Perioperative Complication Profile of Skull Base Meningioma Resection in Older versus Younger Adult Patients

Abstract

Objectives To better understand the risk-benefit profile of skull base meningioma resection in older patients, we compared perioperative complications among older and younger patients.

Design Present study is based on retrospective outcomes comparison.

Setting The study was conducted at a single neurosurgery institute at a quaternary center.

Participants All older (age ≥ 65 years) and younger (<65 years) adult patients treated with World Health Organization grade 1 skull base meningiomas (2008–2017).

Main Outcome Measures Perioperative complications and patient functional status are the primary outcomes of this study.

Results The analysis included 287 patients, 102 older and 185 younger, with a mean (standard deviation [SD]) age of 72 (5) years and 51 (9) years (p < 0.01). Older patients were more likely to have hypertension (p < 0.01) and type 2 diabetes mellitus (p = 0.01) but other patient and tumor factors did not differ (p ≥ 0.14). Postoperative medical complications were not significantly different in older versus younger patients (10.8 [11/102] vs. 4.3% [8/185]; p = 0.06) nor were postoperative surgical complications (13.7 [14/102] vs. 10.8% [20/185]; p = 0.46). Following anterior skull base meningioma resection, diabetes insipidus (DI) was more common in older versus younger patients (14 [5/37] vs. 2% [1/64]; p = 0.01). Among older patients, a decreasing preoperative Karnofsky performance status score independently predicted perioperative complications by logistic regression analysis (p = 0.02). Permanent neurologic deficits were not significantly different in older versus younger patients (12.7 [13/102] vs. 10.3% [19/185]; p = 0.52).

Conclusion The overall perioperative complication profile of older and younger patients was similar after skull base meningioma resection. Older patients were more likely to experience DI after anterior skull base meningioma resection. Decreasing functional status in older patients predicted perioperative complications.

Keywords

elderly - frailty - meningioma - skull base

• References

• 1 Patil CG, Veeravagu A, Lad SP, Boakye M. Craniotomy for resection of meningioma in the elderly: a multicentre, prospective analysis from the National Surgical Quality Improvement Program. J Neurol Neurosurg Psychiatry 2010; 81 (05) 502-505
• 2 Przybylowski CJ, Hendricks BK, Frisoli FA. et al. Prognostic value of the Simpson grading scale in modern meningioma surgery: Barrow Neurological Institute experience. J Neurosurg 2020; (e-pub ahead of print)
• 3 Kolakshyapati M, Ikawa F, Abiko M. et al; Alumni Association Group of the Department of Neurosurgery at Hiroshima University. Multivariate risk factor analysis and literature review of postoperative deterioration in Karnofsky Performance Scale score in elderly patients with skull base meningioma. Neurosurg Focus 2018; 44 (04) E14
• 4 Thakur JD, Mallari RJ, Corlin A. et al. Minimally invasive surgical treatment of intracranial meningiomas in elderly patients (≥ 65 years): outcomes, readmissions, and tumor control. Neurosurg Focus 2020; 49 (04) E17
• 5 Meling TR, Da Broi M, Scheie D, Helseth E. Skull base versus non-skull base meningioma surgery in the elderly. Neurosurg Rev 2019; 42 (04) 961-972
• 6 da Silva CE, de Freitas PEP. Surgical removal of skull base meningiomas in symptomatic elderly patients. World Neurosurg 2018; 120: e1149-e1155
• 7 Li Y, Lu D, Feng D. et al. Management of incidental anterior skull base large and giant meningiomas in elderly patients. J Neurooncol 2020; 148 (03) 481-488
• 8 Black P, Kathiresan S, Chung W. Meningioma surgery in the elderly: a case-control study assessing morbidity and mortality. Acta Neurochir (Wien) 1998; 140 (10) 1013-1016 , discussion 1016–1017
• 9 Roser F, Ebner FH, Ritz R, Samii M, Tatagiba MS, Nakamura M. Management of skull based meningiomas in the elderly patient. J Clin Neurosci 2007; 14 (03) 224-228
• 10 Poon MT, Fung LH, Pu JK, Leung GK. Outcome comparison between younger and older patients undergoing intracranial meningioma resections. J Neurooncol 2013; 114 (02) 219-227
• 11 Louis DN, Ohgaki H, Wiestler OD. et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007; 114 (02) 97-109
• 12 Louis DN, Perry A, Reifenberger G. et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 2016; 131 (06) 803-820
• 13 Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957; 20 (01) 22-39
• 14 Mathiesen T, Kihlström L. Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression. Neurosurgery 2006; 59 (03) 570-576 , discussion 570–576
• 15 Turel MK, Tsermoulas G, Yassin-Kassab A. et al. Tuberculum sellae meningiomas: a systematic review of transcranial approaches in the endoscopic era. J Neurosurg Sci 2019; 63 (02) 200-215
• 16 Loewenstern J, Aggarwal A, Pain M. et al. Peritumoral edema relative to meningioma size predicts functional outcomes after resection in older patients. Oper Neurosurg (Hagerstown) 2019; 16 (03) 281-291