Neurosurgery and elderly: analysis through the years

Chibbaro, Salvatore; Rocco, F. Di; Makiese, O.; Mirone, Giuseppe; Marsella, M.; Lukaszewicz, Anne Claire; Vicaut, Éric; Turner, Benjamin; Hamdi, S.; Spiriev, Toma; Emidio, P. Di; Pirracchio, Romain; Payen, Didier; George, Bernard; Bresson, D.

doi:10.1007/s10143-010-0301-6

Cited by 51 publications

(30 citation statements)

References 22 publications

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“…While elderly patients were traditionally categorized as high-risk surgical candidates, remarkable advances in neuroanesthesia, neuromonitoring, and neurocritical care have afforded neurosurgeons the opportunity to successfully perform complex neurosurgical procedures on the elderly, both on an elective and emergency basis. 7 A steady rise in the number of complex neurosurgical procedures in the elderly has been accompanied by a decline in complication rates as evidenced by morbidity and mortality rates that are lower than ever before. An analysis of several reports on outcomes after neurosurgical procedures in the elderly has revealed that advanced age can no longer be used as an absolute contraindication to any neurosurgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…An analysis of several reports on outcomes after neurosurgical procedures in the elderly has revealed that advanced age can no longer be used as an absolute contraindication to any neurosurgical intervention. 7 Intracranial bAVMs are uncommon, likely congenital vascular lesions that mostly present with hemorrhage or seizures. With widespread use of imaging technologies, the incidence of bAVMs in the elderly is on the rise.…”

Section: Discussionmentioning

confidence: 99%

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Management of arteriovenous malformations in the elderly: a single-center case series and analysis of outcomes

Pabaney¹,

Reinard²,

Kole³

et al. 2016

JNS

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A rteriovenous malformations (AVMs) are congenital vascular lesions with an incidence of 1-1.14 cases per 100,000 persons and an annual rate of hemorrhage around 2%-4% in untreated patients.1,11 While female sex, subcortical location, prior rupture history, deep venous drainage, and association with intracranial aneurysms have previously been identified as risk factors that could increase the risk of hemorrhage, 2 a recent meta-analysis showed that every 10 additional years in patient age correlates with an approximately 30% increase in the risk of AVM rupture. 16 Additionally, while longitudinal population-based studies have demonstrated that most brain AVMs (bAVMs) become symptomatic in the fourth and fifth decade of life and may, consequently, be infrequently encountered in the elderly population, 22 conflicting reports suggest that the course of bAVMs in the elderly is not benign and that a preponderance of bAVMs in this age group present with hemorrhage. 8,12 While the natural history of bAVMs is widely described, only a limited number of reports have exclusively focused on the natural history and management of bAVMs in the elderly population. 12,13,17 Because of this, and as a result of the absence of consensus guidelines for the management of bAVMs in the elderly population, treatment of these complex vascular lesions in the elderly will continue to challenge cerebrovascular surgeons, especially in light of the ubiquity of diagnostic brain imaging tools 10 and a concomitant rise in global life expectancy. 19,25With remarkable advances in endovascular technology, radiation therapy, as well as microsurgical techniques, multimodality management of bAVMs has proven effective and safe across various age groups. methods The bAVM database at the authors' institution was queried for records of elderly patients with bAVMs, and data regarding patient demographics, presenting symptoms, bAVM angioarchitecture, treatment modalities, angiographic results, clinical outcomes, and treatment complications were tabulated and analyzed. results There were 9 male (32%) and 19 female (68%) patients, with an average age (± SD) of 73.0 ± 6.95 years.The most common symptoms on presentation were hemorrhage (36%) and headaches (18%). The bAVMs were equally distributed between the supra- and infratentorial compartments. The most common Spetzler-Martin grade was II, observed in 57% of the patients. Eleven patients (39.3%) underwent resection, 4 patients (14.3%) received standalone radiation therapy, and 13 patients (46%) did not receive treatment or were managed expectantly. Four patients (14.3%) were lost to follow-up. Complete bAVM obliteration was achieved in 87% of the treated patients. None of the patients who received any form of treatment died; the overall mortality rate was 3.6%. coNclusioNs Surgical management of bAVMs in the elderly can result in complete obliteration and acceptable clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of arteriovenous malformations in the elderly: a single-center case series and analysis of outcomes

Pabaney¹,

Reinard²,

Kole³

et al. 2016

JNS

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“…Further studies are needed to compare quality-of-life improvements and the incidence of side effects in the most elderly patients compared to younger populations. As life expectancy is increasing, the elderly and nonagenarian patient populations are growing, and there is an increased need to find suitable treatment options [16].…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance-Guided Focused Ultrasound Thalamotomy to Treat Essential Tremor in Nonagenarians

Paff

Boutet

Neudorfer

et al. 2020

Stereotact Funct Neurosurg

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Essential tremor (ET) is a disabling movement disorder that is most prevalent among the elderly. While deep brain stimulation surgery targeting the ventral intermediate nucleus of the thalamus is commonly used to treat ET, the most elderly patients or those with multiple medical comorbidities may not qualify as surgical candidates. Magnetic resonanceguided focused ultrasound (MRgFUS) constitutes a less invasive modality that may be used to perform thalamotomy without the need for a burr hole craniotomy. Here, we report on 2 patients over the age of 90 years who benefited significantly from MRgFUS thalamotomy to relieve their symptoms and improve their quality of life. The procedure was well tolerated and performed safely in both patients. We conclude that age should not be a limiting factor in the treatment of patients with MRgFUS.

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“…Regarding the amount of postoperative complications after neurosurgery in elderly persons after neurosurgical procedures, there is a report from Chibbaro et al who analyzed the number of procedures performed, the length of hospital stay, and mortality within 1 month at a university hospital in Paris over a 25-year period [32]. The number of neurosurgical interventions in elderly patients increased steeply from 1983 to 1985 from 10% of patients treated to 24% in the period of 2003 to 2005.…”

Section: Surgerymentioning

confidence: 99%

Guiding Treatment Choices for Elderly Patients with Glioblastoma by a Comprehensive Geriatric Assessment

et al. 2020

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Purpose of Review The incidence of glioblastoma multiforme (GBM) increases with age; more than half of newly diagnosed patients are older than 65 years. Due to age-dependent decreasing organ functions, comorbidities, functional decline, and increasing risk of social isolation, not all patients are able to tolerate standard therapy of GBM with 6 weeks of radiochemotherapy. Recent Findings A set of alleviated therapies, e.g., chemotherapy or radiotherapy alone, hypofractionated radiotherapies with different total doses and variable fractionation regimens as well as hypofractionated radiotherapy with concomitant and adjuvant chemotherapy, have been evaluated during the last years. However, clinicians are still unsure which therapy would fit best to a given patient. Recently, the predictive value of comprehensive geriatric assessment regarding tolerance of chemotherapy and prediction of early mortality has been validated for older GBM patients in a retrospective trial. Summary Thus, it appears that neuro-oncology is now ready for the prospective implementation of geriatric assessment to guide treatment planning for elderly GBM patients.

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Neurosurgery and elderly: analysis through the years

Cited by 51 publications

References 22 publications

Management of arteriovenous malformations in the elderly: a single-center case series and analysis of outcomes

Management of arteriovenous malformations in the elderly: a single-center case series and analysis of outcomes

Magnetic Resonance-Guided Focused Ultrasound Thalamotomy to Treat Essential Tremor in Nonagenarians

Guiding Treatment Choices for Elderly Patients with Glioblastoma by a Comprehensive Geriatric Assessment

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