Results in Skull Base Meningiomas Surgery in the Elderly

Purpose: The aim of this study is to report the surgical results in 16 consecutive patients older than 70 years of age harboring symptomatic skull base meningiomas.

Method and Result: Locations of the meningiomas were as follows: olfactory groove, 3 cases; sphenoid ridge, 4; orbital roof/anterior cranial fossa floor, 4; suprasellar region, 2; cerebellopontine angle, 3. In most cases the tumor was larger than 5 cm in diameter. All patients presented with symptoms and signs that were correlated to tumor location, with duration of clinical history commonly lasting for several months. In the patients with olfactory groove, suprasellar, and sphenoid ridge meningiomas, a pterional approach was carried out; in the remaining cases tumor resection was done through a surgical approach chosen according to dural attachment and extension of the meningioma. Total tumor excision (Simpson I and II) was achieved in 15 cases, whereas a suprasellar meningioma was partially removed because of its close relationship with surrounding neurovascular structures. Only 1 patient, with a large olfactory groove meningioma and in poor preoperative condition, died after surgery because of extraneurological complications; in the other cases the postoperative course was uneventful showing satisfactory outcome, even if there were, in some cases, concomitant associated medical diseases. There was no tumor recurrence in survivors with at least 2 years' follow-up.

Conclusion: Meningiomas represent an important neurosurgical problem in the elderly, since surgery carries certain risks; according to some authors, patients with basal meningeal tumors had the worst outcome. Several reports have been published on elderly patients who underwent surgery for intracranial meningiomas, but, to our knowledge, there is no study assessing specifically postoperative outcome in patients in this age group (eighth decade of life) who received surgery for skull base meningiomas. Therefore, it is difficult to compare our results with those obtained by others; nevertheless, we think, based on our experience, that even very elderly patients can be operated on successfully, with good neurological outcome. We believe that today, with advances in neurosurgical techniques and in neuroradiological imaging and modern neuroanesthesia, age alone is not a contraindication to surgical removal of symptomatic basal meningiomas.