.e. patients that are 80 years old and older, is becoming more frequent [2]. Nowadays, these very old patients with meningiomas often have a good functional status and still live independently at home, despite a known increased frailty [2][3][4][5].…”