P15.12 * SURVIVAL AND QUALITY OF LIFE AFTER SURGERY FOR BENIGN INTRACRANIAL TUMOURS: AGE MATTERS?

Abstract

INTRODUCTION: Intracranial benign tumours are an increasingly common condition in the elderly population (>70 years) thanks to the prolonged life expectancy and the improvement of neuroradiological studies. Surgical resection in these patients, even if indicated, could be controversial due to patient's ageing physiology and eventual comorbidities, so it is difficult for surgeons to compare the advantages of a surgical removal against radiosurgery or a “wait and see” behaviour. We report our experience in dealing with patients (>70 years) surgically treated for benign intracranial neoplastic lesions (deep-seated and/or located in eloquent areas). We report how surgery in the elderly could be effective as in younger patients with no higher incidence of complications and reduction of the quality of life and/or survival. METHODS: From January 2010 to January 2014, 42 patients (12 male and 30 female with a mean age of 75 years) were submitted to a benign intracranial tumours surgical removal. The oldest patient was 86 years old. Neurological and physical conditions were assessed preoperatively and neuroradiological examination (MRI or, if it is contraindicated, a CT scan) revealed size and location of the lesions. Intraoperatively we used neuronavigation and neurophysiological monitoring. Outcome data included mortality, recurrence, complications and length of hospital stay (LoS). RESULTS: The patients' pathologies were: meningiomas in 32 patients, followed by 7 pituitary adenomas and 3 acoustic neuromas. In 35 pts a gross total removal was obtained whereas a sub total removal and partial removal were achieved in 5 and 2 pts respectively. Patients had a mean length of hospital stay of 9,7 days. Postoperative complications were observed in 6 patients, represented by CSF leaks (4 pts) and intracerebral haemorrhage (2 pts). There were better postoperative results in patients with few comorbidities and tumours of small dimensions and accessible location. The mortality rate was 2,4 %. Neurological symptoms improved in 38 patients and deteriorated in 4 pts. Patients with recurrent tumours seems to have a higher operative risk. CONCLUSIONS: While in the past age itself often represented a contraindication to surgical removal of benign intracranial tumours, nowadays, thanks the improvements in surgical technique and the minimally invasive attitude along with tailored surgical instruments (microneurosurgery or endoscopy) and new technologies such as neuronavigation and intraoperative brain mapping, these surgical procedures could be effectively performed without higher incidence of postoperative complications, when compared to the same surgery performed in younger patients. Obviously a careful preoperative anaesthetic evaluation is mandatory, and above all a meticulous postoperative management. Patients too long intubated or kept in bed easly develop complications.