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Schwartz C, Ueberschaer MF, Rautalin I, Grauvogel J, Bissolo M, Masalha W, Steiert C, Schnell O, Beck J, Ebel F, Bervini D, Raabe A, Eibl T, Steiner HH, Schebesch KM, Shlobin NA, Nandoliya KR, Youngblood MW, Chandler JP, Magill ST, Romagna A, Lehmberg J, Fuetsch M, Spears J, Rezai A, Ladisich B, Demetz M, Griessenauer CJ, Niemelä M, Korja M. Frailty indices predict mortality, complications and functional improvements in supratentorial meningioma patients over 80 years of age. J Neurooncol 2024; 170:89-100. [PMID: 39230803 PMCID: PMC11447097 DOI: 10.1007/s11060-024-04780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/11/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE To assess whether the Modified 5 (mFI-5) and 11 (mFI-11) Factor Frailty Indices associate with postoperative mortality, complications, and functional benefit in supratentorial meningioma patients aged over 80 years. METHODS Baseline characteristics were collected from eight centers. Based on the patients' preoperative status and comorbidities, frailty was assessed by the mFI-5 and mFI-11. The collected scores were categorized as "robust (mFI=0)", "pre-frail (mFI=1)", "frail (mFI=2)", and "significantly frail (mFI≥3)". Outcome was assessed by the Karnofsky Performance Scale (KPS); functional benefit was defined as improved KPS score. Additionally, we evaluated the patients' functional independence (KPS≥70) after surgery. RESULTS The study population consisted of 262 patients (median age 83 years) with a median preoperative KPS of 70 (range 20 to 100). The 90-day and 1-year mortality were 9.0% and 13.2%; we recorded surgery-associated complications in 111 (42.4%) patients. At last follow-up within the postoperative first year, 101 (38.5%) patients showed an improved KPS, and 183 (69.8%) either gained or maintained functional independence. "Severely frail" patients were at an increased risk of death at 90 days (OR 16.3 (CI95% 1.7-158.7)) and one year (OR 11.7 (CI95% 1.9-71.7)); nine (42.9%) of severely frail patients died within the first year after surgery. The "severely frail" cohort had increased odds of suffering from surgery-associated complications (OR 3.9 (CI 95%) 1.3-11.3)), but also had a high chance for postoperative functional improvements by KPS≥20 (OR 6.6 (CI95% 1.2-36.2)). CONCLUSION The mFI-5 and mFI-11 associate with postoperative mortality, complications, and functional benefit. Even though "severely frail" patients had the highest risk morbidity and mortality, they had the highest chance for functional improvement.
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Affiliation(s)
- Christoph Schwartz
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Ignaz-Harrer-Str. 79, 5020 , Salzburg, Austria.
| | - Moritz F Ueberschaer
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Ilari Rautalin
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- The National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Jürgen Grauvogel
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Marco Bissolo
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Waseem Masalha
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
- Department of Neurosurgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christine Steiert
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
- Department of Neurosurgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Florian Ebel
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern, Switzerland
- Department of Neurosurgery, University of Basel, Basel, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern, Switzerland
| | - Thomas Eibl
- Department of Neurosurgery, Paracelsus Medical University, Klinikum Nuremberg, Nuremberg, Germany
| | - Hans-Herbert Steiner
- Department of Neurosurgery, Paracelsus Medical University, Klinikum Nuremberg, Nuremberg, Germany
| | - Karl-Michael Schebesch
- Department of Neurosurgery, Paracelsus Medical University, Klinikum Nuremberg, Nuremberg, Germany
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University, Chicago, IL, 60601, USA
- Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 2210, Chicago, IL, 60601, USA
| | - Khizar R Nandoliya
- Department of Neurological Surgery, Northwestern University, Chicago, IL, 60601, USA
- Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 2210, Chicago, IL, 60601, USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago, IL, 60601, USA
| | - James P Chandler
- Department of Neurological Surgery, Northwestern University, Chicago, IL, 60601, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL, 60601, USA
| | - Alexander Romagna
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany
| | - Jens Lehmberg
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany
| | - Manuel Fuetsch
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
- Department of Spine and Scoliosis Surgery, Artemed Surgical Clinic Munich South, Munich, Germany
| | - Julian Spears
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Arwin Rezai
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Barbara Ladisich
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Neurosurgery, University Hospital St. Pölten, St. Pölten, Austria
| | - Matthias Demetz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Miikka Korja
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Santiago RACB, Ali A, Ibrahim B, Mandel M, Muhsen BA, Obrzut M, Ranjan S, Borghei-Razavi H, Adada B. Safety of craniotomy for brain tumor resection in octogenarians and older patients - a matched - cohort analysis. Int J Neurosci 2024; 134:958-964. [PMID: 36724879 DOI: 10.1080/00207454.2023.2174866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The incidence of brain tumors has increased in elderly population overtime. Their eligibility to a major surgery remains a questionable subject. This study evaluated prognostic factors and 30-days morbidity and mortality in octogenarian population who underwent craniotomy for resection of brain tumor. MATERIALS AND METHODS A total of 154 patients were divided into two different groups: patients above 80 years old and patients below 65 years old. In both groups, patients were stratified based on diagnosis with benign tumors [meningioma] and malignant tumors [high-grade gliomas and metastases]. Multivariable logistic regression model with backward elimination method was utilized to identify the independent risk factors for 30-days readmission and post-operative complications. RESULTS The analysis revealed no significant difference in 30-day readmission (p = 0.7329), 30-day mortality (0.6854) or in post-operative complication (p = 0.3291) between age ≥ 80 and age ≤ 65 groups. A longer length of stay (LOS) was observed in the older patients (p = 0.0479). There was a significant difference in the pre-post KPS between the two groups (p < 0.0001). ASA (p = 0.0315) and KPS (p = 0.071) were found as important prognostic factors associated with post-operative mortality in both groups. CONCLUSION Octogenarians can withstand craniotomy without any significant increase in 30-day readmission, 30-day mortality and post-operative complications as compared to patients younger than age 65. The ASA score (>3) and/or KPS (<70) were the most important prognostic factors for 30-days readmission and mortality.
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Affiliation(s)
| | - Assad Ali
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Bilal Ibrahim
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Mauricio Mandel
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | | | - Michal Obrzut
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Surabhi Ranjan
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | | | - Badih Adada
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
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El-Hajj VG, Singh A, Fletcher-Sandersjöö A, Buwaider A, Gharios M, Habashy KJ, Blixt S, Stenimahitis V, Nilsson G, Gerdhem P, Edström E, Elmi-Terander A. Long-term outcomes after surgery for subaxial cervical spine injuries in octogenarians, a matched population-based cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3099-3108. [PMID: 38773018 DOI: 10.1007/s00586-024-08312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 04/17/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE We aimed to investigate surgical outcomes in octogenarians with subaxial cervical spine injuries and determine the predictors of complications and mortality. METHODS Eligible for inclusion were all patients surgically treated between 2006 and 2018, with either anterior or posterior fixation for subaxial spine injuries. A cohort of octogenarians was identified and matched 1:1 to a corresponding cohort of younger adults. Primary outcomes were perioperative complications and mortality. RESULTS Fifty-four patients were included in each of the octogenarian and younger groups (median age: 84.0 vs. 38.5). While the risks for surgical complications, including dural tears and wound infections, were similar between groups, the risks of postoperative medical complications, including respiratory or urinary tract infections, were significantly higher among the elderly (p < 0.05). Additionally, there were no differences in operative time (p = 0.625) or estimated blood loss (p = 0.403) between groups. The 30 and 90-day mortality rates were significantly higher among the elderly (p = 0.004 and p < 0.001). These differences were due to comorbidities in the octogenarian cohort as they were revoked when propensity score matching was performed to account for the differences in American Society of Anesthesiology (ASA) grade. Multivariable logistic regression revealed age and ASA score to be independent predictors of complications and the 90-day mortality, respectively. CONCLUSIONS Octogenarians with comorbidities were more susceptible to postoperative complications, explaining the increased short-term mortality in this group. However, octogenarians without comorbidities had similar outcomes compared to the younger patients, indicating that overall health, including comorbidities, rather than chronological age should be considered in surgical decision-making.
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Affiliation(s)
| | - Aman Singh
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Box 2074, 194 02, Upplands-Vasby, Stockholm, Sweden
| | | | - Ali Buwaider
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Gharios
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Karl J Habashy
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Simon Blixt
- Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | | | - Gunnar Nilsson
- Capio Spine Center Stockholm, Löwenströmska Hospital, Box 2074, 194 02, Upplands-Vasby, Stockholm, Sweden
| | - Paul Gerdhem
- Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Orthopedics and Hand Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Box 2074, 194 02, Upplands-Vasby, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Capio Spine Center Stockholm, Löwenströmska Hospital, Box 2074, 194 02, Upplands-Vasby, Stockholm, Sweden.
- Department of Orthopedics and Hand Surgery, Uppsala University Hospital, Uppsala, Sweden.
