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Intracranial Meningiomas in Patients Aged ≥80 Years: Pathological Features and Surgical Problems
Francesco Maiuri1, Sergio Corvino1, Marco Lorenzetti1
1Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy.
Background:
Patients aged >80 years frequently have intracranial meningiomas. In the present study, we have discussed the pathological features, comorbidities, and surgical complications for this age group from a surgical series and literature review.
Methods:
In the present study, we reviewed a surgical series of 354 intracranial meningiomas and compared the oldest age group (age, ≥80 years) of 17 patients with 73 patients aged 70-79 years and 264 patients aged <70 years. From a literature review, we selected 10 studies of meningiomas in patients aged ≥80 years. The analyzed factors included sex, meningioma location, World Health Organization grade, Ki-67 MIB1, progesterone receptor expression, comorbidities, American Society of Anesthesiologists class, Karnofsky performance scale score, postoperative complications, and death.
Results:
Patients aged ≥80 years had had higher rates of World Health Organization grade II meningioma, higher rates of Ki-67 expression of >4% and <20%, and progesterone receptor expression <15%. Of the postoperative complications, only neurological deficits and acute bronchopneumonia were significantly more frequent in patients aged ≥80 years. The incidence of intracerebral hematoma, lung embolism, acute heart ischemia, and death were not significantly different between the patients aged ≥80 years and those aged 70-79 years and <70 years.
Conclusions:
Patients aged ≥80 years must be considered a true elderly group with higher rates of comorbidities. The very old age is not a limitation to surgery; however, careful patient selection is necessary. In addition, for the oldest age group, the surgical decision should not be delayed because of advancing age.
Insights
Elderly patients over 80 with intracranial meningiomas show higher rates of aggressive tumors and specific complications like pneumonia. However, advanced age is not a surgical barrier, necessitating careful patient selection and timely intervention.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Oncology
Background:
- Intracranial meningiomas are frequently diagnosed in patients over 80 years old.
- Understanding pathological features and surgical outcomes in this demographic is crucial for effective treatment.
- This study focuses on the unique challenges and considerations for managing meningiomas in the very elderly.
Approach:
- A retrospective surgical series of 354 intracranial meningiomas was analyzed.
- The oldest cohort (≥80 years, n=17) was compared with younger groups (70-79 years and <70 years).
- A literature review of 10 studies on meningiomas in patients ≥80 years was also conducted, analyzing various clinical and pathological factors.
Key Points:
- Patients aged ≥80 years exhibited higher rates of World Health Organization (WHO) grade II meningioma.
- Elevated Ki-67 expression (>4% and <20%) and reduced progesterone receptor expression (<15%) were noted in the oldest group.
- Neurological deficits and acute bronchopneumonia were significantly more frequent postoperative complications in patients ≥80 years.
Conclusions:
- Patients aged ≥80 represent a distinct elderly group with increased comorbidities.
- Very advanced age alone should not preclude surgery for intracranial meningiomas; careful patient selection is paramount.
- Surgical decisions for the oldest patients should not be postponed due to age, emphasizing the need for timely intervention.
