Geriatric brain tumor management part I: Meningioma

Life expectancy continues to rise exponentially. The concept of frailty has emerged as a tool helping to gauge overall health status and risk of adverse events in aging patients, has shown to exhibit a linear relationship with poor survival in the elderly. Multiple pathologies have different genetic, radiographic, clinical and prognostic characteristics in the elderly, responding differently to various treatment modalities and thus present as unique clinical entities, not properly represented in large - guidelines generating studies. We present a two parts review discussing the unique features of the elderly patient harboring an intracranial neoplasm. In this Part-I, we review the management of benign meningioma in the elderly population. Meningioma is the second most common primary brain tumor. The risk of developing meningioma increases dramatically after 65 years of age. Predicting a specific meningioma's growth pattern and clinical behavior is impossible. Clinicians must choose between GTR with associated morbidity/ mortality, SRS or a combined AHS approach, since progression rates after STR are high. Several scoring systems attempt to offer risk stratification in meningiomas (five systems presented). The most comprehensive and validated GSS (for both resection and SRS) offers the opportunity for intervention, with potentially modifiable parameters.