Yurdal GEZERCAN, Güner MENEKŞE, Ali İhsan ÖKTEN

Altmış beş yaş üzeri hastalarda intrakranial meningiomların cerrahi tedavisi: 70 olguluk retrospektif bir çalışma

Aim: Intracranial meningiomas are the most common types of brain tumor in patients over 65 years of age. Surgical resection in this group of patients may be at risk of severe complications, due to limited physiological capacities and the presence of comorbidities. This retrospective study aimed to summarise outcome data of patients older than 65 years who underwent surgery for intracranial meningioma at our clinic between Jan 2007 and Dec 2012.Materials and Methods: Medical records of 70 cases diagnosed with intracranial meningioma were retrospectively reviewed. Demographic and clinical data (age, sex, symptoms), tumor localization, histopathologic properties, American Society of Anesthesiology (ASA) class, complications of the early postoperative period were analyzed.Results: Male/female ratio was 0.37 and mean age was 71.3. The most common experienced symptoms were headache (78.5%), motor deficit (18.5%) and seizure (17.1%). Tumors were mostly settled to convexities (34.3%) and parasagittal regions (17.1%). Histopathological diagnoses were classified as follows; Meningothelial (40.0%), transitional (18.6%), fibroblastic (114%) and psammomateous (11.4%). Postoperative complications were manifested in 10 of 70 patients (14.2%) Complication rate was prominently higher in patients with class III and IV of ASA class.Conclusions: Surgery for intracranial meningiomas in selected elderly patients is beneficial. Old age alone should not be used as a selection criterion for treatment.

Surgical treatment of intracranial meningiomas in patients over 65 years old: A retrospective study of 70 cases

Aim: Intracranial meningiomas are the most common types of brain tumor in patients over 65 years of age. Surgical resection in this group of patients may be at risk of severe complications, due to limited physiological capacities and the presence of comorbidities. This retrospective study aimed to summarise outcome data of patients older than 65 years who underwent surgery for intracranial meningioma at our clinic between Jan 2007 and Dec 2012. Materials and Methods: Medical records of 70 cases diagnosed with intracranial meningioma were retrospectively reviewed. Demographic and clinical data (age, sex, symptoms), tumor localization, histopathologic properties, American Society of Anesthesiology (ASA) class, complications of the early postoperative period were analyzed. Results: Male/female ratio was 0.37 and mean age was 71.3. The most common experienced symptoms were headache (78.5%), motor deficit (18.5%) and seizure (17.1%). Tumors were mostly settled to convexities (34.3%) and parasagittal regions (17.1%). Histopathological diagnoses were classified as follows; Meningothelial (40.0%), transitional (18.6%), fibroblastic (114%) and psammomateous (11.4%). Postoperative complications were manifested in 10 of 70 patients (14.2%) Complication rate was prominently higher in patients with class III and IV of ASA class. Conclusions: Surgery for intracranial meningiomas in selected elderly patients is beneficial. Old age alone should not be used as a selection criterion for treatment.

PDF

___

Awad IA, Kalfas I, Hahn JF, Little JR. Intracranial meningiomas in the aged: surgical outcome in the era of computed tomography. Neurosurgery 1989;24(4):557- 60.
Arienta C, Caroli M, Balbi S. Intracranial meningiomas in patients over 70 years old. Follow-up in operated and unoperated cases. Aging (Milano) 1992;4(1):29-33.
Cornu P, Chatellier G, Dagreou F, Clemenceau S, Foncin JF, Rivierez M. et al. Philippon J. Intracranial meningiomas in elderly patients. Postoperative morbidity and mortality. Factors predictive of outcome. Acta Neurochir (Wien) 1990;102(3-4):98-102.
Gijtenbeek JM, Hop WC, Braakman R, Avezaat CJ. Surgery for intracranial meningiomas in elderly patients. Clin Neurol Neurosurg 1993;95(4):291-5.
Niiro M, Yatsushiro K, Nakamura K, Kawahara Y, Kuratsu J. Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry 2000;68(1):25-8.
Cohen-Inbar O, Sviri GE, Soustiel JF, Zaaroor M. The Geriatric Scoring System (GSS) in meningioma patients-- validation. Acta Neurochir (Wien) 2011;153(7):1501-8.
Caroli M, Locatelli M, Prada F, Beretta F, Martinelli- Boneschi F, Campanella R. Et al. Surgery for intracranial meningiomas in the elderly: a clinical-radiological grading system as a predictor of outcome. J Neurosurg. 2005;102(2):290-4.
Konglund A, Rogne SG, Lund-Johansen M, Scheie D, Helseth E, Meling TR. Outcome following surgery for intracranial meningiomas in the aging. Acta Neurol Scand 2013;127(3):161-9.
Cohen-Inbar O, Soustiel JF, Zaaroor M. Meningiomas in the elderly, the surgical benefit and a new scoring system. Acta Neurochir (Wien) 2010;152(1):87-97.
Schul DB, Wolf S, Krammer MJ, Landscheidt JF, Tomasino A, Lumenta CB. Meningioma surgery in the elderly: outcome and validation of 2 proposed grading score systems. Neurosurgery 2012;70(3):555-65.
Black P, Kathiresan S, Chung W. Meningioma surgery in the elderly: a case-control study assessing morbidity and mortality. Acta Neurochir (Wien) 1998;140(10):1013-6.
Bateman BT, Pile-Spellman J, Gutin PH, Berman MF. Meningioma resection in the elderly: nationwide inpatient sample, 1998-2002. Neurosurgery 2005;57(5):866-72.
Roser F, Ebner FH, Ritz R, Samii M, Tatagiba MS, Nakamura M. Management of skull based meningiomas in the elderly patient. J Clin Neurosci 2007;14(3):224-8.
Boviatsis EJ, Bouras TI, Kouyialis AT, Themistocleous MS, Sakas DE. Impact of age on complications and outcome in meningioma surgery. Surg Neurol 2007;68(4):407-11.
Sacko O, Sesay M, Roux FE, Riem T, Grenier B, Liguoro D. et al. Intracranial meningioma surgery in the ninth decade of life. Neurosurgery 2007;61(5):950-4.
D'Andrea G, Roperto R, Caroli E, Crispo F, Ferrante L. Thirty-seven cases of intracranial meningiomas in the ninth decade of life: our experience and review of the literature. Neurosurgery 2005;56(5):956-61.
Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C. et al. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012. Neuro Oncol 2015;17 Suppl 4:iv1-iv62.
Perry A, Louis DN, Scheithauer BW, Budka H, Von Deimling A: Meningiomas. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds), WHO classification of tumours of the central nervous system, Lyon: IARC Press. 2007. p. 164–72.