gms | German Medical Science

The decision to operate on elderly patients with an intracranial meningioma is difficult, especially when the tumour is located at the base of the skull. The aim of this study is to assess the morbidity and mortality of meningioma surgery in patients over 70 years harbouring a tumour at the cerebellopontine angle as one representative location. Data were compared with a matched group of young patients.

A retrospective analysis based on clinical charts, surgical records, histological records, imaging studies and follow-up records was conducted to select patients over 70 years of age who underwent surgery of cerebellopontine angle meningiomas. Tumours were classified in 5 groups according to their location in relation to the inner auditory canal (IAC); the tumour diameter was also measured. Tumours with comparable size and location were matched with the younger group of patients. Patients with recurrent, atypical or anaplastic tumours were excluded.

Out of a consecutive series of 1,800 meningiomas operated between 1978 and 2002, 421 were located in the cerebellopontine angle. There were 21 patients older than 70 years (range 70-84). Mean Karnofsky-Index at presentation was 79 (70-90), 16 patients had a physical status grading ASA 2 and 5 patients ASA 3. The average length of hospital stay was 22 days (7-99 days). The postoperative Karnofsky score at time of discharge was 77 (50-90). The most common medical complication turned out to be postoperative pneumonia in 4 patients, among them 3 patients had lower cranial nerve disturbance postoperatively. There were 56 younger patients (mean age 52.4 years; range 24.5-69.75 years) with corresponding tumour size and location. Pre-op Karnofsky score was 81.25 (80-90), 53 patients were graded as ASA 2 and 3 patients as ASA 3. The mean hospital stay was 13.6 days (8-32 days). Post-op Karnofsky score was 80.2 (70-90). Among 5 patients with postoperative caudal nerve disturbance no patient had pneumonia postoperatively. There was no perioperative mortality in both groups.

With modern neurosurgical techniques and neuroanesthesia elderly patients with CPA meningiomas can be operated with acceptable low morbidity and good neurological outcome but recovery from surgery lasts longer compared to younger patients. However, postoperative lower cranial nerve deficits in elderly patients may not be well tolerated compared to younger patients.