Surgical Management of Intracranial Meningiomas in the Elderly: Early and Long-term Outcomes

Figures & data

Table 1 Type and Frequency of Comorbidities

Comorbidities	Number of Patients n (%)
Hypertension	46 (79.3)
Thyroid disease	17 (29.3)
Ischemic heart disease	15 (25.9)
Diabetes	13 (22.4)
Arrhythmia	8 (13.8)
Chronic obstructive pulmonary disease	6 (10.3)
Chronic heart failure	3 (5.2)
Chronic renal failure	3 (5.2)
Artificial heart valves	2 (3.45)
Liver disease	1 (1.7)

Table 2 Preoperative Functional Status According to the KPS Scale

Preoperative KPS Status	Number of Patients n (%)
40	1 (1.7)
50	5 (8.6)
60	6 (10.3)
70	4 (6.9)
80	11 (19)
90	27 (46.6)
100	4 (6.9)

Figure 1 Preoperative contrast-enhanced T1-weighted MR images in the axial (A) and coronal (B) planes of a 71-year-old woman operated on for a parasagittal meningioma. Last follow-up MRI examination obtained after Simpson grade III resection of a fibroblastic meningioma (WHO grade I) showed no recurrence in contrast-enhanced T1-weighted images in the axial (C) and sagittal (D) planes.

Figure 2 Preoperative contrast-enhanced T1-weighted MR image in the axial plane (A) of an 82-year-old woman operated on for a convexity meningioma. Last follow-up MRI examination obtained after Simpson grade I resection of an atypical meningioma (WHO grade II) with no postoperative radiotherapy showed no recurrence in the native T1-weighted image in the axial plane (B) and in contrast-enhanced T1-weighted images in the axial (C) and coronal (D) planes.

Figure 3 Preoperative MRI examination in contrast-enhanced T1-weighted axial (A) and T2-weighted coronal (B) planes of a convexity meningioma in a 72-year-old woman with Simpson grade I resection of an atypical meningioma (WHO grade II). No postoperative radiotherapy was used. MRI examination performed 18 months after surgery revealed a small recurrence shown in the axial contrast-enhanced T1-weighted image (C). Cyberknife radiotherapy was used. MRI examination performed 42 months after surgery showed further tumor growth (D) and Cyberknife radiotherapy was reapplied. The patient was alive at the last follow-up contact (50 months post-surgery).

Table 3 Neurological Morbidity, Overall Morbidity and Mortality in Relation to the Simpson Grade of Removal

Extent of Removal (Simpson Grade)	Neurological Morbidity n (%)	Overall Morbidity n (%)	Mortality n (%)
I + II n=47	9 (19.15)	13 (27.7)	3 (6.4)
III n=3	0	1 (33.3)	1 (33.3)
IV n=8	3 (37.5)	4 (50)	2 (25)

Table 4 The Relationship Between the Grading Scales’ Scores and the Incidence of Neurological Morbidity, Overall Morbidity, and Mortality

Grading Scale	Neurological Morbidity	Overall Morbidity	Mortality
CRGS score	P=0.108	P=0.0171^a	P=0.017^a
SKALE score	P=0.56	P=0.067	P<0.005^a
GSS score	P=0.35	P=0.152	P=0.0494^a

Note: ^aSignificant relationships.

Table 5 The Course of Patients with Tumor Recurrence

Case	WHO Grade	Simpson Grade	Postop Rth	Time to Recurrence	Additional Treatment	Last Patient Status (Length of Follow-up)
78-year-old man	II	IV	Yes	41 months	Reoperation, GKS, reoperation	Deceased (75 months)
74-year-old man	II	IV	Yes	97 months	No; watchful observation	Alive (110 months)
74-year-old woman	II	I	No	88 months	No; watchful observation	Alive (106 months)
72-year-old woman	II	I	No	18 months	2 × Cyberknife	Alive (50 months)
76-year-old man	III	I	Yes	23 months	Chemotherapy	Deceased (26 months)
85-year-old man	III	III	Refused	3 months	No	Deceased (5.5 months)