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Karabacak M, Lampros M, Mavridis O, Jagtiani P, Feng R, Shrivastava R, Margetis K. Atypical and anaplastic meningiomas in the later decades of life: A national cancer database analysis. Acta Neurochir (Wien) 2024; 166:282. [PMID: 38967664 DOI: 10.1007/s00701-024-06157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE We conducted a National Cancer Database (NCDB) study to investigate the epidemiological characteristics and identify predictors of outcomes associated with geriatric meningiomas. METHODS The NCDB was queried for adults aged 60-89 years diagnosed between 2010 and 2017 with grade 2 and 3 meningiomas. The patients were classified into three age groups based on their age: 60-69 (hexagenarians), 70-79 (septuagenarians), and 80-89 (octogenarians). The log-rank test was utilized to compare the differences in overall survival (OS). Univariate and multivariate Cox proportional hazards regressions were used to evaluate the mortality risk associated with various patient and disease parameters. RESULTS A total of 6585 patients were identified. Hexagenerians were the most common age group (49.8%), with the majority of meningiomas being classified as grade 2 (89.5%). The incidence of high-grade meningiomas increased in all age groups during the study period. Advanced age, male sex, black race, lower socioeconomic status, Charlson-Deyo score ≥ 2, and higher tumor grade were independent factors of poor survival. Among the modes of treatment, the extent of surgical resection, adjuvant radiotherapy, and treatment at a noncommunity cancer program were linked with better outcomes. CONCLUSION In geriatric patients with high-grade meningiomas, the greater extent of surgical resection and radiotherapy are associated with improved survival. However, the management and outcome of geriatric patients with higher-grade meningiomas are also associated with several socioeconomic factors.
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Affiliation(s)
- Mert Karabacak
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, USA
| | - Marios Lampros
- Department of Neurosurgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Olga Mavridis
- Dietrich College of Humanities and Social Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Pemla Jagtiani
- School of Medicine, SUNY Downstate Health Sciences University, New York, NY, USA
| | - Rui Feng
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, USA
| | - Raj Shrivastava
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, USA
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5
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Schwartz C, Rautalin I, Grauvogel J, Bissolo M, Masalha W, Steiert C, Schnell O, Beck J, Ebel F, Bervini D, Raabe A, Eibl T, Steiner HH, Shlobin NA, Nandoliya KR, Youngblood MW, Chandler JP, Magill ST, Romagna A, Lehmberg J, Fuetsch M, Spears J, Rezai A, Ladisich B, Demetz M, Griessenauer CJ, Niemelä M, Korja M. Surgical Outcome of Patients With Supratentorial Meningiomas Aged 80 Years or Older-Retrospective International Multicenter Study. Neurosurgery 2024; 94:399-412. [PMID: 37847034 DOI: 10.1227/neu.0000000000002673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/13/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Demographic changes will lead to an increase in old patients, a population with significant risk of postoperative morbidity and mortality, requiring neurosurgery for meningiomas. This multicenter study aims to report neurofunctional status after resection of patients with supratentorial meningioma aged 80 years or older, to identify factors associated with outcome, and to validate a previously proposed decision support tool. METHODS Neurofunctional status was assessed by the Karnofsky Performance Scale (KPS). Patients were categorized in poor (KPS ≤40), intermediate (KPS 50-70), and good (KPS ≥80) preoperative subgroups. Volumetric analyses of tumor and peritumoral brain edema (PTBE) were performed; volumes were scored as small (<10 cm 3 ), medium (10-50 cm 3 ), and large (>50 cm 3 ). RESULTS The study population consisted of 262 patients, and the median age at surgery was 83.0 years. The median preoperative KPS was 70; 117 (44.7%) patients were allotted to the good, 113 (43.1%) to the intermediate, and 32 (12.2%) to the poor subgroup. The median tumor and PTBE volumes were 30.2 cm 3 and 27.3 cm 3 ; large PTBE volume correlated with poor preoperative KPS status ( P = .008). The 90-day and 1-year mortality rates were 9.0% and 13.2%, respectively. Within the first postoperative year, 101 (38.5%) patients improved, 87 (33.2%) were unchanged, and 74 (28.2%) were functionally worse (including deaths). Each year increase of age associated with 44% (23%-70%) increased risk of 90-day and 1-year mortality. In total, 111 (42.4%) patients suffered from surgery-associated complications. Maximum tumor diameter ≥5 cm (odds ratio 1.87 [1.12-3.13]) and large tumor volume (odds ratio 2.35 [1.01-5.50]) associated with increased risk of complications. Among patients with poor preoperative status and large PTBE, most (58.3%) benefited from surgery. CONCLUSION Patients with poor preoperative neurofunctional status and large PTBE most often showed postoperative improvements. The decision support tool may be of help in identifying cases that most likely benefit from surgery.
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Affiliation(s)
- Christoph Schwartz
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
- Current Affiliations: Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
| | - Ilari Rautalin
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
- The National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland , New Zealand
| | - Jürgen Grauvogel
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Marco Bissolo
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Waseem Masalha
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Christine Steiert
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg , Germany
| | - Florian Ebel
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland
- Department of Neurosurgery, University of Basel, Basel , Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern , Switzerland
| | - Thomas Eibl
- Department of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg , Germany
| | - Hans-Herbert Steiner
- Department of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg , Germany
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
- Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA
| | - Khizar R Nandoliya
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
- Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - James P Chandler
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - Alexander Romagna
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
- Department of Neurosurgery, München Klinik Bogenhausen, Munich , Germany
| | - Jens Lehmberg
- Department of Neurosurgery, München Klinik Bogenhausen, Munich , Germany
| | - Manuel Fuetsch
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , ON , Canada
- Department of Spine and Scoliosis Surgery, Artemed Klinikum München Süd, Munich , Germany
| | - Julian Spears
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , ON , Canada
| | - Arwin Rezai
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
| | - Barbara Ladisich
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
- Department of Neurosurgery, University Hospital St. Pölten, St. Pölten , Austria
| | - Matthias Demetz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck , Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg , Austria
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
| | - Miikka Korja
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki , Finland
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Yang S, Teng H, Wang Y, Ji K, Chen W, Zhou H. Risk factors on surgical compliance and its impact on survival outcomes in meningioma patients: a SEER-based retrospective propensity-score matched analysis. BMC Surg 2024; 24:39. [PMID: 38291417 PMCID: PMC10826196 DOI: 10.1186/s12893-024-02326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND This study aimed to analyze the effect of surgical compliance on the survival outcome of patients with meningioma and explore the factors affecting surgical compliance. METHODS We selected data from the Surveillance, Epidemiology, and End Results database for 122,632 meningioma patients diagnosed between 2004 and 2018. The effect of surgical compliance on patients' overall survival (OS) was analyzed through Cox regression and Kaplan-Meier curves. Independent risk factors for surgical compliance were identified through multifactorial logistic regression analyses to construct diagnostic nomograms, further assessed by receiver operating characteristic curves. Furthermore, we used univariate and multivariate logistic regression analyses to evaluate relevant variables linked to adherence with meningioma surgery. Moreover, 1:1 propensity score matching was applied to assess the validity of the results in patients with favorable and poor surgical compliance. RESULTS A total of 48,735 were eligible from the initial cohort of 122,632 patients with meningioma. Among them, 45,038 (92.40%) exhibited good surgical compliance, while 3697 (7.60%) had poor surgical compliance. The rate of patients with good surgical compliance was significantly higher than that of patients with inadequate surgical compliance (p < 0.001). Moreover, surgical compliance is an independent prognostic factor for OS in meningioma patients. Univariate Cox regression analysis indicated that individuals with poor surgical compliance demonstrated lower OS rates than those with good surgical compliance (hazard ratio [HR 2.404; 95% confidence interval [CI] 2.276-2.54, p < 0.001], consistent with the observation in the multivariate analysis (HR 1.564; 95% CI 1.471-1.663, p < 0.001). We developed a prediction model using seven variables: age, sex, race, tumor behavior recode, tumor size, family income, and residential setting (p < 0.05). Surgical compliance was associated with patient age, sex, race, tumor behavior recode, tumor size, family income, and residential setting by logistic regression analysis. CONCLUSIONS Surgical compliance emerged as an independent prognostic factor for survival in patients with meningioma. Poor surgical compliance was associated with older age, black and other races, females, advanced-stage tumors, larger tumor size, lower household income, and rural residence. When patients experienced these conditions, OS was shorter, requiring more aggressive treatment.
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Affiliation(s)
- Shengkai Yang
- Department of Neurosurgery, Binhai County People's Hospital, Yancheng, China
| | - Hongwei Teng
- Department of Neurosurgery, Binhai County People's Hospital, Yancheng, China
| | - Yingdan Wang
- Department of Pediatric, Binhai County People's Hospital, Yancheng, China
| | - Kangkang Ji
- Department of Central Laboratory, Binhai County People's Hospital, Yancheng, China
| | - Weihua Chen
- Department of Neurosurgery, Binhai County People's Hospital, Yancheng, China.
| | - Hai Zhou
- Department of Neurosurgery, Binhai County People's Hospital, Yancheng, China.
