Intracranial Meningioma in Elderly Patients. Retrospective Multicentric Risk and Surgical Factors Study of Morbidity and Mortality.

Daniele Armocida,Fabio Cofano,Alessandro Pesce,Antonio Santoro,Alessandro Frati,Maurizio Salvati,Umberto Aldo Arcidiacono,Giancarlo D’Andrea,Veronica Picotti,Diego Garbossa,Mauro Palmieri

doi:10.3390/diagnostics12020351

Abstract

With the increasing life expectancy, a large number of intracranial meningiomas (IM) have been identified in elderly patients. There is no general consensus regarding the management for IMs nor studies regarding the outcome of older patients undergoing meningioma surgery. We aimed to determine whether preoperative variables and postoperative clinical outcomes differ between age groups after meningioma surgery. We analyzed data from all patients who had undergone IM surgery from our departments. The final cohort consisted of 340 patients affected by IM with ASA class I-II: 188 in the young group (<65) and 152 in the elderly. The two subgroups did not present significant differences concerning biological characteristics of tumor, localization, diameters, lesion and edema volumes and surgical radicality. Despite these comparable data, elderly presented with a significantly lower Karnofsky Performance status value on admission and remained consistently lower during the follow-up. We establish instead that there is no intrinsic correlation to the presence of IM and no significant increased risk of complications or recurrence in elderly patients, but rather only an increased risk of reduced performance status with mortality related to the comorbidity of the patient, primarily cardiovascular disease, and an intrinsic frailty of the aged population.

Highlights

Meningiomas are the most common benign intracranial tumors, which may occur at any age, but in actuality, they present an incidence peak between the sixth and seventh decades of life [1,2], and the incidence rate increases progressively with increasing age [3].With the availability of advanced diagnostic imaging modalities and an increasing human life expectancy, a large number of intracranial meningiomas (IM) have been identified in elderly patients [4,5]
The aim of this study is to determine whether preoperative variables and postoperative clinical outcome differ between age groups after meningioma surgery
The results confirm that older people might experience greater difficulty than In the present study, we demonstrated that IMs in elderly patients did not exhibit younger patients, from mild to severe postoperative impairments of performance status, more frequent locations, a significantly larger tumor size, or a higher edema volume when after tumor resection

Summary

Introduction

Meningiomas are the most common benign intracranial tumors, which may occur at any age, but in actuality, they present an incidence peak between the sixth and seventh decades of life [1,2], and the incidence rate increases progressively with increasing age [3].With the availability of advanced diagnostic imaging modalities and an increasing human life expectancy, a large number of intracranial meningiomas (IM) have been identified in elderly patients [4,5]. There is still no general consensus regarding surgical management for IMs in elderly patients, and the predictive factors of elderly patients with surgically resected IMs are not well established [13]. This raises the question of whether the surgical procedure, as a first treatment option, is as good for older patients as it is for younger adult patients, and whether the postoperative clinical outcome in these patients, in terms of complications, surgical morbidity, and mortality, is comparable to that of younger patients [15]

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