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

Abstract

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.

Surgical Management of Intracranial Meningiomas in the Elderly: Early and Long-term Outcomes

“…14,15 limited to the status at discharge may underestimate the true mortality rate of meningioma resection and overestimate the long-term morbidity of the surgery. 17 In our cohort, there was no mortality within a few months after surgery associated with postoperative complications, and an improvement in the functional condition was observed in half of surviving patients during long-term follow-up, with deterioration in a minority of patients. The major limitation of this study is its retrospective nature, patients who were already selected for surgery with the same surgical policies, but however, without a precise protocol were assessed, thus making selection to some extent dependent on surgeons' experience and subjective assessments.…”

“…Every day, neurosurgeons are faced with the dilemma of whether to operate on meningiomas in patients in this age group. 5,[12][13][14][15][16][17][18] Surgery in the elderly population may be associated with a risk of serious or even life-threatening postoperative complications due to the physiology of ageing and multiple comorbidities. 1,5,6,10,11,13 However, it should also be noted that the intraoperative and postoperative management of intracranial lesions improved dramatically in recent decades and surgical treatment of intracranial meningiomas has become a valid therapeutic option as well in the elderly population.…”

“…Many investigators have attempted to define preoperative indicators of morbidity in the elderly population, with several authors demonstrating the predictive value of more advanced patient age, 1 , 6 male sex, 1 , 10 , 11 tumor size, 11 , 14 tumor location, 6 , 11 presence and severity of edema, 11 , 14 and general health indicators, such as ASA and KPS scores, 11 , 15 whereas some authors have negated the value of these parameters. 17–20 Conflicting results and divergent prognostic factors highlight the importance of future detailed investigations in morbidity analysis. In our cohort, it confirmed an often described fact that patients in poor physical status (ASA class III) fared worse than patients in good health condition (ASA class I or II).…”

“…The results comparing mortality in elderly patients to younger patients are conflicting, with some authors 6 , 7 reporting greater mortality in the older population in opposition to results of other investigators reporting similar mortality. 13 , 16 , 17 , 20 , 22 Likewise, the results regarding the incidence rates of postoperative neurological deterioration between older and younger patients assessed in long-term follow-up are inconsistent. 13 , 17 , 20 And finally, analyses focusing on the overall complication rate also yielded conflicting data with some investigators, 6 , 13 , 16 , 22 but not all, 17 , 20 showing that elderly patients have a higher overall complication rate.…”

“… 13 , 16 , 17 , 20 , 22 Likewise, the results regarding the incidence rates of postoperative neurological deterioration between older and younger patients assessed in long-term follow-up are inconsistent. 13 , 17 , 20 And finally, analyses focusing on the overall complication rate also yielded conflicting data with some investigators, 6 , 13 , 16 , 22 but not all, 17 , 20 showing that elderly patients have a higher overall complication rate. However, when looking at their structure, elderly patients have minor complications more frequently and have a similar number of serious complications as younger subjects.…”