gms | German Medical Science

Objective: The general availability of cerebral CT and MRI scans makes the observation of symptomatic intracranial meningiomas in elderly patients (aged 70 or more) quite frequent. Morbidity and mortality rates reported for meningioma resection in the elderly vary widely. Thus, it is difficult for neurosurgeons to compare the risks and benefits of operating on elderly patients against opting for watchful waiting or radiosurgery. To address this issue, we studied the effect of advanced age on outcome of patients operated on for an intracranial meningioma by reviewing the literature and our personal experience.

Method: A few authors have reported on patients who have undergone surgery for intracranial meningiomas in their 8^th and 9^th decade of life, without providing indications regarding the surgical criteria and the prognostic factors. We report on a series of 40 consecutive patients aged 70 or more, who have received surgery for intracranial meningiomas, with the goal of determining some surgical criteria for predicting results and outcome.

Results: Patients with severe systemic disease and definite functional limitations (American Society of Anesthesiology Class III) had a major postoperative morbidity (p<0.05) and mortality (p<0.01), especially if they scored low (<70) on the preoperative Karnofsky Rating Scale (p<0.01). The risk of postoperative morbidity was higher when severe peritumoral edema was present (p<0.05) and if the maximum diameter of the tumor was >5 cm (p<0.05).

Conclusions: Surgical removal of a meningioma in the elderly is a safe procedure if the preoperative ASA classification is I or II and if the KPS rating is at least 70. Age seems not to be an insuperable obstacle when adequate management of all risk factors has been obtained.