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

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.

Keywords: brain tumor; elderly patient; meningioma; neurosurgery; risk factors.

Figure 1

Images show calculation of edema volumes and contrast-capturing lesion with 3D reconstruction of the tumor obtained with Osirix software.

Figure 2

The distribution of the WHO grading found at histological analysis between young and elderly patients does not present statistically significant differences in the chi-square test.

Figure 3

(A) ANOVA study performed analyzing ki-67 values and (B) observation of increasing number of mitoses per 10 HPF shows a progressive increase with increasing age. This finding does not correlate with grading or radiological features.

Figure 4

There is no more frequent intracranial localization in elderly patients than in young patients, upon analyzing individual cases with ANOVA study.

Figure 5

ANOVA study performed on the four age groups shows a significantly lower KPS value in patients over 65 years old. Further, recovery of neurological function and performance grade after the surgical procedure remained consistently lower in the elderly group both in the postoperative phase and in the last evaluation at follow-up (both p < 0.01).

Figure 6

Analysis of complications with chi-square testing does not demonstrate the presence of an increased number of complications in the post-operative phase of young patients compared with the elderly.

Figure 7

In the analysis of complications performed with ANOVA study, there is no one type of complication more frequent than another between the two groups.

Figure 8

Bar chart of the ANOVA study shows that the difference in mortality at last evaluation is maintained even when analyzing rates over the four age subdivisions (p < 0.01), thus showing no differences in the groups between 65–75 and >75 years.

Figure 9

Images show the presence of a surgically treated right frontal parasagittal meningioma in an 80-year-old woman. Postoperative follow-up documents include a complete Simpson grade I resection; the procedure had no postoperative complications. Histologic examination confirmed the presence of grade I meningioma with progesterone negativity. The patient started experiencing seizures after 3 months. Sixteen months after the procedure, the patient died of cardiological and infectious problems.