Meningiomas in the elderly

Mentalizing can be Impaired in Patients with Meningiomas Originating in the Anterior Skull Base

OBJECTIVE

Mentalizing is an essential function of our social lives. Impairment of mentalizing due to meningiomas has not received attention because most patients return to their social lives after surgical treatment. We investigated the influence of meningiomas and their surgical resection on mentalizing.

METHODS

Low- and high-level mentalizing were retrospectively examined in 61 patients with meningiomas and 14 healthy volunteers. Mentalizing was assessed using the facial expression recognition test and picture arrangement test of the Wechsler Adult Intelligence Scale, third edition, before and after surgery. We examined the influence of tumor localization on mentalizing and recovery from mentalizing disorders after tumor resection. Voxel-based lesion-symptom mapping was performed to investigate the relationship between impairments in mentalizing and tumor location.

RESULTS

Before surgery, mentalizing was impaired significantly in patients with meningiomas compared to those in the control group (low-level: P = 0.015, high-level: P = 0.011). This impairment was associated with contact between the tumor and frontal lobe (low-level: P = 0.036, high-level: P = 0.047) and was severe in patients with tumors arising in the anterior skull base (low-level: P = 0.0045, high-level: P = 0.043). Voxel-based lesion-symptom mapping revealed that when the basal cortex of the frontal lobe was compressed by the tumor, the risk of impaired mentalizing was high. The region responsible for high-level mentalizing was located deeper than that responsible for low-level mentalizing. After the surgical removal of the tumor, the test scores significantly improved (low-level: P = 0.035, high-level: P = 0.045).

CONCLUSIONS

Mentalizing was impaired by meningiomas arising from the anterior skull base, but it can improve after surgical resection of the tumors.

Intracranial Meningioma in Elderly Patients. Retrospective Multicentric Risk and Surgical Factors Study of Morbidity and Mortality

With the increasing life expectancy, a large number of intracranial meningiomas (IM) have been identified in elderly patients. There is no general consensus regarding the management for IMs nor studies regarding the outcome of older patients undergoing meningioma surgery. We aimed to determine whether preoperative variables and postoperative clinical outcomes differ between age groups after meningioma surgery. We analyzed data from all patients who had undergone IM surgery from our departments. The final cohort consisted of 340 patients affected by IM with ASA class I-II: 188 in the young group (<65) and 152 in the elderly. The two subgroups did not present significant differences concerning biological characteristics of tumor, localization, diameters, lesion and edema volumes and surgical radicality. Despite these comparable data, elderly presented with a significantly lower Karnofsky Performance status value on admission and remained consistently lower during the follow-up. We establish instead that there is no intrinsic correlation to the presence of IM and no significant increased risk of complications or recurrence in elderly patients, but rather only an increased risk of reduced performance status with mortality related to the comorbidity of the patient, primarily cardiovascular disease, and an intrinsic frailty of the aged population.