gms | German Medical Science

Objective: The objective of this study was to assess the morbidity and mortality of patients aged 70 years and older, who are harbouring a symptomatic intracranial meningioma, which had to be subjected to microsurgical resection. The aim was to define and identify the most influential prognostic factors within this elderly population which affect their outcome.

Methods: We carried out a retrospective review of the clinical course of patients aged 70 years or older with intracranial meningiomas, treated by surgery during the past 12 years in our hospital. Pre- and postoperative neurological status were assessed using the modified Rankin Scale as grading system. To asses the preoperative medical status, we used the classification according to the American Society of Anesthesiologists (ASA). All patients underwent microsurgical resection and had MR or CT imaging within 72 hours after surgery. Operative complications, 30-day mortality, the pre- and the postoperative neurological status after three months were assessed and analyzed.

Results: Between 1998 and 2010, 85 patients (median age 75 years, range 70–89 years, 32 male and 53 female patients) underwent resection of an intracranial meningioma. The most common signs and symptoms at presentation were seizures (31%), motoric deficits and hemiparesis (20%), apathy, changes in personality and cognitive changes (21%). 75 patients had an ASA score of II, 10 patients one of III. A Simpson Grade 0 or 1 resection was achieved in 76 patients (89%). 69 tumours (81%) were WHO Grade I, 13 (15%) were WHO Grade II, three patients had a WHO grade III meningioma. Medical or neurosurgical complications were seen in the postoperative course of 12 patients. Surgical complications were observed in 7 patients (haematoma formation requiring evacuation in 5 patients, CSF leakage in one, infection also in one case). Medical complications such as respiratory insufficiency, pneumonia, vein thrombosis have been noted in 7 cases. All patients with postoperative haematomas died during the hospital stay, but none of those with purely medical complications. Thus overall morbidity was 14% and mortality was 5,8%.

Conclusions: Morbidity and mortality of elder patients subjected to a meningioma resection are comparable to those of younger patients. Thus advanced age is no contraindication for surgery, even in patients with pronounced preoperative neurological deficits and/or ASA scores of III. In the most cases the quality of life can be improved significantly.