Surgical Removal of Skull Base Meningiomas in Symptomatic Elderly Patients

Meningiomas frequently occur in elderly patients, and surgical treatment is hazardous owing to multiple comorbidities. We report a series of elderly patients who were treated with surgical removal of meningiomas and compare them with a group of younger patients with similar tumors.

A retrospective study of elderly patients with symptomatic skull base meningiomas and a matched control group of younger patients was performed. Medical records, operative reports, radiologic examinations, and follow-up data were reviewed. Main outcome measures were morbidity, mortality, and Simpson grade.

The study included 46 patients (23 elderly [age >65 years], 23 younger [age <65 years]). Average age was 71 years in elderly patients and 48 years in younger patients. Mean follow-up period was 32 months and 49 months, respectively. Radical removal (Simpson grades I and II) was observed in 83% and 91%, respectively. Mortality was 8% and 4%, respectively. Definite cranial nerve lesions occurred in 8% and 26%, respectively; cerebrospinal fluid leaks occurred in 12.5% and 4%, respectively; hemiparesis occurred in 4% of patients in both groups. Glasgow Outcome Scale score of 5 was obtained in 87% and 65.2%, respectively.

Elderly patients with symptomatic skull base meningiomas should be considered for surgical treatment owing to acceptable morbidity and mortality compared with younger patients. Previous comorbidities and involvement of neurovascular structures are important factors in the decision regarding extent of surgical resection.