LAUSR

BACKGROUND Improved life expectancy and advanced diagnostic tools including computed tomography and magnetic resonance imaging increased the awareness and diagnosis of intracranial meningiomas in elderly population. The risk-benefit ratio of surgery in elderly patients with intracranial meningioma has not been clearly defined due to the lack of objective measurement tools. We aimed to understand the risk factors associated with post-surgical outcomes, and how these risk factors affected post-surgical outcomes in elderly patients with intracranial meningioma. METHODS We retrospectively evaluated 1372 patients, who were operated for intracranial meningioma, using our prospectively collected database. The same senior author operated all patients at two different tertiary clinics. Patients' clinical charts, pre-surgical post-contrast T1-weighted magnetic resonance images, operative reports, and pathology reports were reviewed. The relevant literature was also reviewed. RESULTS Higher ASA class, presence of co-morbidities, tumor location, larger initial tumor size and presence of peritumoral edema were all associated with post-surgical complications in elderly patients with intracranial meningioma. Age of at or above 50 years was the strongest predictor of post-surgical systemic complications, whereas higher ASA class was the strongest predictor of post-surgical neurological complications. Literature review showed higher morbidity and mortality rates of elderly patients with intracranial meningioma. Initial tumor size and post-surgical MIB-1 labeling index were higher in the elderly patients, all of which were predictors of tumor growth. CONCLUSIONS Even though elderly patients operated for intracranial meningioma had higher morbidity and mortality rates compared to younger patients, surgery is still much more beneficial than wait-and-see strategy in elderly patients.