Top

Published in:

01-12-2019 | Original Article

Skull base versus non-skull base meningioma surgery in the elderly

Authors: Torstein R. Meling, Michele Da Broi, David Scheie, Eirik Helseth

Published in: Neurosurgical Review | Issue 4/2019

Abstract

To compare outcomes after surgery for skull base meningiomas (SBMs) with non-skull base meningiomas (NSBMs) in the elderly. Overall, 128 consecutive patients ≥ 70 years of age with intracranial SBMs operated between 1990 and 2010 were compared to 193 consecutive patients ≥ 70 years of age with NSBMs operated within the same time period. Median age at surgery was 75.0 years (mean 75.7, range 70.0–92.4). Follow-up was complete with median 4.7 years (mean 5.5, range 0–19). The female-to-male ratio was 2.8 for SBMs and 1.3 for NSBMs (p < 0.005). The groups had similar preoperative KPS (median 80, range 20–100), but SBMs presented significantly more frequently with raised ICP (RR = 2.2, p < 0.005) and less frequently with seizures (RR = 0.6, p < 0.05). WHO I was significantly more frequent in SBMs (p < 0.005). Gross-total resection (GTR) was less frequent in SBMs (63 vs 82%) (RR = 2.1, p < 0.0001). SBMs were similar to NSBMs with respect to neurological outcome at 6–12 months, reoperations for hematomas, postoperative infections, and 30-day mortality. Retreatment rates and time to retreatments were also similar. There were no differences between the two groups with respect to risk of retreatment and overall survival (OS) at 5, 10, 15, and 20 years. In elderly patients with SBMs selected to surgical treatment, the risks of surgery, risk of retreatment, and OS were similar to NBSMs. Therefore, surgery for SBMs may be considered as safe as NSBMs in the elderly population.

Arienta C, Caroli M, Crotti F, Villani R (1990) Treatment of intracranial meningiomas in patients over 70 years old. Acta Neurochir 107:47–55CrossRef

Awad IA, Kalfas I, Hahn JF, Little JR (1989) Intracranial meningiomas in the aged: surgical outcome in the era of computed tomography. Neurosurgery 24:557–560CrossRef

Bartek J Jr, Sjavik K, Forander P, Solheim O, Gulati S, Weber C, Ingebrigtsen T, Jakola AS (2015) Predictors of severe complications in intracranial meningioma surgery: a population-based multicenter study. World Neurosurg 83:673–678. https://doi.org/10.1016/j.wneu.2015.01.022 CrossRefPubMed

Bassiouni H, Asgari S, Stolke D (2006) Olfactory groove meningiomas: functional outcome in a series treated microsurgically. Acta Neurochir 149:109–121; discussion 121. https://doi.org/10.1007/s00701-006-1075-z CrossRefPubMed

Bateman BT, Pile-Spellman J, Gutin PH, Berman MF (2005) Meningioma resection in the elderly: nationwide inpatient sample, 1998–2002. Neurosurgery 57:866–872 discussion 866-872CrossRef

Bir SC, Maiti T, Konar S, Nanda A (2016) Comparison of the surgical outcome of pterional and frontotemporal-orbitozygomatic approaches and determination of predictors of recurrence for sphenoid wing meningiomas. World Neurosurg 99:308–319. https://doi.org/10.1016/j.wneu.2016.10.057 CrossRefPubMed

Black P, Kathiresan S, Chung W (1998) Meningioma surgery in the elderly: a case-control study assessing morbidity and mortality. Acta Neurochir 140:1013–1016 discussion 1016-1017CrossRef

Boviatsis EJ, Bouras TI, Kouyialis AT, Themistocleous MS, Sakas DE (2007) Impact of age on complications and outcome in meningioma surgery. Surg Neurol 68:407–411; discussion 411. https://doi.org/10.1016/j.surneu.2006.11.071 CrossRefPubMed

Buhl R, Hasan A, Behnke A, Mehdorn HM (2000) Results in the operative treatment of elderly patients with intracranial meningioma. Neurosurg Rev 23:25–29CrossRef

10.

Caroli M, Locatelli M, Prada F, Beretta F, Martinelli-Boneschi F, Campanella R, Arienta C (2005) Surgery for intracranial meningiomas in the elderly: a clinical-radiological grading system as a predictor of outcome. J Neurosurg 102:290–294. https://doi.org/10.3171/jns.2005.102.2.0290 CrossRefPubMed

11.

Chen ZY, Zheng CH, Tang L, Su XY, Lu GH, Zhang CY, Xiao SW, Tan YF (2015) Intracranial meningioma surgery in the elderly (over 65 years): prognostic factors and outcome. Acta Neurochir 157:1549–1557; discussion 1557. https://doi.org/10.1007/s00701-015-2502-9 CrossRefPubMed

12.

Chen WC, Magill ST, Englot DJ, Baal JD, Wagle S, Rick JW, McDermott MW (2017) Factors associated with pre- and postoperative seizures in 1033 patients undergoing supratentorial meningioma resection. Neurosurgery 81:297–306. https://doi.org/10.1093/neuros/nyx001 CrossRefPubMedPubMedCentral

13.