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Filippidis AS, Phillips KR, Lopez-Rivera V, Enriquez-Marulanda A, Mackel CE, Alterman RL, Vega RA. Surgery in octogenarians with intracranial meningiomas improves functional outcome at 1 year. Acta Neurochir (Wien) 2023; 165:4183-4189. [PMID: 37831227 DOI: 10.1007/s00701-023-05827-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE The population is aging, and age remains an important factor in deciding surgical candidacy for intracranial tumors. The natural history and surgical behavior of meningiomas in octogenarians are not well understood. We evaluated the surgical and functional outcomes, including survival, among octogenarians with intracranial meningiomas in a single institution. METHODS The Tumor Registry (2004-2021) was used to identify octogenarian patients (ages 80-89) diagnosed with intracranial meningioma. Primary endpoints were 1-year survival and functional outcome measured with mRS postsurgery. Kaplan-Meier, univariable Log-rank tests, and multivariable Cox hazards proportional regression models were used for assessing factors associated with overall survival (OS) in octogenarians with meningiomas who underwent surgery; logistic regression and McNemar's were used to further characterize risk factors affecting functional surgical outcome at 1 year. RESULTS Thirty octogenarians with intracranial meningioma who underwent surgery were identified. Median age was 82.5 years and 66.6% were female patients. The 1-year median postsurgical survival probability for all octogenarians with meningioma was 86.3% and no intraoperative mortality was observed. Frailty (mFI-5, p = 0.84), tumor grade (p = 0.11), tumor size (p = 0.22), extent of resection (p = 0.35), and Karnofsky scale on admission (p = 0.93) did not significantly affect the survival in octogenarians with meningiomas which were treated surgically. The 1-year postoperative functional status of octogenarian meningioma patients who underwent surgery was significantly improved compared to pre-op mRS (McNemar's chi-squared = 9.6, df = 1, p-value = 0.001946). CONCLUSION In octogenarians with meningiomas, surgical intervention significantly improves the pre-operative modified Rankin Scale at 1 year postsurgery in this cohort.
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Affiliation(s)
- Aristotelis S Filippidis
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Katharine R Phillips
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Charles E Mackel
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ron L Alterman
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rafael A Vega
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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8
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Maiuri F, Corvino S, Lorenzetti M, Franca RA, Esposito F, Del Basso De Caro M. Intracranial Meningiomas in Patients Aged ≥80 Years: Pathological Features and Surgical Problems. World Neurosurg 2023; 173:e498-e508. [PMID: 36841531 DOI: 10.1016/j.wneu.2023.02.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Patients aged >80 years frequently have intracranial meningiomas. In the present study, we have discussed the pathological features, comorbidities, and surgical complications for this age group from a surgical series and literature review. METHODS In the present study, we reviewed a surgical series of 354 intracranial meningiomas and compared the oldest age group (age, ≥80 years) of 17 patients with 73 patients aged 70-79 years and 264 patients aged <70 years. From a literature review, we selected 10 studies of meningiomas in patients aged ≥80 years. The analyzed factors included sex, meningioma location, World Health Organization grade, Ki-67 MIB1, progesterone receptor expression, comorbidities, American Society of Anesthesiologists class, Karnofsky performance scale score, postoperative complications, and death. RESULTS Patients aged ≥80 years had had higher rates of World Health Organization grade II meningioma, higher rates of Ki-67 expression of >4% and <20%, and progesterone receptor expression <15%. Of the postoperative complications, only neurological deficits and acute bronchopneumonia were significantly more frequent in patients aged ≥80 years. The incidence of intracerebral hematoma, lung embolism, acute heart ischemia, and death were not significantly different between the patients aged ≥80 years and those aged 70-79 years and <70 years. CONCLUSIONS Patients aged ≥80 years must be considered a true elderly group with higher rates of comorbidities. The very old age is not a limitation to surgery; however, careful patient selection is necessary. In addition, for the oldest age group, the surgical decision should not be delayed because of advancing age.
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Affiliation(s)
- Francesco Maiuri
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy.
| | - Sergio Corvino
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy
| | - Marco Lorenzetti
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy
| | - Raduan Ahmed Franca
- Department of Advanced Biomorphological Sciences, Section of Pathology, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Felice Esposito
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomorphological Sciences, Section of Pathology, School of Medicine, University of Naples "Federico II", Naples, Italy
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9
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Dullea JT, Chaluts D, Vasan V, Rutland JW, Gill CM, Ellis E, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Umphlett M, Shrivastava RK. NF2 mutation associated with accelerated time to recurrence for older patients with atypical meningiomas. Br J Neurosurg 2023:1-7. [PMID: 37096420 PMCID: PMC10598238 DOI: 10.1080/02688697.2023.2204927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 02/01/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Meningiomas occur more frequently in older adults, with the incidence rates increasing from 5.8/100,000 for adults 35-44 years old to 55.2/100,000 for those 85+. Due to the increased risk of surgical management in older adults, there is a need to characterize the risk factors for aggressive disease course to inform management decisions in this population. We therefore sought to determine age-stratified relationships between tumour genomics and recurrence after resection of atypical meningiomas. METHODS We identified 137 primary and recurrent Grade 2 meningiomas from our existing meningioma genomic sequencing database. We examined the differential distribution of genomic alterations in those older than 65 compared to younger. We then performed an age stratified survival analysis to model recurrence for a mutation identified as differentially present. RESULTS In our cohort of 137 patients with grade 2 meningiomas, alterations in NF2 were present at a higher rate in older adults compared to younger (37.8% in < 65 vs. 55.3% in > 65; recurrence adjusted p-value =0.04). There was no association between the presence of NF2 and recurrence in the whole cohort. In the age-stratified model for those less than 65 years old, there was again no relationship. For patients in the older age stratum, there is a relationship between NF2 and worsened recurrence outcomes (HR = 3.64 (1.125 - 11.811); p = 0.031). CONCLUSIONS We found that mutations in NF2 were more common in older adults. Further, the presence of mutant NF2 was associated with an increased risk of recurrence in older adults.
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Affiliation(s)
- Jonathan T. Dullea
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Danielle Chaluts
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - John W. Rutland
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Corey M. Gill
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Ethan Ellis
- Department of Genetics and Genomic Sciences, Icahn School
of Medicine at Mount Sinai, New York, NY
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Russell B. McBride
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
- The Institute for Translational Epidemiology, Icahn School
of Medicine at Mount Sinai, New York, NY
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School
of Medicine at Mount Sinai, New York, NY
- Sema4, A Mount Sinai venture, Stamford, CT
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Raj K. Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
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10
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Phillips KR, Filippidis A, Mackel CE, Enriquez-Marulanda A, Vega RA. Octogenarian Brain Tumor Registry: Single-Institution Surgical Outcomes and Mortality Study. Brain Tumor Res Treat 2023; 11:114-122. [PMID: 37151153 PMCID: PMC10172014 DOI: 10.14791/btrt.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Surgical intervention for brain tumor patients aged 80 to 89 years is controversial, as the comorbidities and physiology associated with aging are often thought to increase surgical risks. Surgical outcomes, however, are not well characterized for octogenarians. This review therefore assessed the outcomes and mortality risk associated with tumor removal in octogenarians at our academic institution. METHODS Retrospective review of patients aged 80 to 89 who underwent craniotomy for tumor resection (CTR) at our institution between 2004-2021 and who were diagnosed with meningioma, glioblastoma, or metastatic disease. Primary outcome was 30-day mortality. RESULTS Sixty-one CTRs were included in analysis. Median age was 83 (interquartile range 81-85) years, and the most common preoperative comorbidity was hypertension (n=44). Most patients (n=35) had a preoperative modified Rankin Scale (mRS) score between 0-2. Seventeen (27.9%) patients experienced postoperative complications (i.e., urinary tract infection, deep venous thrombosis, etc.), and 26.2% (n=16) experienced new-onset neurologic deficits postoperatively (i.e., aphasia, motor deficits, etc.). Upon discharge, most patients (n=43) had an mRS score of 3-4. Within 30 days of surgery, 14.8% (n=9) of patients were readmitted to the hospital and 8.2% (n=5) of patients died: 2 with meningioma, 1 with glioblastoma, and 2 with metastatic disease. The most common cause of death was intracranial hemorrhage (n=3). Three-month mortality was 23.0% (n=14). Mean survival after surgery was 33 months for meningioma patients, 6.9 months for glioblastoma patients, and 15 months for patients with metastatic lesions. CONCLUSION Our review found a 30-day mortality rate of 8.2% across all tumor types, and mean survival was similar to that previously reported for patients across all age groups. Surgical intervention for octogenarian tumor patients is therefore feasible, safe, and likely worthwhile for extending and improving lives.
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Affiliation(s)
- Katharine R Phillips
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aristotelis Filippidis
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Charles E Mackel
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Rafael A Vega
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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11
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Jimenez AE, Mukherjee D. High-Value Care Outcomes of Meningiomas. Neurosurg Clin N Am 2023; 34:493-504. [DOI: 10.1016/j.nec.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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12
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Cao J, Yan W, Li G, Zhan Z, Hong X, Yan H. Incidence and Survival of Benign, Borderline, and Malignant Meningioma Patients in the United States from 2004 to 2018. Int J Cancer 2022; 151:1874-1888. [PMID: 35779059 DOI: 10.1002/ijc.34198] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/06/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022]
Abstract
Meningioma is the most common primary central nervous system tumor, and its incidence is increasing. A systematic epidemiological and clinical analysis is required to better estimate its public health impact and understand its prognostic factors. Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2018 for all types of meningiomas without an age restriction. Age-adjusted incidence rates (IRs) and 95% confidence intervals were estimated according to sex, age, race, ethnicity, and tumor location. Kaplan-Meier analysis and multivariate Cox proportional hazard models were used to analyze the overall survival (OS). The competing risk regression model of Fine-Gray was used to analyze cause-specific survival. Data from a total of 109,660 meningioma patients were analyzed. A majority of patients were older than 60 years, and only 0.41% of patients were 0-19 years. The meningioma IRs were higher in females, Black, and non-Hispanic patients than in males, White, and Hispanic patients, respectively, and IRs increased with age. The ratio of IRs for females to males was 2.1 and also increased with age, peaking at 3.6 in the 45-49-year-old group. Older and male patients with all types of meningiomas, Black patients with benign and borderline meningiomas, and patients with larger borderline and malignant meningiomas showed poorer prognosis. For all meningioma types, surgical resection improved survival. The reported incidence rates and survival trends covered all demographics and subtypes of meningiomas. Older age, male sex, Black race, and tumor size may be important prognostic factors for meningioma cases, and tumor resection can substantially improve survival among meningioma patients.
