Clinical Features,Factors Impacting The Post-operative Outcome,and Treatment Strategy For Elderly Meningioma Patients

Meningioma is one of the most common intracranial tumors for adults.It has the features of benign and slow growing.The intracranial condition for the elderly patients is different with the one of relative younger patients.We retrospectively analyzed 528 valid meningioma patients,including 115(21.8%)patients older than 65 years old.We compared the difference of the intracranial condition,clinical features of meningioma patients,and surgical features between the elderly patients and the young patients with the cutoff age of 65 years old.Then we focused on the meningioma in the elderly,the elderly patients were shown to have significantly larger tumor diameter(mean [± SD] 43.4 ± 18.0 mm)comparing with the young group(mean [± SD] 37.6 ± 16.5 mm).The elderly group was shown to have a significantly higher morbidity and mortality compared with the young group.Post-operative KPS was significantly lower in the elderly group(mean [± SD] 79.64 ± 26.37)than the young group(mean [± SD] 88.81 ± 17.36).Postoperative complications included intracranial hemorrhage,intracranial infection,motor or sensory deficit,and cranial nerve defects.Multivariate regression of KPS scale showed operative complication(p<0.01),pre-operative comorbidities(p < 0.01)and non-convexity location(p < 0.01)had a significant impact on the outcome.The diameter was shown to have a significance trend.However,tumor blood supply(p=0.94),Simpson grading(p = 0.50),pathology(p = 0.67),and pre-operative symptoms(p = 0.52)were not the factors affecting the post-operative KPS scale.The outcome for meningioma in elderly patients is affected by factors related more to the safety of the operation than characteristics of the tumor.We preformed systemic research for the surgical approaches and techniques for meningioma at different locations,summarized the strategy for different meningiomas for the elderly patients in terms of surgical complication prevention.Conclusion: the intracranial free space in elderly patients is more substantial than the younger patients as the aging and brain parenchyma atrophy,meningiomas in the elderly group have the features of larger diameter and being less symptomatic.The postoperative outcome and life quality are associated with surgical factors including location,operative complications,and preoperative comorbidity.But not related with diameter,tumor blood supply,Simpson grades,pathological grade,and preoperative symptoms.Therefore,rather than achieving total resection,conservative and safety preferential treatment strategies should be regarded as a higher priority for better quality of life.Even if the tumor was not able to be completely resected,by postoperative radiotherapy,or by other means such as seeds implantation,tumor control equal to the Simpson grade I resection can still be achieved.Depending on the tumor location,neurosurgeons should adopt different approaches and different surgical strategies to plan individualized treatment strategy.In order to protect neurological function and quality of life for the elderly patients post-operatively,conservative surgical strategies and postoperative supplementary treatments for tumors growth control should be carried out.