The Effect of Functional Status, Age, and Medical Comorbidities on the Perioperative Complication Profile of Skull Base Meningioma Resection in Elderly Patients

Background: Elderly patients, particularly those with medical comorbidities and low functional status, are high risk surgical candidates. We aimed to describe the perioperative complication profile of skull base meningioma resection in this high risk population and identify any factors associated with an increased risk of complication.

Methods: We performed a retrospective review of all patients ≥ 65 years old who underwent microsurgical resection of a skull base meningioma at our institution from 2009 to 2018. A logistic regression model was used to analyze for predictors of any perioperative (medical or surgical) complication.

Results: The cohort (n = 102) included 75 females (73.5%) and 27 males (26.5%) with a mean age of 72 ± 5 years. 62 patients (60.8%) had at least one medical comorbidity, including hypertension (n = 53; 52.0%), diabetes mellitus-II (n = 21; 20.6%), coronary artery disease or congestive heart failure (n = 10; 9.8%), chronic obstructive pulmonary disease (n = 3; 2.9%), stage III chronic kidney disease (n = 3; 2.9%), and cirrhosis (n = 1; 1.0%). Six patients (5.9%) were taking oral anticoagulation medication. The mean largest tumor diameter was 2.7 ± 1.1 cm. Extent of resection included Simpson grades I–II in 46 patients (45.1%), grade III in 16 patients (15.7%), and grade IV in 40 patients (39.2%). New focal neurological deficits occurred in 13 patients (12.7%). Postoperative medical complications occurred in 11 patients (10.8%), including diabetes insipidus (n = 5; 4.9%), pneumonia or respiratory failure (n = 4; 3.9%), UTI (n = 2; 2.0%), and SIADH (n = 2, 2.0%). Postoperative surgical complications occurred in 14 patients (13.7%), including hydrocephalus (n = 7; 6.9%), acute encephalopathy (n = 6; 5.9%), wound infection or breakdown (n = 4; 3.9%), hemorrhage (n = 4; 3.9%), and CSF leak (n = 2; 2.0%). Overall, any perioperative complication occurred in 21 patients (20.6%). In univariate analysis, lower preoperative KPS score (p < 0.01), age ≥ 75 years (p = 0.02), chronic kidney disease (p = 0.04), tumor laterality (p < 0.01), and anterior skull base location (p = 0.01) were associated with an increased risk of complication. In the logistic regression model, only lower preoperative KPS score remained significant as an independent predictor of a perioperative complication (p = 0.02).

Conclusion: Low functional status, but not increasing age or the presence of a medical comorbidity, increases the perioperative complication risk in elderly patients with skull base meningiomas.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021