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Affiliation(s)
- Junguo Cao
- Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Northwest University Affiliated People's Hospital, Xi'an, Shaanxi Province, China.,Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Weijia Yan
- Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Northwest University Affiliated People's Hospital, Xi'an, Shaanxi Province, China.,Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Guihong Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhixin Zhan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Xinyu Hong
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Hong Yan
- Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Northwest University Affiliated People's Hospital, Xi'an, Shaanxi Province, China
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13
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Feng S, Li J, Fan F, Wang Z, Zhang Q, Zhang H, Dai Z, Zhang X, Luo P, Liu Z, Zhang J, Liu Z, Cheng Q. Prognostic Factors and Treatment Strategies for Elderly Patients with Malignant Meningioma: A SEER Population-Based Study. Front Oncol 2022; 12:913254. [PMID: 35646660 PMCID: PMC9136104 DOI: 10.3389/fonc.2022.913254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Malignant meningioma (MM) is a relatively rare disease with poor survival. Few studies had focused on MM in the elderly population. This study aims to explore the prognostic factors and optimal therapeutic strategy in elderly patients with MM. Methods We took advantage of the Surveillance, Epidemiology, and End Results (SEER) database to include 275 adult patients with histologically confirmed MM between 2011 and 2018. The Kaplan–Meier curves were plotted by different covariates to reveal the survival probability. Univariate and multivariable Cox proportional hazard regression analyses were applied to identify prognostic factors for cancer-specific survival (CSS). Results The multivariable analysis in the elderly group revealed that when compared with patients receiving gross total resection (GTR), patients receiving biopsy had significantly worse CSS (HR = 3.72; 95% CI: 1.35–10.21; P = 0.011), whereas patients receiving subtotal resection (STR) had nearly the same CSS (HR = 0.83; 95% CI: 0.37–1.86; P = 0.653). Meanwhile, postoperative radiotherapy (PORT) showed no significant association with CSS in the elderly patient group (HR = 0.94; 95% CI: 0.42–2.12; P = 0.888). Conclusion Surgical resection is recommended for elderly patients with MM in the absence of surgical contraindications, but GTR does not present survival benefit in the elderly patients compared with STR. Additional large-scale clinical studies are needed to explore the survival benefit of PORT applied in patients with MM.
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Affiliation(s)
- Songshan Feng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Molecular Radiation Oncology Hunan Province, Changsha, China
| | - Jing Li
- Department of Rehabilitation, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Fan Fan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zeyu Wang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Zhang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Hao Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ziyu Dai
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xun Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zaoqu Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhuoyi Liu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Quan Cheng, ; Zhuoyi Liu,
| | - Quan Cheng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Quan Cheng, ; Zhuoyi Liu,
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14
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Spadola M, Farooqi AS, Borja AJ, Dimentberg R, Blue R, Shultz K, McClintock SD, Malhotra NR. Socioeconomic Status Predicts Short-Term Emergency Department Utilization Following Supratentorial Meningioma Resection. Cureus 2022; 14:e24508. [PMID: 35651388 PMCID: PMC9135464 DOI: 10.7759/cureus.24508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction By identifying drivers of healthcare disparities, providers can better support high-risk patients and develop risk-mitigation strategies. Household income is a social determinant of health known to contribute to healthcare disparities. The present study evaluates the impact of household income on short-term morbidity and mortality following supratentorial meningioma resection. Methods A total of 349 consecutive patients undergoing supratentorial meningioma resection over a six-year period (2013-2019) were analyzed retrospectively. Primary outcomes were unplanned hospital readmission, reoperations, emergency department (ED) visits, return to the operating room, and all-cause mortality within 30 days of the index operation. Standardized univariate regression was performed across the entire sample to assess the impact of household income on outcomes. Subsequently, outcomes were compared between the lowest (household income ≤ $51,780) and highest (household income ≥ $87,958) income quartiles. Finally, stepwise regression was executed to identify potential confounding variables. Results Across all supratentorial meningioma resection patients, lower household income was correlated with a significantly increased rate of 30-day ED visits (p = 0.002). Comparing the lowest and highest income quartiles, the lowest quartile was similarly observed to have a significantly higher rate of 30-day ED evaluation (p = 0.033). Stepwise regression revealed that the observed association between household income and 30-day ED visits was not affected by confounding variables. Conclusion This study suggests that household income plays a role in short-term ED evaluation following supratentorial meningioma resection.
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Affiliation(s)
- Michael Spadola
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Ali S Farooqi
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Austin J Borja
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Ryan Dimentberg
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Rachel Blue
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Kaitlyn Shultz
- Department of Mathematics, West Chester University, West Chester, USA
| | | | - Neil R Malhotra
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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15
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Löfgren D, Valachis A, Olivecrona M. Older meningioma patients: a retrospective population-based study of risk factors for morbidity and mortality after neurosurgery. Acta Neurochir (Wien) 2022; 164:2987-2997. [PMID: 35978200 PMCID: PMC9613739 DOI: 10.1007/s00701-022-05336-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Meningioma is the most common primary CNS tumour. Most meningiomas are benign, and most patients are 65 years or older. Surgery is usually the primary treatment option. Most prior studies on early surgical outcomes in older patients with meningioma are small, and there is a lack of larger population-based studies to guide clinical decision-making. We aimed to explore the risks for perioperative mortality and morbidity in older patients with meningioma and to investigate changes in surgical incidence over time. METHODS In this retrospective population-based study on patients in Sweden, 65 years or older with surgery 1999-2017 for meningioma, we used data from the Swedish Brain Tumour Registry. We analysed factors contributing to perioperative mortality and morbidity and used official demographic data to calculate yearly incidence of surgical procedures for meningioma. RESULTS The final study cohort included 1676 patients with a 3.1% perioperative mortality and a 37.6% perioperative morbidity. In multivariate analysis, higher age showed a statistically significant association with higher perioperative mortality, whereas larger tumour size and having preoperative symptoms were associated with higher perioperative morbidity. A numerical increased rate of surgical interventions after 2012 was observed, without evidence of worsening short-term surgical outcomes. CONCLUSIONS Higher mortality with increased age and higher morbidity risk in larger and/or symptomatic tumours imply a possible benefit from considering surgery in selected older patients with a growing meningioma before the development of tumour-related symptoms. This study further underlines the need for a standardized method of reporting and classifying complications from neurosurgery.
