Meningioma Surgery in the Elderly

Schul, David B.; Wolf, Steffen; Krammer, Matthias J.; Landscheidt, Julia F.; Tomasino, Andrè; Lumenta, Christianto B.

doi:10.1227/neu.0b013e318233a99a

Cited by 59 publications

(14 citation statements)

References 40 publications

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“…ASA-classification is one of the most commonly identified factors associated with mortality after surgery for meningioma [ 13 ]. Compared to adults, Bateman et al found that patients over 70 years old are three times as likely to die in the hospital, but conflicting data for 65 + have been reported [ 6 – 9 , 12 , 17 , 19 , 26 – 42 ]. In our cohort, the overall 30-day mortality was 2%, which is comparable to results of recent literature.…”

Section: Discussionmentioning

confidence: 99%

Meningioma surgery in younger and older adults: patient profile and surgical outcomes

et al. 2017

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BackgroundDue to increasing life expectancy, the number of older patients harboring a meningioma is expected to increase. We determined whether preoperative variables and postoperative clinical outcome differ between younger and older adults.MethodsMedical records of meningioma patients were retrospectively analyzed. Preoperative variables were age, gender, neurological symptoms, Karnofsky Performance Status (KPS), American Society of Anesthesiologists Physical Status (ASA)-classification and tumor characteristics. Clinical outcome was assessed using complication rates, length of hospital stay and destination after discharge. After 6–12 and 12–18-month KPS, neurological symptoms and Glasgow Outcome Scale (GOS) scores were assessed for older (age ≥ 65 years) and younger adults (18–65 years) using Mann–Whitney U, T test, Pearson’s Chi square or Fisher’s exact.Results89 patients were included (23 ≥ 65 years). Before surgery, older patients scored higher on ASA classification (p = 0.003) and lower on KPS (p = 0.017). There was no significant difference postoperatively in mortality, complications and duration of hospital stay. Less older patients were discharged directly to home compared to younger adults (52 vs 80%, respectively; p = 0.004). In surviving patients, less older subjects had a good recovery (GOS 4–5) at 6–12 months’ follow-up compared to younger subjects (64 vs 93%, respectively; p = 0.035). At 12–18 months, there was no significant difference in good recovery between both age groups (82 vs 92%).ConclusionIn this cohort, outcome was worse for patients ≥ 65 years old in terms of discharge destination and good recovery at 6–12 months. At 12–18 months follow-up, older subjects performed not significantly different from younger ones. Careful patient selection seems essential to reach good results in meningioma surgery for patients ≥ 65 years old.

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Section: Discussionmentioning

confidence: 99%

Meningioma surgery in younger and older adults: patient profile and surgical outcomes

et al. 2017

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“…Nevertheless, they primarily aim to standardize surgical indications, but are unable to offer advanced and timely information for postoperative care. In addition, these grading systems emphasize elderly patients harboring meningiomas, and have difficulty in reproducing their predictive ability when extended to younger patients [19]. In comparison, SAS is not confined by cut-off values of parameters, and can be applied in a population with a wide age distribution.…”

Section: Discussionmentioning

confidence: 99%

Application of Surgical Apgar Score in intracranial meningioma surgery

Hsu

et al. 2017

PLoS ONE

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Surgical resection is the main therapeutic option for intracranial meningiomas, but it is not without significant morbidities. The Surgical Apgar Score (SAS), assessed by intraoperative blood pressure, heart rate, and blood loss, was developed for prognostic prediction in general and vascular surgery. We aimed to examine whether the application of SAS in patients undergoing craniotomy for meningioma resection can predict postoperative major complications. We retrospectively enrolled 99 patients that had undergone intracranial meningioma surgery. The patients were subdivided into 2 groups based on whether major complications were present (N = 34) or not (N = 65). We recognized the intergroup differences in SAS and clinical variables. The incidence of 30-day major complications in patients after operation was 34.3%. The lengths of ICU and hospital stay for the morbid cases were prolonged significantly (p = 0.009, p < 0.001, respectively). In the multivariate logistic regression model, SAS was an independent predicting factor of major complications following surgery for intracranial meningiomas (odds ratio, 95% confidence interval = 0.57, 0.38–0.87; p = 0.009), and thus a decrease of one mean SAS increased the rate of major complications by 43%. In conclusions, SAS is an independent predictor of major complications in patients undergoing intracranial meningioma surgery, and provides acceptable risk discrimination. Since this scoring system is relatively simple, objective, and practical, we suggest that SAS be included as an indicator in the guidance for the level of care after craniotomy for meningioma resection.

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“…The largest surgical series that examined outcome in 258 older patients with meningioma indicated morbidity rates of 29.8% [ 20 ]. Schul et al published outcome data for surgically treated patients and reported a 21% rate of surgery-related morbidity [ 21 ]. Similar numbers (17.8%) were reported by Boviatsis et al [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Elderly Patients with Meningioma after Image-Guided Stereotactic Radiotherapy: A Study of 100 Cases

Kaul

Budach

Graaf

et al. 2015

BioMed Research International

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Introduction. Incidence of meningioma increases with age. Surgery has been the mainstay treatment. Elderly patients, however, are at risk of severe morbidity. Therefore, we conducted this study to analyze long-term outcomes of linac-based fractionated stereotactic radiotherapy (FSRT) for older adults (aged ≥65 years) with meningioma and determine prognostic factors. Materials and Methods. Between October 1998 and March 2009, 100 patients (≥65, median age, 71 years) were treated with FSRT for meningioma. Two patients were lost to follow-up. Eight patients each had grade I and grade II meningiomas, and five patients had grade III meningiomas. The histology was unknown in 77 cases (grade 0). Results. The median follow-up was 37 months, and 3-year, 5-year, and 10-year progression-free survival (PFS) rates were 93.7%, 91.1%, and 82%. Patients with grade 0/I meningioma showed 3- and 5-year PFS rates of 98.4% and 95.6%. Patients with grade II or III meningiomas showed 3-year PFS rates of 36%. 93.8% of patients showed local tumor control. Multivariate analysis did not indicate any significant prognostic factors. Conclusion. FSRT may play an important role as a noninvasive and safe method in the clinical management of older patients with meningioma.

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Meningioma Surgery in the Elderly

Cited by 59 publications

References 40 publications

Meningioma surgery in younger and older adults: patient profile and surgical outcomes

Meningioma surgery in younger and older adults: patient profile and surgical outcomes

Application of Surgical Apgar Score in intracranial meningioma surgery

Outcome of Elderly Patients with Meningioma after Image-Guided Stereotactic Radiotherapy: A Study of 100 Cases

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