gms | German Medical Science

Objective: Although meningiomas are most common in people aged between 40 and 70. The custom of operating elderly for benign tumors has increased in the past decade, as humans become older in general. Several studies have investigated complications and outcome in elderly with intracranial meningiomas. Less is known about the intraspinal meningiomas in the elderly. Therefore we have investigated our intraspinal meningioma patients.

Method: We retrospectively reviewed pre-, intra- and postoperative data and scored the neurological status with the McCormick scale, as well as CT and MR-images, of all intraspinal cervical and thoracic meningioma that were primarily operated between 2004 and 2015.

Results: In total 129 patients were operated of which 44 were older than 70. Ninety-eight patients (76%) were female. Mean age was 63 years (range 17-91). Elderly had more often a thoracic localization of the tumor (73% vs. 65%). Duration from clinical symptoms to operation appeared to be longer in elderly patients (1.9 vs. 1.2 years n.s.). Preoperative McCormick score was worse in elderly (2.38 vs. 2.04, p=0.04). Mean clinical follow-up was 1.38 years (range 0.01 - 7 years). McCormick at follow-up was significantly worse as well in elderly (1.87 vs. 1.51, p=0.01). However, both groups showed significant clinical improvement. Intraoperative changes of SEP and MEP did not differ between the groups. Nine patients needed revision surgery, one of them twice. Three of which were > 70 years (2 wound infections, 1 CSF fistula). There was no perioperative mortality or postoperative paraplegia.

Conclusions: Elderly have a worse McCormick score preoperatively. However, they did improve neurologically and did not have more surgical complications. Reluctance against operating spinal meningioma in elderly patients appears to worsen outcome more than perioperative risks. Awareness of meningioma as possible cause of gait disturbance in elderly should be increased in order to increase chances of better outcome.