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Affiliation(s)
- David Löfgren
- Department of Oncology, Faculty of Medicine & Health, Örebro University, 70182 Örebro, SE Sweden
| | - Antonios Valachis
- Department of Oncology, Faculty of Medicine & Health, Örebro University, 70182 Örebro, SE Sweden
| | - Magnus Olivecrona
- Department of Neurosurgery, Faculty of Medicine & Health, Örebro University, 70182 Örebro, SE Sweden
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16
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Thakur JD, Mallari RJ, Corlin A, Yawitz S, Huang W, Eisenberg A, Sivakumar W, Krauss HR, Griffiths C, Barkhoudarian G, Kelly DF. Minimally invasive surgical treatment of intracranial meningiomas in elderly patients (≥ 65 years): outcomes, readmissions, and tumor control. Neurosurg Focus 2021; 49:E17. [PMID: 33002879 DOI: 10.3171/2020.7.focus20515] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Increased lifespan has led to more elderly patients being diagnosed with meningiomas. In this study, the authors sought to analyze and compare patients ≥ 65 years old with those < 65 years old who underwent minimally invasive surgery for meningioma. To address surgical selection criteria, the authors also assessed a cohort of patients managed without surgery. METHODS In a retrospective analysis, consecutive patients with meningiomas who underwent minimally invasive (endonasal, supraorbital, minipterional, transfalcine, or retromastoid) and conventional surgical treatment approaches during the period from 2008 to 2019 were dichotomized into those ≥ 65 and those < 65 years old to compare resection rates, endoscopy use, complications, and length of hospital stay (LOS). A comparator meningioma cohort of patients ≥ 65 years old who were observed without surgery during the period from 2015 to 2019 was also analyzed. RESULTS Of 291 patients (median age 60 years, 71.5% females, mean follow-up 36 months) undergoing meningioma resection, 118 (40.5%) were aged ≥ 65 years and underwent 126 surgeries, including 20% redo operations, as follows: age 65-69 years, 46 operations; 70-74 years, 40 operations; 75-79 years, 17 operations; and ≥ 80 years, 23 operations. During 2015-2019, of 98 patients referred for meningioma, 67 (68%) had surgery, 1 (1%) had radiosurgery, and 31 (32%) were observed. In the 11-year surgical cohort, comparing 173 patients < 65 years versus 118 patients ≥ 65 years old, there were no significant differences in tumor location, size, or outcomes. Of 126 cases of surgery in 118 elderly patients, the approach was a minimally invasive approach to skull base meningioma (SBM) in 64 cases (51%) as follows: endonasal 18, supraorbital 28, minipterional 6, and retrosigmoid 12. Endoscope-assisted surgery was performed in 59.5% of patients. A conventional approach to SBM was performed in 15 cases (12%) (endoscope-assisted 13.3%), and convexity craniotomy for non-skull base meningioma (NSBM) in 47 cases (37%) (endoscope-assisted 17%). In these three cohorts (minimally invasive SBM, conventional SBM, and NSBM), the gross-total/near-total resection rates were 59.5%, 60%, and 91.5%, respectively, and an improved or stable Karnofsky Performance Status score occurred in 88.6%, 86.7%, and 87.2% of cases, respectively. For these 118 elderly patients, the median LOS was 3 days, and major complications occurred in 10 patients (8%) as follows: stroke 4%, vision decline 3%, systemic complications 0.7%, and wound infection or death 0. Eighty-three percent of patients were discharged home, and readmissions occurred in 5 patients (4%). Meningioma recurrence occurred in 4 patients (3%) and progression in 11 (9%). Multivariate regression analysis showed no significance of American Society of Anesthesiologists physical status score, comorbidities, or age subgroups on outcomes; patients aged ≥ 80 years showed a trend of longer hospitalization. CONCLUSIONS This analysis suggests that elderly patients with meningiomas, when carefully selected, generally have excellent surgical outcomes and tumor control. When applied appropriately, use of minimally invasive approaches and endoscopy may be helpful in achieving maximal safe resection, reducing complications, and promoting short hospitalizations. Notably, one-third of our elderly meningioma patients referred for possible surgery from 2015 to 2019 were managed nonoperatively.
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Affiliation(s)
- Jai Deep Thakur
- 1Pacific Neuroscience Institute, and.,2John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California; and.,3University of South Alabama, Mobile, Alabama
| | | | | | | | | | | | - Walavan Sivakumar
- 1Pacific Neuroscience Institute, and.,2John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California; and
| | - Howard R Krauss
- 1Pacific Neuroscience Institute, and.,2John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California; and
| | - Chester Griffiths
- 1Pacific Neuroscience Institute, and.,2John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California; and
| | - Garni Barkhoudarian
- 1Pacific Neuroscience Institute, and.,2John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California; and
| | - Daniel F Kelly
- 1Pacific Neuroscience Institute, and.,2John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California; and
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17
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Corniola MV, Lemée JM, Meling TR. Resection of meningiomas in octogenarians: a comparison with a younger geriatric population. Neurosurg Focus 2021; 49:E18. [PMID: 33002882 DOI: 10.3171/2020.7.focus20306] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial meningiomas (ICMs) may be diagnosed in octogenarians. Since the lesions are rarely life-threatening, surgery is a questionable choice in this age group. The authors' aim in this study was to analyze factors associated with the extent of resection (EOR), overall survival (OS), and postoperative complications in octogenarians undergoing ICM surgery, by using a cohort of septuagenarians as a reference. METHODS All patients ≥ 70 years of age who underwent surgery at Oslo University Hospital for an ICM between 1990 and 2010 were included in this study. Data on these cases were retrospectively (1990-2002) and prospectively (2003-2010) acquired from a databank belonging to Oslo University Hospital. All related preoperative imaging studies or reports (earlier cases) were reviewed to confirm tumor location, the presence of bone invasion, and the postoperative EOR. RESULTS In this study, 49 octogenarians (29 females [59.2%], mean age 83.3 ± 2.5 years) were compared with 272 septuagenarians (173 females [63.6%], mean age 74.3 ± 2.7 years). Forty octogenarians (81.6%) and 217 septuagenarians (79.8%) underwent gross-total resection. Simpson grade IV resection was achieved in 9 octogenarians (18.4%) and 4 septuagenarians (1.4%), while Simpson grade V resection was obtained in 4 septuagenarians (1.4%). Postoperative complications were similar in both groups, and 4 octogenarians (8.2%) and 11 septuagenarians (4.1%) died within 30 days after surgery (p = 0.25). No octogenarian underwent adjuvant radiotherapy. The OS was 4.2 ± 2.8 years in the octogenarians and 5.8 ± 4.4 years in the septuagenarians (p < 0.001). Female sex (OR 0.36, 95% CI 0.14-0.93; p = 0.03) and a preoperative Karnofsky Performance Scale score ≥ 70 (OR 0.27, 95% CI 0.10-0.72; p = 0.009) were correlated to the OS. CONCLUSIONS Octogenarians undergoing surgery for ICMs had an overall reduced OS compared to septuagenarians. However, the clinical relevance of this difference in OS is debatable and has to be put in perspective with expected survival without surgery. Data on symptoms upon admission, EOR, invasive tumor features, and postoperative complications in octogenarians are similar to those observed in septuagenarians. Therefore, the decision concerning whether surgery should be performed must be based on a case-by-case discussion, and surgery should not be immediately dismissed when it comes to ICMs in octogenarians.
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Affiliation(s)
- Marco V Corniola
- 1Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva.,2Faculty of Medicine, University of Geneva, Switzerland
| | - Jean-Michel Lemée
- 3Division of Neurosurgery, Angers University Hospital, Angers, France; and
| | - Torstein R Meling
- 1Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva.,2Faculty of Medicine, University of Geneva, Switzerland.,4Department of Neurological Surgery, Istituto Nazionale Neurologico "C. Besta," Milan, Italy
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Comparison of outcomes of surgery for intracranial meningioma in elderly and young patients - A systematic review and meta-analysis. Clin Neurol Neurosurg 2021; 207:106772. [PMID: 34245986 DOI: 10.1016/j.clineuro.2021.106772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/31/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The proportion of elderly patients with intracranial meningiomas is increasing as the life expectancy has improved. Increasing age is classically believed to be associated with higher perioperative morbidity and mortality in neurosurgical patients. METHODS We performed a systematic literature search in 'PUBMED' and 'EMBASE' databases and reviewed all the studies comparing outcomes of surgery between young and elderly patients with intracranial meningiomas (IM). Data related to 3-month mortality rates, length of hospital stay and complications, preoperative status and comorbidity, meningioma size, location, histology, peritumoral edema, and grade of excision were extracted and analyzed. RESULTS Thirteen retrospective studies fulfilled the eligibility criteria out of the 893 reviewed articles. Pooled analysis showed that the 3-month mortality rate (4.65% versus 1.42%) and length of stay (10d versus 6.8d) for elderly patients were significantly higher as compared to the young population. The rates of cardio-respiratory complications (16.3% v/s 8.3%), intracranial hemorrhage (10.2% v/s 4.2%) and new-onset neurologic deficit (20.7% v/s 10.1%) were also significantly high in the elderly group as compared to the young patients. Moreover, a higher prevalence of associated comorbidities and poor performance score was noted in the elderly patients of IM. CONCLUSIONS The overall mortality rate and rates of perioperative complications (cardio-respiratory, neurologic, intracranial hemorrhage) after surgery in elderly patients with IM patients are higher as compared to young patients and should be kept in mind when formulating treatment strategy for IM in this patient population.
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Mortality of surgically treated 80-year-old or older intracranial meningioma patients in comparison to matched general population. Sci Rep 2021; 11:11454. [PMID: 34075085 PMCID: PMC8169827 DOI: 10.1038/s41598-021-90842-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/11/2021] [Indexed: 11/08/2022] Open
Abstract
Population aging is likely increasing the number of surgically treated very old (≥ 80-year-old) intracranial meningioma (IM) patients. Since there is little data on mortality in this patient group, we studied whether survival of surgically treated very old IM patients differs from survival of a matched general population. We retrospectively identified 83 consecutive very old IM patients (median age 83 years; 69% women) operated between 2010 and 2018. During the first postoperative year, operated IM patients suffered 2.5 times higher mortality as compared to age- and sex-matched general population but no annual survival difference occurred thereafter. Regarding cumulative estimates, no excess mortality was detected after the second postoperative year. Of the patient who were and who were not able to live at home preoperatively, 78% and 42% lived at home within 3 months, respectively. Preoperative loss of capability to live at home associated with a less frequent return to home [odds ratio (95% confidence interval) 0.21 (0.06-0.67)]. Operated very old IM patients had short-term excess mortality but similar cumulative survival as the matched general population. Moreover, most patients returned home soon after surgery.
