Introduction: The reported outcomes of intracranial meningioma resection in the elderly varied greatly mainly due to variations in inclusion criteria and the definitions of peri-operative complications.[1-2] We compared the mortalities and morbidities of elderly patients with those of a contemporary cohort of younger patients, with an emphasis on sub-group analyses based on tumor locations and the use of a standardized classification system of operative complications.[3]

Methods: Consecutive elderly patients (aged =65) and tumor-location-matched younger patients who underwent surgery were retrospectively reviewed. Outcomes were assessed at 30-day, 90-day, 6-month and 1-year. Tumor locations were classified as CPF (convexity, parasagittal and falcine) or SB (skull base). Peri-operative complications were graded as Class I (least serious) to Class IV (most serious). Predictors for adverse outcome were identified using multinomial logistic regression analyses.

Results: There were 92 patients in each group. The cumulative 30-day, 90-day and 1-year mortality rates were 0%, 2.2% and 4.3% in the elderly, respectively, and 1.1% for all time points in the young. These did not differ significantly between the two groups. The elderly had a significantly higher overall complication rate than the young (69.6% vs. 51.1% P = 0.010), with the differences being significant only for SB (P = 0.049) but not CPF (P = 0.095) lesions, and only for Class I/II but not Class III/IV complications. The odds ratio (OR) of developing Class I/II complications in the elderly was 2.4 (95% CI, 2.1-2.8). Women were more likely to develop Class I/II (OR 2.6; 95% CI, 2.2-2.9) and Class III/IV complications (OR 4.1; 95% CI, 3.5-4.8) than men.

Conclusions: Elderly patients undergoing meningioma resections are not necessarily at higher risks of developing serious or life-threatening complications. Patients’ gender and tumor locations should be considered as important predictors of adverse outcomes during patient selection and counseling.

Patient Care: With our aging populations and wide availability of diagnostic imaging, the management of intracranial meningioma in the elderly is an increasingly important issue. The findings of this study will facilitate patient selection and counseling as well as treatment planning during the management of this group of patients.

Learning Objectives: By the conclusion of this session, participants should be able to identify, in addition to age, other risk factors for unfavorable surgical outcome in elderly patients undergoing meningioma resection, and to appreciate the importance of using a standardized way of classifying complications in the critical appraisal of literature and the conduction of future studies.

References: 1. Patil CG, Veeravagu A, Lad SP, Boakye M. Craniotomy for resection of meningioma in the elderly: a multicentre, prospective analysis from the National Surgical Quality Improvement Program. J Neurol Neurosurg Psychiatry. 2010;81(5):502-505. 2. 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):407-411. 3.Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213.