Introduction: The average life expectancy has increased over the last decades and with it the number of elderly meningioma patients. Elderly patients have increased morbidity and mortality rates as compared to younger patients undergoing intracranial surgery. Our aim was to figure out whether elderly meningioma patients should undergo surgery without limitations or not.

Methods: We investigated 556 patients (female 375 / male 181) that underwent meningioma resection between 2000 and 2016. Recurrent tumors were also included. In a total of 43 patients > 74 years of age (male/female 21/22) all data were available. We investigated pre- and postoperative Karnofski-Performance-Score (KPS), stay on ICU or IMC and the occurrence of post-operative seizures.

Results: Preoperative seizures were present in 8 patients. Median preoperative KPS was 90 (Range 30-100). Histology was WHO grade I in 18, grade II in 22; grade III in 3 patients. Incidence of WHO grade II meningiomas was significantly increased in elderly patients (p=0.02). Median follow-up was 250 days. Median postoperative KPS was 80 (Range 20-100). Clinical improvement was seen in 5 patients, however, 13 patients showed worsening of KPS with 9 of them decreasing 20 points or more. At last follow-up, only 11 patients had reached a KPS that was at least as good as the preoperative KPS. Four of 8 patients were seizure-free, however, two patients developed new seizures after surgery. Median stay on ICU was 1.5 days (range 1-46) and median stay on IMC was 0 days (range 0-27). Perioperative mortality was 0%.

Conclusions: In patients > 74 years old the incidence of WHO grade II meningiomas is significantly higher than in younger patients. More aggressive tumors suggest radical surgery. However, in line with recent literature, surgery appears to be associated with a substantial risk of postoperative morbidity [Ikawa F. etal., 2017]. Thus surgery needs to be carefully indicated.

Patient Care: Our results will improve patient selection for operation of intracranial meningiomas in elderly patients and thus improve the outcome and live quality after diagnosis of patients >75 years of age suffering from intracranial meningiomas.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the problems and increased risks for elderly Patients undergoing intracranial meningioma surgery 2) Weigh the pros and cons for operations in elderly meningioma patients 3) Discuss whether those patients should be operated or not in the future.

References: Ikawa F, Kinoshita Y, Takeda M, Saito T, Yamaguchi S, Yamasaki F, Iida K, Sugiyama K, Arita K, Kurisu K. Review of Current Evidence Regarding Surgery in Elderly Patients with Meningioma. Neurol Med Chir (Tokyo). 2017 Oct 15;57(10):521-533. doi: 10.2176/nmc.ra.2017-0011. Epub 2017 Aug 15.