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Liu F, Tang X, Wang X, Chen J, Zhou L. High-grade meningiomas in octogenarian and elderly patients: A population-based SEER analysis. J Clin Neurosci 2021; 89:165-170. [PMID: 34119263 DOI: 10.1016/j.jocn.2021.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/30/2020] [Accepted: 04/30/2021] [Indexed: 02/08/2023]
Abstract
Knowledge on high-grade meningiomas in octogenarian and elderly patients is limited. We aimed to analyze the outcomes and identify factors that influence overall survival (OS) in this population, using data from the Surveillance, Epidemiology, and End Results (SEER) database.Patients (≥80 years old) diagnosed with high-grade meningiomas between 1990 and 2016 were retrieved from the SEER database. According to treatments received, patients were classified into three groups: observation, radiation only, and surgery (with or without radiation). A Cox proportional hazards regression model was used for univariate and multivariate analyses. Based on the inclusion criteria, 678 patients with high-grade meningiomas were included.Surgery was the most common treatment modality. The median OS was 32 months for patients who received surgery, compared with 20 months for observation (p = 0.001).The factors significantly associated with OS on multivariate analysis included increasing age (hazard ratio [HR] 1.353, p < 0.001), diagnosis after 2008 (HR 0.693, p = 0.022), and surgical treatment (HR 0.807, p = 0.028). Further analysis revealed increasing age (HR 1.451, p = 0.003), and subtotal resection (HR 1.275, p = 0.043) were significantly associated with worse OS following surgery. This is the largest clinical study of high-grade meningiomas in octogenarian and elderly patients conducted thus far. Age, treatment modality, and year of diagnosis were associated with OS in octogenarian and elderly patients with high-grade meningiomas. Patients who received subtotal resection had a worse prognosis than gross total resection.
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Affiliation(s)
- Fujun Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyu Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
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21
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Ekaireb RI, Edwards CS, Ali MS, Nguyen MP, Daggubati V, Aghi MK, Theodosopoulos PV, McDermott MW, Magill ST. Meningioma surgical outcomes and complications in patients aged 75 years and older. J Clin Neurosci 2021; 88:88-94. [PMID: 33992210 DOI: 10.1016/j.jocn.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Meningioma incidence increases with age, yet limited data exist on how comorbidities impact complication rates in elderly patients undergoing meningioma resection. The objective of this study was to report surgical outcomes and identify risk factors for perioperative complications. METHODS We performed a retrospective study of patients 75 years and older undergoing meningioma resection. Outcomes included survival and complications. Major complications were those requiring surgical intervention or causing permanent neurological deficit. Recursive partitioning, Kaplan-Meier survival, univariate and multi-variate (MVA) analyses were performed. RESULTS From 1996 to 2014, 103 patients with a median age of 79 years (IQR 77-83 years) underwent cranial meningioma resection. Median follow-up was 5.8 years (IQR 1.7-8.7 years). Median actuarial survival was 10.5 years. Complications occurred in 32 patients (31.1%), and 13 patients (12.6%) had multiple complications. Major complications occurred in 16 patients (15.5%). Increasing age was not a significant predictor of any (p = 0.6408) or major complication (p = 0.8081). On univariate analysis, male sex, Charlson Comorbidity Index greater than 8, and cardiovascular comorbidities were significantly associated with major complications. On MVA only cardiovascular comorbidities (OR 3.94, 95% CI 1.05-14.76, p = 0.0238) were significantly associated with any complication. All patients with major complications had cardiovascular comorbidities, and on MVA male gender (OR 3.78, 95%CI 1.20-11.93, p = 0.0212) was associated with major complications. CONCLUSIONS Cardiovascular comorbidities and male gender are significant risk factors for complications after meningioma resection in patients aged 75 years and older. While there is morbidity associated with meningioma resection in this cohort, there is also excellent long-term survival.
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Affiliation(s)
- Rachel I Ekaireb
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA
| | - Caleb S Edwards
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA
| | - Muhammad S Ali
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA
| | - Minh P Nguyen
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA
| | - Vikas Daggubati
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA
| | - Manish K Aghi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA
| | - Philip V Theodosopoulos
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA
| | - Michael W McDermott
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA; Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL 33176, USA
| | - Stephen T Magill
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA.
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Schär RT, Tashi S, Branca M, Söll N, Cipriani D, Schwarz C, Pollo C, Schucht P, Ulrich CT, Beck J, Z'Graggen WJ, Raabe A. How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases. J Neurosurg 2021; 134:1113-1121. [PMID: 32330879 DOI: 10.3171/2020.2.jns193460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE With global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery. METHODS For this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed. RESULTS In total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001). CONCLUSIONS Mortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy. Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).
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Affiliation(s)
- Ralph T Schär
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
| | - Shpend Tashi
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
| | - Mattia Branca
- 2Clinical Trials Unit Bern, University of Bern, Switzerland; and
| | - Nicole Söll
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
| | - Debora Cipriani
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
- 3Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christa Schwarz
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
| | - Claudio Pollo
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
| | - Philippe Schucht
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
| | - Christian T Ulrich
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
| | - Jürgen Beck
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
- 3Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Werner J Z'Graggen
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
| | - Andreas Raabe
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern
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Joubert C, Sellier A, Sahuc P, Beucler N, Desse N, Bernard C, Cungi PJ, Dagain A. Neurosurgery for intracranial meningioma in patients aged more than 80 years: benefits and rationale. Br J Neurosurg 2021; 35:470-475. [PMID: 33470146 DOI: 10.1080/02688697.2021.1875397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Elderly patients with symptomatic benign intracranial tumours such as meningioma pose particular problems in decision making. We report on the outcome, morbidity and mortality in patients aged over 80 years after undergoing cranial surgery for meningiomas. METHODS In this retrospective study, 37 patients aged more than 80 years underwent surgery at our neurosurgery department. The Karnofsky Performance Scale (KPS) was used to assess functional status. The American Society of Anesthesiologists (ASA) classification system, the Geriatric Scoring System, the Clinical-Radiological Grading System and the Sex, Karnofsky, ASA, Location and Edema score were used to define clinical status and tumour characteristics. The Charlson Comorbidity Index and Clavien-Dindo classification scores reflected therapeutic morbidity. RESULTS Preoperative KPS scores were generally higher than 60 (n = 32). Of the 37 patients, 24 (64.8%) were in ASA class I or II, and 27 (73.0%) had one or more comorbidities. The median length of follow-up was 80.0 months (range: 1-96 months). The 1-year mortality rate was 2.7% (n = 1). Tumour control was achieved in 33 patients. At discharge, KPS scores were improved in 21 patients (with an average gain of +18.1 ± 8.7), stable in 10 patients and poorer in 6 patients. KPS scores improved or were stable in patients with shorter lengths of hospital stay (15.5 ± 17.9 days vs 51.4 ± 25.4 days; p < 0.01), those with Clavien-Dindo scores lower than 2 (p < 0.01) and those with less favourable preoperative KPS scores (69.4 ± 10.9 vs 82.0 ± 11.0; p = 0.04). CONCLUSION Historically, surgery for intracranial meningiomas in patients aged >80 years has been feasible; this series demonstrated decreasing rates of postoperative mortality. Functional benefit should be the main goal of surgery. Perioperative morbidity should be better assessed and predicted because it significantly influences functional outcomes.
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Affiliation(s)
- Christophe Joubert
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - Aurore Sellier
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - Pauline Sahuc
- Department of Neurology, Sainte Anne Military Hospital, Toulon, France
| | - Nathan Beucler
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - Nicolas Desse
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - Cedric Bernard
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | | | - Arnaud Dagain
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France.,French Military Health Service Academy, Paris, France
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Yang Y, Zeitlberger AM, Neidert MC, Staartjes VE, Broggi M, Zattra CM, Vasella F, Velz J, Bartek J, Fletcher-Sandersjöö A, Förander P, Kalasauskas D, Renovanz M, Ringel F, Brawanski KR, Kerschbaumer J, Freyschlag CF, Jakola AS, Sjåvik K, Solheim O, Schatlo B, Sachkova A, Bock HC, Hussein A, Rohde V, Broekman ML, Nogarede CO, Lemmens CM, Kernbach JM, Neuloh G, Krayenbühl N, Ferroli P, Regli L, Bozinov O, Stienen MN. The association of patient age with postoperative morbidity and mortality following resection of intracranial tumors. BRAIN AND SPINE 2021; 1:100304. [PMID: 36247402 PMCID: PMC9560674 DOI: 10.1016/j.bas.2021.100304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022]
Abstract
Introduction The postoperative functional status of patients with intracranial tumors is influenced by patient-specific factors, including age. Research question This study aimed to elucidate the association between age and postoperative morbidity or mortality following the resection of brain tumors. Material and methods A multicenter database was retrospectively reviewed. Functional status was assessed before and 3–6 months after tumor resection by the Karnofsky Performance Scale (KPS). Uni- and multivariable linear regression were used to estimate the association of age with postoperative change in KPS. Logistic regression models for a ≥10-point decline in KPS or mortality were built for patients ≥75 years. Results The total sample of 4864 patients had a mean age of 56.4 ± 14.4 years. The mean change in pre-to postoperative KPS was −1.43. For each 1-year increase in patient age, the adjusted change in postoperative KPS was −0.11 (95% CI -0.14 - - 0.07). In multivariable analysis, patients ≥75 years had an odds ratio of 1.51 to experience postoperative functional decline (95%CI 1.21–1.88) and an odds ratio of 2.04 to die (95%CI 1.33–3.13), compared to younger patients. Discussion Patients with intracranial tumors treated surgically showed a minor decline in their postoperative functional status. Age was associated with this decline in function, but only to a small extent. Conclusion Patients ≥75 years were more likely to experience a clinically meaningful decline in function and about two times as likely to die within the first 6 months after surgery, compared to younger patients. A multicenter database of patients with intracranial tumors is analyzed in this study. Age is associated with a minor decline in the postoperative functional status & mortality. Patients ≥75 years are more likely to experience a clinically meaningful decline in function and to die.
