Outcome of elderly patients undergoing intracranial meningioma resection: a single-center experience

Zoia, Cesare; Bongetta, Daniele; Guerrini, Francesco; Alicino, Cristiano; Cattalani, Andrea; Bianchini, Simonetta; Galzio, Renato; Luzzi, Sabino

doi:10.23736/s0390-5616.18.04333-3

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…Patients who presented with cognitive changes were older, and a prior report has documented increased age as being associated with an increased risk of postoperative neurological deficits and more severe complications. 27,28 Maximum tumor diameter may increase the risk of postoperative deficits because of the increased brain compression and increased complication risk, including hemorrhage. 29,30 It is fascinating, however, that tumor size did not remain independently associated with either a new neurological deficit or postoperative DWI signal > 1 cm on multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Postoperative diffusion-weighted imaging and neurological outcome after convexity meningioma resection

Magill¹,

Nguyen²,

Aghi³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEConvexity meningiomas are commonly managed with resection. Motor outcomes and predictors of new deficits after surgery are poorly studied. The objective of this study was to determine whether postoperative diffusion-weighted imaging (DWI) was associated with neurological deficits after convexity meningioma resection and to identify the risk factors for postoperative DWI restriction.METHODSA retrospective review of patients who had undergone convexity meningioma resection from 2014 to 2018 was performed. Univariate and multivariate logistic regressions were performed to identify variables associated with postoperative neurological deficits and a DWI signal. The amount of postoperative DWI signal was measured and was correlated with low apparent diffusion coefficient maps to confirm ischemic injury.RESULTSThe authors identified 122 patients who had undergone a total of 125 operations for convexity meningiomas. The median age at surgery was 57 years, and 70% of the patients were female. The median follow-up was 26 months. The WHO grade was I in 62% of cases, II in 36%, and III in 2%. The most common preoperative deficits were seizures (24%), extremity weakness/paralysis (16%), cognitive/language/memory impairment (16%), and focal neurological deficit (16%). Following resection, 89% of cases had no residual deficit. Postoperative DWI showed punctate or no diffusion restriction in 78% of cases and restriction > 1 cm in 22% of cases. An immediate postoperative neurological deficit was present in 14 patients (11%), but only 8 patients (7%) had a deficit at 3 months postoperatively. Univariate analysis identified DWI signal > 1 cm (p < 0.0001), tumor diameter (p < 0.0001), preoperative motor deficit (p = 0.0043), older age (p = 0.0113), and preoperative embolization (p = 0.0171) as risk factors for an immediate postoperative deficit, whereas DWI signal > 1 cm (p < 0.0001), tumor size (p < 0.0001), and older age (p = 0.0181) were risk factors for deficits lasting more than 3 months postoperatively. Multivariate analysis revealed a DWI signal > 1 cm to be the only significant risk factor for deficits at 3 months postoperatively (OR 32.42, 95% CI 3.3–320.1, p = 0.0002). Further, estimated blood loss (OR 1.4 per 100 ml increase, 95% CI 1.1–1.7, p < 0.0001), older age (OR 1.1 per year older, 95% CI 1.0–1.1, p = 0.0009), middle third location in the sagittal plane (OR 16.9, 95% CI 1.3–216.9, p = 0.0026), and preoperative peritumoral edema (OR 4.6, 95% CI 1.2–17.7, p = 0.0249) were significantly associated with a postoperative DWI signal > 1 cm.CONCLUSIONSA DWI signal > 1 cm is significantly associated with postoperative neurological deficits, both immediate and long-lasting. Greater estimated blood loss, older age, tumor location over the motor strip, and preoperative peritumoral edema increase the risk of having a postoperative DWI signal > 1 cm, reflective of perilesional ischemia. Most immediate postoperative deficits will improve over time. These data are valuable when preoperatively communicating with patients about the risks of surgery and when postoperatively discussing prognosis after a deficit occurs.

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Section: Discussionmentioning

confidence: 99%

Postoperative diffusion-weighted imaging and neurological outcome after convexity meningioma resection

Magill¹,

Nguyen²,

Aghi³

et al. 2021

Journal of Neurosurgery

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“…Elderly patients are at higher risk of peri- and postoperative adverse events, 18 , 53 , 62 , 64–67 and the majority of these complications appear to be medical. 64 , 67 Postoperative complications significantly influence survival and functional course in the elderly. 66 , 71 , 72 , 88 It is important to note that comorbidities, frailty, and poor baseline performance status may be stronger predictors of adverse events than age, 73 , 74 and age alone is often not associated with complications in multivariable models adjusted for these factors.…”

