Surgery in octogenarians with intracranial meningiomas improves functional outcome at 1 year

• Published in: Acta neurochirurgica 2023-12, Vol.165 (12), p.4183-4189
• Main Authors: Filippidis, Aristotelis S., Phillips, Katharine R., Lopez-Rivera, Victor, Enriquez-Marulanda, Alejandro, Mackel, Charles E., Alterman, Ron L., Vega, Rafael A.
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Aging; Female; Humans; Interventional Radiology; Male; Medicine; Medicine & Public Health; Meningeal Neoplasms - pathology; Meningeal Neoplasms - surgery; Meningioma; Meningioma - pathology; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Octogenarians; Original Article; Regression analysis; Retrospective Studies; Risk factors; Surgery; Surgical Orthopedics; Survival; Treatment Outcome; Tumor – Meningioma; Tumors
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-023-05827-9

Purpose The population is aging, and age remains an important factor in deciding surgical candidacy for intracranial tumors. The natural history and surgical behavior of meningiomas in octogenarians are not well understood. We evaluated the surgical and functional outcomes, including survival, among octogenarians with intracranial meningiomas in a single institution. Methods The Tumor Registry (2004–2021) was used to identify octogenarian patients (ages 80–89) diagnosed with intracranial meningioma. Primary endpoints were 1-year survival and functional outcome measured with mRS postsurgery. Kaplan–Meier, univariable Log-rank tests, and multivariable Cox hazards proportional regression models were used for assessing factors associated with overall survival (OS) in octogenarians with meningiomas who underwent surgery; logistic regression and McNemar’s were used to further characterize risk factors affecting functional surgical outcome at 1 year. Results Thirty octogenarians with intracranial meningioma who underwent surgery were identified. Median age was 82.5 years and 66.6% were female patients. The 1-year median postsurgical survival probability for all octogenarians with meningioma was 86.3% and no intraoperative mortality was observed. Frailty (mFI-5, p  = 0.84), tumor grade ( p  = 0.11), tumor size ( p  = 0.22), extent of resection ( p  = 0.35), and Karnofsky scale on admission ( p  = 0.93) did not significantly affect the survival in octogenarians with meningiomas which were treated surgically. The 1-year postoperative functional status of octogenarian meningioma patients who underwent surgery was significantly improved compared to pre-op mRS (McNemar's chi-squared = 9.6, df = 1, p -value = 0.001946). Conclusion In octogenarians with meningiomas, surgical intervention significantly improves the pre-operative modified Rankin Scale at 1 year postsurgery in this cohort.