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Garcia CM, Pertsch NJ, Leary OP, Rivera Perla KM, Tang O, Toms SA, Weil RJ. Early outcomes of supratentorial cranial surgery for tumor resection in older patients. J Clin Neurosci 2020; 83:88-95. [PMID: 33342625 DOI: 10.1016/j.jocn.2020.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/15/2020] [Accepted: 11/23/2020] [Indexed: 01/12/2023]
Abstract
With longevity increasing in the United States, more older individuals are presenting with supratentorial brain tumors. Despite improved perioperative management, there is persistent disparity in surgical resection rates among patients aged 65 years or older. We aim to assess the effects of advanced age (≥65 years) on 30-day outcomes in patients with supratentorial tumors who underwent craniotomy for supratentorial tumor resection. Data obtained in adults who underwent supratentorial tumor resections was extracted from the prospectively-collected American College of Surgeons: National Surgical Quality Improvement Program (NSQIP; 2012-2018) database. Using multivariate regression, we compared odds of major and minor complications; prolonged length-of-stay (LOS); discharge anywhere other than home; and 30-day readmission, reoperation, and mortality rates between patients aged 18-64 years (the control cohort) and those 65-74 years or ≥75 years of age. Of the 14,234 patients who underwent craniotomy for supratentorial tumors and met inclusion criteria, 30.7% were ≥65 years of age; 71.4% of these were 65-74 years and 28.6% were ≥75 years old. Compared to the control group, both older subpopulations had more medical comorbidities. Both older subgroups had increased odds of major complications and prolonged LOS relative to the control group. Older patients had greater odds of mortality at 30 days. Advanced age, defined as ≥65 years, was significantly associated with higher odds of complications, prolonged LOS, and mortality within the 30-day post- operative period after adjusting for potential confounders. Age is one important consideration when prospectively risk-stratifying patients to minimize and mitigate suboptimal perioperative outcomes.
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Affiliation(s)
- Catherine M Garcia
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Nathan J Pertsch
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Owen P Leary
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Oliver Tang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Steven A Toms
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
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Ginalis EE, Danish SF. Magnetic resonance–guided laser interstitial thermal therapy for brain tumors in geriatric patients. Neurosurg Focus 2020; 49:E12. [DOI: 10.3171/2020.7.focus20462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThere is a paucity of studies assessing the use of MR-guided laser interstitial thermal therapy (LITT), specifically in the elderly population. The aim of this study was to evaluate the safety of LITT for brain tumors in geriatric patients.METHODSGeriatric patients (≥ 65 years of age) treated with LITT for intracranial tumors at a single institution between January 2011 and November 2019 were retrospectively identified. The authors grouped patients into two distinct age cohorts: 65–74 years (group 1) and 75 years or older (group 2). Baseline characteristics, operative parameters, postoperative course, and morbidity were recorded for each patient.RESULTSFifty-five geriatric patients underwent 64 distinct LITT procedures for brain tumors. The majority of lesions (40 [62.5%]) treated were recurrent brain metastases or radiation necrosis. The median modified frailty index was 0.1 (low frailty; range 0–0.4) for patients in group 1 and 0.2 (intermediate frailty; range 0–0.4) for patients in group 2 (p > 0.05). The median hospital length of stay (LOS) was 1 day (IQR 1–2 days); there was no significant difference in LOS between the age groups. The hospital stay was significantly longer in patients who presented with a neurological symptom and in those who experienced a postoperative complication. The majority of patients (43 [68.3%] of 63 cases) were fit for discharge to their preoperative accommodation following LITT. The rate of discharge to home was not significantly different between the age groups. Those discharged to rehabilitation facilities were more likely to have presented with a neurological symptom. Nine patients (14.1% of cases) were found to have acute neurological complications following LITT, with nearly all patients showing complete or partial recovery at follow-up. The 30-day postoperative mortality rate was 1.6% (1 case). The complication and 30-day postoperative mortality rates were not significantly different between the two age groups.CONCLUSIONSLITT can be considered a minimally invasive and safe neurosurgical procedure for the treatment of intracranial tumors in geriatric patients. Careful preoperative preparation and postoperative care is essential as LITT is not without risk. Appropriate patient selection for cranial surgery is essential, because neurosurgeons are treating an increasing number of elderly patients, but advanced age alone should not exclude patients from LITT without considering frailty and comorbidities.
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Hadanny A, Tzubery S, Hadelsberg U, Gonen L, Margalit N. The Outcome of Intracranial Meningioma Surgery in Octogenarians: Matched Cohort Study. World Neurosurg 2020; 144:e582-e588. [PMID: 32916350 DOI: 10.1016/j.wneu.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Previous studies compared outcomes of intracranial meningioma surgery in octogenarians with outcomes in younger patients without accounting for different tumor locations and sizes. The aim of the current study was to evaluate outcomes of intracranial meningioma surgery in octogenarians taking into account patient preoperative status and comorbidities as well as tumor properties. METHODS The study cohort included all octogenarian patients who underwent elective craniotomies for intracranial meningiomas during 2008-2020 and patients <70 years old in the same time period matched for tumor size, tumor location, and preoperative Karnofsky scale score. Each group comprised 31 patients. Postoperative complications were divided into systemic, neurological, and wound related. Mortality and long-term complications were evaluated at 6-month follow-up. RESULTS Mean age of patients was 82.6 ± 2.6 years for the study group and 57.9 ± 9.9 years for the control group (P < 0.0001). Two octogenarians (6.5%) died within 30 days after elective craniotomy compared with none in the younger group (P = 0.49). Mortality rates at 6 months were comparable between the 2 groups (12.9% vs. 3.2%, P = 0.35). There was no significant difference in overall postoperative complications between the octogenarian and control groups (77.4% vs. 74.2%, P = 0.77). American Society of Anesthesiologists score was the single predictor for any postoperative complications (odds ratio = 2.219, 95% confidence interval 1.024-4.811, P = 0.04). CONCLUSIONS This study found no excess mortality or morbidity in octogenarians compared with younger patients. The American Society of Anesthesiologists score rather than age is a significant risk factor for overall morbidity and mortality following intracranial meningioma surgery in octogenarians.
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Affiliation(s)
- Amir Hadanny
- Department of Neurosurgery, Galilee Medical Center, Naharyia, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat-Gan, Israel
| | - Sappir Tzubery
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Uri Hadelsberg
- Department of Neurosurgery, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Lior Gonen
- Department of Neurosurgery, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Nevo Margalit
- Department of Neurosurgery, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel.
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Ge Y, Liu D, Zhang Z, Li Y, Lin Y, Wang G, Zong Y, Liu E. Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients. Neurosurg Focus 2020; 46:E7. [PMID: 31153153 DOI: 10.3171/2019.3.focus1956] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors retrospectively analyzed the follow-up data in 130 patients with intracranial benign meningiomas after Gamma Knife radiosurgery (GKRS), evaluated the tumor progression-free survival (PFS) rate and neurological function preservation rate, and determined the predictors by univariate and multivariate survival analysis.METHODSThis cohort of 130 patients with intracranial benign meningiomas underwent GKRS between May 2012 and May 2015 at the Second Hospital of Tianjin Medical University. The median age was 54.5 years (range 25-81 years), and women outnumbered men at a ratio of 4.65:1. All clinical and radiological data were obtained for analysis. No patient had undergone prior traditional radiotherapy or chemotherapy. The median tumor volume was 3.68 cm3 (range 0.23-45.78 cm3). A median margin dose of 12.0 Gy (range 10.0-16.0 Gy) was delivered to the tumor with a median isodose line of 50% (range 50%-60%).RESULTSDuring a median follow-up of 36.5 months (range 12-80 months), tumor volume regressed in 37 patients (28.5%), was unchanged in 86 patients (66.2%), and increased in 7 patients (5.4%). The actuarial tumor progression-free survival (PFS) rate was 98%, 94%, and 87% at 1, 3, and 5 years, respectively, after GKRS. Tumor recurred in 7 patients at a median follow-up of 32 months (range 12-56 months). Tumor volume ≥ 10 cm3 (p = 0.012, hazard ratio [HR] 8.25, 95% CI 1.60-42.65) and pre-GKRS Karnofsky Performance Scale score < 90 (p = 0.006, HR 9.31, 95% CI 1.88-46.22) were independent unfavorable predictors of PFS rate after GKRS. Of the 130 patients, 101 (77.7%) presented with one or more neurological symptoms or signs before GKRS. Neurological symptoms or signs improved in 40 (30.8%) patients, remained stable in 83 (63.8%), and deteriorated in 7 (5.4%) after GKRS. Two (1.5%) patients developed new cranial nerve (CN) deficit. Tumor volume ≥ 10 cm3 (p = 0.042, HR = 4.73, 95% CI 1.06-21.17) and pre-GKRS CN deficit (p = 0.045, HR = 4.35, 95% CI 0.84-22.48) were independent unfavorable predictors for improvement in neurological symptoms or signs. Six (4.6%) patients developed new or worsening peritumoral edema with a median follow-up of 4.5 months (range 2-7 months).CONCLUSIONSGKRS provided good local tumor control and high neurological function preservation in patients with intracranial benign meningiomas. Patients with tumor volume < 10 cm3, pre-GKRS Karnofsky Performance Scale score ≥ 90, and no pre-GKRS CN deficit (I-VIII) can benefit from stereotactic radiosurgery. It can be considered as the primary or adjuvant management of intracranial benign meningiomas.
