Six-month Outcome After Meningioma Removal

Abstract & Commentary

Synopsis: Meningioma surgery can be performed with good results in the elderly, but with increased complications and mortality.

Source: Konglund A, et al. Outcome following surgery for intracranial meningiomas in the aging. ACTA Neurol Scand DOI; 10.1111/j.1600-0404.2012.01692x.

The U.S. Census Bureau projects the number of americans aged 65 years and older to be 88.5 million in 2050, more than double the number in 2010. Worldwide, the proportion of older people (60 years and older) is expected to reach 22% in 2050 (2 billion people). Even if age-specific per capita use of surgical services remains constant, there will be an increase in the amount of work in all surgical fields.1 Specifically, the demand for neurosurgical procedures in the elderly is likely to grow significantly because the incidence of brain tumors increases with age.

Older age is an important risk factor for post-operative morbidity and mortality.2 Therefore, in the specific case of surgery for intracranial meningiomas, the authors prospectively assessed postoperative mortality, morbidity, and functional outcome in patients ≥ 60 years. Thirty-five women and 19 men, median age 70 (60-84) years, were evaluated pre- and post-operatively at two neurosurgical institutions in Norway. Of these 54 patients, 47 (87%) received a 6-month follow-up evaluation. Four patients had died and three were lost to follow-up.

Meningioma surgery in the age group 60 to 84 years carried a higher risk of complications compared to intracranial surgery in general. Surgical mortality was 5.6% at 30 days and 7.4% at 3 and 6 months. The numbers and rates of complications were: intracranial hematomas requiring surgical evacuation in two (5.6%) patients, both of whom died; deep vein thrombosis, and bone flap infection in one patient each, (1.9%); CSF disturbances in seven (13%); and seizures, transient neurological deterioration, and death in another four.

At 6 months, surgery resulted in an improvement in the MMSE score to ≥ 25 in 15% of patients but without a change in the level of independence according to the Karnofsky performance scale. Quality-of-life assessments indicated "acceptable to good" functioning post-operatively that was reduced compared to data from the age-matched general population.

Commentary

The availability of sophisticated, non-invasive diagnostic imaging, as well as the introduction of Medicare in 1965, which has facilitated the use of these diagnostic tools in the elderly, have led to brain tumors being diagnosed earlier and with increased frequency.3

The present series of surgical patients, aged 60 to 84 years, does not constitute a homogenous group for surgical risk. Patients older than 80 years can be expected to have a higher rate of postoperative complications than younger patients because of increased preexisting disease and debility.4 Nevertheless, the present results support the conclusions of previous reports of patients undergoing surgery for intracranial meningiomas;5 namely, that a good outcome can be predicted in an older patient with a good physical state and a favorable postoperative risk, especially if the meningioma is located at the convexity.

That's the good news; the bad news is that old age is incurable.

References

1. Etzioni DA, et al. The aging population and its impact on the surgery workforce. Ann Surg 2003;238:170-177.

2. Turrentine FE, et al. Surgical risk factors, morbidity and mortality in elderly patients. J Am Coll Surg 2006;203:865-877.

3. Mulan B, et al. Increased mortality from brain tumors: A combined outcome of diagnostic technology and change of attitude toward the elderly. Am J Epidemiol 1992;135:1349-1357.

4. Hamel MB, et al. Surgical outcome for patients aged 80 and older. Morbidity and mortality from major non-cardiac surgery. J Amer Geriatrics Society 2005;53:424-429.

5. Black P, et al. Meningioma surgery in the elderly: A case control study assessing morbidity and mortality. Acta Neurochirurgica 1998;140:1013-1017.