Section: Managementmentioning

confidence: 99%

“…Multidisciplinary evaluation for patients with medical concerns, careful patient selection, minimally invasive approaches, and optimized perioperative care may reduce this excess risk and produce outcomes similar to younger cohorts. 41 , 58 , 63–65 , 67–70 , 72 , 76–78 Increased consideration of these factors may explain a lower rate of adverse events in elderly patients in more recent surgical series. 65 Multiple scoring systems have been proposed to aid in preoperative risk stratification of elderly patients, but there is insufficient evidence of their validity to support their routine use.…”

Section: Managementmentioning

confidence: 99%

Meningioma in the elderly

Amoo

Henry

Farrell

et al. 2023

Neuro-Oncology Advances

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Meningiomas are the most common primary intracranial neoplasm, accounting for approximately 40% of all primary brain tumors. The incidence of meningioma increases with age to 50 per 100,000 in patients older than 85. As the population ages, an increasing proportion of meningioma patients are elderly. Much of this increase is accounted for by an increase in incidental, asymptomatic diagnoses, which have a low risk of progression in the elderly. The first-line treatment of symptomatic disease is resection. Fractionated radiotherapy (RT) or stereotactic radiosurgery (SRS) can be considered as primary treatment where surgery is not feasible, or as adjuvant therapy in cases of subtotal resection or high grade histopathology. The role of RT/SRS, particularly following gross total resection of atypical meningioma, is unclear and requires further evaluation. There is an increased risk of perioperative and postoperative morbidity in the elderly and therefore management decisions must be tailored to individual circumstances. Good functional outcomes can be achieved in selected patients and age alone is not a contraindication to intervention. The immediate postoperative course is an important determinant of prognosis. Therefore, careful preoperative evaluation and avoidance of complications are necessary to optimize outcomes.

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“…In contrast, many other studies have found no association between elderly age and increased risk for complications or mortality following CTR suggesting that CTR is a safe procedure for geriatric patients. For elderly patients who do experience complications, ICH, seizure, DVT, PE, infection, and stroke are most common [ 1 7 8 10 11 12 13 14 15 16 ].…”

Section: Discussionmentioning

confidence: 99%

Octogenarian Brain Tumor Registry: Single-Institution Surgical Outcomes and Mortality Study

Phillips

Filippidis

Mackel

et al. 2023

Brain Tumor Res Treat

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Background Surgical intervention for brain tumor patients aged 80 to 89 years is controversial, as the comorbidities and physiology associated with aging are often thought to increase surgical risks. Surgical outcomes, however, are not well characterized for octogenarians. This review therefore assessed the outcomes and mortality risk associated with tumor removal in octogenarians at our academic institution. Methods Retrospective review of patients aged 80 to 89 who underwent craniotomy for tumor resection (CTR) at our institution between 2004–2021 and who were diagnosed with meningioma, glioblastoma, or metastatic disease. Primary outcome was 30-day mortality. Results Sixty-one CTRs were included in analysis. Median age was 83 (interquartile range 81–85) years, and the most common preoperative comorbidity was hypertension (n=44). Most patients (n=35) had a preoperative modified Rankin Scale (mRS) score between 0–2. Seventeen (27.9%) patients experienced postoperative complications (i.e., urinary tract infection, deep venous thrombosis, etc.), and 26.2% (n=16) experienced new-onset neurologic deficits postoperatively (i.e., aphasia, motor deficits, etc.). Upon discharge, most patients (n=43) had an mRS score of 3–4. Within 30 days of surgery, 14.8% (n=9) of patients were readmitted to the hospital and 8.2% (n=5) of patients died: 2 with meningioma, 1 with glioblastoma, and 2 with metastatic disease. The most common cause of death was intracranial hemorrhage (n=3). Three-month mortality was 23.0% (n=14). Mean survival after surgery was 33 months for meningioma patients, 6.9 months for glioblastoma patients, and 15 months for patients with metastatic lesions. Conclusion Our review found a 30-day mortality rate of 8.2% across all tumor types, and mean survival was similar to that previously reported for patients across all age groups. Surgical intervention for octogenarian tumor patients is therefore feasible, safe, and likely worthwhile for extending and improving lives.

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Outcome of elderly patients undergoing intracranial meningioma resection: a single-center experience

Cited by 7 publications

References 10 publications

Postoperative diffusion-weighted imaging and neurological outcome after convexity meningioma resection

Postoperative diffusion-weighted imaging and neurological outcome after convexity meningioma resection

Meningioma in the elderly

Octogenarian Brain Tumor Registry: Single-Institution Surgical Outcomes and Mortality Study

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