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Affiliation(s)
| | | | | | | | | | | | | | - Enhu Liu
- 2Neuroradiology, the Second Hospital of Tianjin Medical University, Tianjin, China
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The effect of household income on outcomes following supratentorial meningioma resection. Clin Neurol Neurosurg 2020; 195:106031. [PMID: 32652393 DOI: 10.1016/j.clineuro.2020.106031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study assesses the impact of Median Household Income (MHI) on short- and long-term morbidity and mortality following supratentorial meningioma resection. PATIENTS AND METHODS 351 consecutive patients undergoing supratentorial meningioma tumor resection, at a single health system over a six-year period (June 09, 2013 to April 26, 2019) were analyzed retrospectively. Outcomes assessed included readmission, emergency department (ED) evaluation, and mortality within 90 days of surgery. Univariate regression analysis was conducted amongst the entire population. The population was then divided into quartiles based on median household income and univariate analysis was conducted between the lowest (Q1) and highest (Q4) quartiles. Significance was set at a P-value < 0.05. Stepwise regression was performed to identify confounding variables in the logistic model. RESULTS In the whole population, lower Median Household Income correlated to a significant increase in ED evaluation within 90-days of supratentorial meningioma resection. No significant difference was noted between median household income and 90-day readmission, 90-day unplanned re-operation, return to surgery after index admission within 90-days, return to surgery during the duration of the follow-up period, mortality within 90-days, and mortality during the duration of the follow-up period. In addition, when comparing Q1 (MHI ≤ $51,780) and Q4 (MHI ≥ $87,958), similar results were noted with increased ED evaluation for patients with lower MHI, but no significant difference in other factors of morbidity or mortality. CONCLUSION Following supratentorial meningioma resection, a lower median household income was significantly associated with increased emergency department visits within 90 post-operative days.
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Albert A, Lee A, Thomas TV, Vijayakumar S. Outcomes of benign meningioma in older patients in the United States. J Geriatr Oncol 2020; 11:709-717. [DOI: 10.1016/j.jgo.2019.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/16/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
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Is surgery justified for 80-year-old or older intracranial meningioma patients? A systematic review. Neurosurg Rev 2020; 44:1061-1069. [PMID: 32248508 PMCID: PMC8035086 DOI: 10.1007/s10143-020-01282-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/10/2020] [Accepted: 03/06/2020] [Indexed: 11/10/2022]
Abstract
Since the number of elderly people with intracranial meningiomas (IM) continues to rise, surgical treatment has increasingly become a considerable treatment option, even in very old (≥ 80 years old) meningioma patients. Since little is known about whether meningioma surgery in this age group is safe and justified, we conducted a systematic review to summarize the results of surgical outcomes in very old meningioma patients. We performed a systematic literature search in Pubmed, Cochrane Library, and Scopus databases. Primarily, we extracted 1-month and 1-year survival rates, and 1-year morbidity rates, as well as information about preoperative morbidity, operative complications, meningioma size, location, histology, and peritumoral edema. Quality of the included studies was evaluated by Cochrane Collaboration Handbook and Critical Appraisal Skills Program. From the 1039 reviewed articles, seven retrospective studies fulfilled our eligibility criteria. Motor deficits (27–65%) and mental changes (51–59%) were the most common indications for surgery. One-month and 1-year mortality rates varied between 0–23.5% and 9.4–27.3%, respectively. Most of the operated IM patients (41.2–86.5%) improved their performance during postoperative follow-up. Impaired preoperative performance and comorbidities were most commonly related to higher postoperative mortality. None of the studies fulfilled the criteria of high quality. Based on the evidence currently available, surgical treatment of very old IM patients seems to improve the performance of highly selected individuals. Given the rapid increase of the aging population, more detailed retrospective studies as well as prospective studies are needed to prove the outcome benefits of surgery in this patient group.
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Brain Tumor Surgery is Safe in Octogenarians and Nonagenarians: A Single-Surgeon 741 Patient Series. World Neurosurg 2019; 132:e185-e192. [PMID: 31505286 DOI: 10.1016/j.wneu.2019.08.219] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Elderly patients with surgically accessible brain tumors are often not offered clinically indicated brain tumor surgery (BTS) because of to assumptions of greater risk for perioperative morbidity and mortality. Because brain tumor incidence is highest in the geriatric population, and because the global population is aging, accurate understanding of BTS risk in elderly patients is critical. We aimed to compare safety of BTS in elderly patients with younger counterparts to better understand the risk-benefit profile of BTS for elderly patients. METHODS Retrospective cohort study of young (20-29 years), senior (60-79 years), and elderly (80+ years) patients who underwent BTS with a single neurosurgeon. Differences between pre- and postoperative modified Rankin score (ΔmRS), length of hospitalization (LOH), complication rate, and 30-day readmission rates (30DRR) were recorded. RESULTS A total of 741 patients (83 elderly, 570 senior, and 88 young) were identified. No significant difference in preoperative mRS between different age groups, χ2 = 0.269, P = 0.874. Elderly complication rate was 6.0%, not significantly different from young (4.5%, P = 0.667) or senior (7.2%, P = 0.696) complication rate. Elderly LOH was 1.93 ± SD 0.176 days; not significantly different from young (3.01 ± 0.384 days, P = 0.081) or senior (2.47 ± 0.144 days, P = 0.881). Statistical equivalence testing showed with 95% confidence that there was equivalence in ΔmRS among age groups. CONCLUSIONS Elderly patients did not have significantly different ΔmRS, LOH, 30DRR, or complication rates after BTS compared with younger counterparts. Therefore, in healthy patients, advanced age alone should not prevent patients from being offered BTS.
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Lemée JM, Corniola MV, Da Broi M, Schaller K, Meling TR. Early Postoperative Complications in Meningioma: Predictive Factors and Impact on Outcome. World Neurosurg 2019; 128:e851-e858. [DOI: 10.1016/j.wneu.2019.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
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Achey RL, Gittleman H, Schroer J, Khanna V, Kruchko C, Barnholtz-Sloan JS. Nonmalignant and malignant meningioma incidence and survival in the elderly, 2005-2015, using the Central Brain Tumor Registry of the United States. Neuro Oncol 2019; 21:380-391. [PMID: 30295804 PMCID: PMC6380426 DOI: 10.1093/neuonc/noy162] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Meningioma incidence increases significantly with age. In the expanding elderly population, we lack complete understanding of population-based trends in meningioma incidence/survival. We provide an updated, comprehensive analysis of meningioma incidence and survival for individuals aged over 65. METHODS Data were obtained from the Central Brain Tumor Registry of the United States (CBTRUS) from 2005-2015 for nonmalignant and malignant meningioma. Age-adjusted incidence rates per 100000 person-years were analyzed by age, sex, race, ethnicity, location, and treatment modalities. Survival was analyzed using Kaplan-Meier and multivariable Cox proportional hazards models for a subset of CBTRUS data. RESULTS Nonmalignant meningioma incidence doubled from adults age 65-69 years to adults over age 85 years and was significantly greater in females than males for all ages. Malignant meningioma incidence did not differ by sex for any age grouping. Nonmalignant and malignant meningioma incidence was significantly greater in black populations versus others. Nonmalignant meningioma survival was worse with age, in black populations, and in males, including when analyzed by 5-year age groups. Surgical resection and radiation did not improve survival compared with resection alone in nonmalignant meningioma. CONCLUSIONS This study reports increasing nonmalignant meningioma incidence in the elderly, increased incidence in black populations, and in females. In contrast, malignant meningioma incidence did not differ between sexes. Risk of death was higher for black individuals and males. Additionally, radiation did not confer a survival advantage when combined with resection for nonmalignant meningioma. Thus, we identify clinically relevant discrepancies in meningioma incidence/survival that require further study.
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Affiliation(s)
- Rebecca L Achey
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Haley Gittleman
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Julia Schroer
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vishesh Khanna
- Department of Internal Medicine, Stanford University, Stanford, California
| | - Carol Kruchko
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
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Champeaux C, Weller J, Katsahian S. Epidemiology of meningiomas. A nationwide study of surgically treated tumours on French medico-administrative data. Cancer Epidemiol 2019; 58:63-70. [DOI: 10.1016/j.canep.2018.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/17/2018] [Accepted: 11/13/2018] [Indexed: 11/25/2022]
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Gihr GA, Horvath-Rizea D, Garnov N, Kohlhof-Meinecke P, Ganslandt O, Henkes H, Meyer HJ, Hoffmann KT, Surov A, Schob S. Diffusion Profiling via a Histogram Approach Distinguishes Low-grade from High-grade Meningiomas, Can Reflect the Respective Proliferative Potential and Progesterone Receptor Status. Mol Imaging Biol 2018; 20:632-640. [DOI: 10.1007/s11307-018-1166-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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