Risks and neurological benefits of meningioma surgery in elderly patients compared to young patients

• Published in: Journal of neuro-oncology Vol. 154; no. 3; pp. 335 - 344
• Main Authors: Ahmeti, Hajrullah, Borzikowsky, Christoph, Hollander, Dieter, Röcken, Christoph, Jansen, Olav, Synowitz, Michael, Mehdorn, Maximilian H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2021; Springer Nature B.V
• Subjects: Age; Aged; Aged, 80 and over; Bleeding; Brain cancer; Cerebrospinal fluid; Clinical Study; Cranial nerves; Humans; Medicine; Medicine & Public Health; Meningeal Neoplasms - epidemiology; Meningeal Neoplasms - surgery; Meningioma; Meningioma - epidemiology; Meningioma - surgery; Middle Aged; Neurology; Neurosurgical Procedures - adverse effects; Oncology; Paralysis; Patients; Postoperative Period; Renal insufficiency; Retrospective Studies; Surgery; Treatment Outcome; Neurological conditions; Comorbidities; Meningioma surgery; Intracranial meningiomas; Operative risks; Elderly patients
• ISSN: 0167-594X; 1573-7373; 1573-7373
• DOI: 10.1007/s11060-021-03832-5

Introduction While surgery is the primary treatment choice for intracranial meningiomas in young patients, surgery in elderly patients, especially those with pre-existing comorbidities, has been the subject of repeated discussion. This study investigated the postoperative risks and neurological benefits of meningioma surgery in elderly patients compared to young patients. Methods In total, 768 patients were included and divided into two main groups: group I (age: ≤ 64 years; 484 young patients) and group II (age: ≥ 65 years; 284 elderly patients). Group II was subdivided into: IIa (age: 65–69 years), IIb (age: 70–79 years); and IIc (age: ≥ 80 years). Results The total tumor resection rate was higher in the elderly cohort than in the young cohort (84.5 and 76.2%, respectively). 154 young patients (31.8%) and 132 elderly patients (46.5%) developed postoperative morbidities, with the three most common being bleeding (12.9%), cranial nerve disorder (10%) and CSF fistula (8.1%). Postoperative bleeding, palsy, speech disorder, pneumonia and renal insufficiency were dependent on age (r = 0.123, p = 0.001; r = 0.089, p = 0.014; r = 0.100, p = 0.006; r = 0.098, p = 0.007 and r = 0.084, p = 0.020) and presented more often in elderly patients. 6 young and 15 elderly patients died during the 17.4-year observation period. Most patients showed a significant improvement in postoperative KPS (p < 0.001), except those over 80 years old (p = 0.753). The KPS at the last follow-up was significantly improved in all patients (p < 0.001). Conclusion Meningioma surgery is associated with a higher rate of postoperative complications in elderly patients than in young patients. Most elderly patients, similar to young patients, show a significant improvement in neurological status postoperatively.