Outcomes following Modern-Day Meningioma Surgery in the Elderly

Introduction: The aging world population has led increasing number of older patients seeking care for meningiomas. Most large studies assessing outcome in older patients undergoing meningiomas surgery are greater than two decades old. Advances in surgical and perioperative care have likely lead to improved outcome for older patients undergoing meningiomas surgery. This study's objective was to provide meaningful data regarding age and comorbidity on overall outcome following modern-day meningioma surgery.

Methods: Retrospective chart review was performed on patients 60 years or older undergoing meningioma surgery between 1993 and 2010 by the senior author (JHL). 301 operations for patients aging 60–88 years old were identified and stratified into risk groups based on decade of life, health status, tumor size and location. Health status was assessed using the American Society of Anesthesia Scale (ASA). Early & late functional outcomes were assessed using the Glasgow outcome scale (GOS). Univariate analysis was performed to assess the significance of these risk factors on outcome and potential complications. To assess if age & comorbidity were independent of each other, univariate analysis for comorbidity stratified by each age group and vice versa was performed.

Results: Overall early outcome was good (GOS 5) for 77.4%, acceptable (GOS 4) 14.0%, and poor (GOS 1–3) 8.6%. Late outcomes were 83.4%, 6.1%, & 10.5%, respectively. Nineteen (7.7%) mortalities occurred. Of which, 12 were directly or indirectly attributed to neurologic injury or surgical complication. With univariate analysis, age, comorbidity, and tumor size were each associated with poor functional outcome (p < 0.05). Tumor location was not associated with poor functional outcome. When stratified by comorbidity class, age was not significantly associated with poor outcome except in very sick patients (ASA 3) (p < 0.02). Comorbidity was associated with risk of developing poor outcome in 60 & 70 year olds (p < 0.05) and trended toward significance (p = 0.07) in 80 year olds.

Conclusions: Overall good to acceptable results were achieved in 91.4% at early follow-up and 89.5% by late follow-up. Tumor location was not associated with risk of developing poor outcome. For patients under the age of 80, comorbidity is independent of age and is associated with developing poor outcome. Age over 80 was only associated with developing a poor outcome in very sick patients (ASA 3).