Meningioma surgery in younger and older adults: patient profile and surgical outcomes

Background: Due to increasing life expectancy, the number of older patients harboring a meningioma is expected to increase. We determined whether preoperative variables and postoperative clinical outcome differ between younger and older adults.

Methods: Medical records of meningioma patients were retrospectively analyzed. Preoperative variables were age, gender, neurological symptoms, Karnofsky Performance Status (KPS), American Society of Anesthesiologists Physical Status (ASA)-classification and tumor characteristics. Clinical outcome was assessed using complication rates, length of hospital stay and destination after discharge. After 6-12 and 12-18-month KPS, neurological symptoms and Glasgow Outcome Scale (GOS) scores were assessed for older (age ≥ 65 years) and younger adults (18-65 years) using Mann-Whitney U, T test, Pearson's Chi square or Fisher's exact.

Results: 89 patients were included (23 ≥ 65 years). Before surgery, older patients scored higher on ASA classification (p = 0.003) and lower on KPS (p = 0.017). There was no significant difference postoperatively in mortality, complications and duration of hospital stay. Less older patients were discharged directly to home compared to younger adults (52 vs 80%, respectively; p = 0.004). In surviving patients, less older subjects had a good recovery (GOS 4-5) at 6-12 months' follow-up compared to younger subjects (64 vs 93%, respectively; p = 0.035). At 12-18 months, there was no significant difference in good recovery between both age groups (82 vs 92%).

Conclusion: In this cohort, outcome was worse for patients ≥ 65 years old in terms of discharge destination and good recovery at 6-12 months. At 12-18 months follow-up, older subjects performed not significantly different from younger ones. Careful patient selection seems essential to reach good results in meningioma surgery for patients ≥ 65 years old.