Al Rhoton as Neurosurgeon of the Year

Abstract

Many neurosurgeons prefer conservative treatments in the elderly because of higher rates of mortality and morbidity after surgery. We aim to evaluate safety and efficacy of surgery in elderly patients with frontobasal and suprasellar meningiomas with a simple operative procedure, the frontolateral approach.Retrospective analysis was made in consecutive patients with meningiomas operated via frontolateral approach. They were divided into 2 groups: elderly group (age ≥ 65 years) and young group (age < 65 years). Multivariate logistic regression analysis was performed for postoperative complications and Karnofsky Performance Scale score (KPS).The study comprises 128 patients operated over a 19-year period, of which 35 patients were in the elderly group and 93 patients were in the young group. More elderly patients presented with American Society of Anesthesiology (ASA) class II and III (57.1% vs. 43%). Gross resection was achieved in 31 cases in the elderly and 85 cases in young group (88.6% vs. 90.3%, P = 0.17). Postoperative KPS in both groups was improved (85.7% vs. 91.4%, P = 0.18). One death occurred in elderly group (2.9%, P = 0.27). Approach-related and medical morbidity in the elderly group was slightly higher than in the young group without significant difference (respectively, 11.4% and 14.3% vs. 9.7% and 8.6%, P = 0.18). Multivariate logistic regression showed increasing age was not associated with approach-related morbidity (odds ratio [OR]: 1.39, P = 0.53), medical morbidity (OR: 1.94, P = 0.88), and improvement of KPS (OR: 0.32, P = 0.25).Frontobasal and suprasellar meningiomas in elderly patients can be treated surgically with acceptably low morbidity and mortality rates via the frontolateral approach. Preoperative KPS score ≤60 and ASA classification ≥III predict an unfavorable postoperative outcome.