Cohen-Inbar O, Soustiel JF, Zaaroor M (2009) Meningiomas in the elderly, the surgical benefit and a new scoring system. Acta Neurochir 152:87–97; discussion 97. https://doi.org/10.1007/s00701-009-0552-6 CrossRef

14.

Cohen-Inbar O, Sviri GE, Soustiel JF, Zaaroor M (2011) The geriatric scoring system (GSS) in meningioma patients—validation. Acta Neurochir 153:1501–1508; discussion 1508. https://doi.org/10.1007/s00701-011-1034-1 CrossRefPubMed

15.

Cohen-Inbar O, Lee CC, Schlesinger D, Xu Z, Sheehan JP (2015) Long-term results of stereotactic radiosurgery for skull base meningiomas. Neurosurgery 79:58–68. https://doi.org/10.1227/neu.0000000000001045 CrossRef

16.

Cornu P, Chatellier G, Dagreou F, Clemenceau S, Foncin JF, Rivierez M, Philippon J (1990) Intracranial meningiomas in elderly patients. Postoperative morbidity and mortality. Factors predictive of outcome. Acta Neurochir 102:98–102CrossRef

17.

Couldwell WT, Fukushima T, Giannotta SL, Weiss MH (1996) Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84:20–28. https://doi.org/10.3171/jns.1996.84.1.0020 CrossRefPubMed

18.

da Silva CE, Peixoto de Freitas PE (2016) Recurrence of skull base meningiomas: the role of aggressive removal in surgical treatment. J Neurol Surg B Skull Base 77:219–225. https://doi.org/10.1055/s-0035-1566251 CrossRefPubMed

19.

D'Andrea G, Roperto R, Caroli E, Crispo F, Ferrante L (2005) Thirty-seven cases of intracranial meningiomas in the ninth decade of life: our experience and review of the literature. Neurosurgery 56:956–961 discussion 956-961PubMed

20.

DeMonte F, McDermott MW, Al-Mefty O (2011) Al-Mefty’s meningiomas, 2nd edn. Thieme Medical, New York

21.

Djindjian M, Caron JP, Athayde AA, Fevrier MJ (1988) Intracranial meningiomas in the elderly (over 70 years old). A retrospective study of 30 surgical cases. Acta Neurochir 90:121–123CrossRef

22.

Englot DJ, Magill ST, Han SJ, Chang EF, Berger MS, McDermott MW (2015) Seizures in supratentorial meningioma: a systematic review and meta-analysis. J Neurosurg 124:1552–1561. https://doi.org/10.3171/2015.4.jns142742 CrossRefPubMedPubMedCentral

23.

Gerlach R, Raabe A, Scharrer I, Meixensberger J, Seifert V (2004) Post-operative hematoma after surgery for intracranial meningiomas: causes, avoidable risk factors and clinical outcome. Neurol Res 26:61–66. https://doi.org/10.1179/016164104773026543 CrossRefPubMed

24.

Gijtenbeek JM, Hop WC, Braakman R, Avezaat CJ (1993) Surgery for intracranial meningiomas in elderly patients. Clin Neurol Neurosurg 95:291–295CrossRef

25.

Gousias K, Schramm J, Simon M (2016) The Simpson grading revisited: aggressive surgery and its place in modern meningioma management. J Neurosurg 125:551–560. https://doi.org/10.3171/2015.9.jns15754 CrossRefPubMed

26.

Grossman R, Mukherjee D, Chang DC, Bennett R, Brem H, Olivi A, Quinones-Hinojosa A (2011) Preoperative charlson comorbidity score predicts postoperative outcomes among older intracranial meningioma patients. World Neurosurg 75:279–285. https://doi.org/10.1016/j.wneu.2010.09.003 CrossRefPubMed

27.

Hasseleid BF, Meling TR, Ronning P, Scheie D, Helseth E (2012) Surgery for convexity meningioma: Simpson grade I resection as the goal: clinical article. J Neurosurg 117:999–1006. https://doi.org/10.3171/2012.9.jns12294 CrossRefPubMed

28.

Jung HW, Yoo H, Paek SH, Choi KS (2000) Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery 46:567–574; discussion 574-565. https://doi.org/10.1097/00006123-200003000-00008 CrossRefPubMed

29.

Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH (1948) The use of the nitrogen mustards in the palliative treatment of carcinoma—with particular reference to bronchogenic carcinoma. Cancer 1:634–656CrossRef

30.

Kasuya H, Kubo O, Tanaka M, Amano K, Kato K, Hori T (2006) Clinical and radiological features related to the growth potential of meningioma. Neurosurg Rev 29:293–296; discussion 296-297. https://doi.org/10.1007/s10143-006-0039-3 CrossRefPubMedPubMedCentral

31.

Konglund A, Rogne SG, Lund-Johansen M, Scheie D, Helseth E, Meling TR (2012) Outcome following surgery for intracranial meningiomas in the aging. Acta Neurol Scand 127:161–169. https://doi.org/10.1111/j.1600-0404.2012.01692.x CrossRefPubMed

32.

Konglund A, Rogne SG, Helseth E, Meling TR (2013) Meningioma surgery in the very old-validating prognostic scoring systems. Acta Neurochir 155:2263–2271; discussion 2271. https://doi.org/10.1007/s00701-013-1872-0 CrossRefPubMed

33.

Lassen B, Helseth E, Ronning P, Scheie D, Johannesen TB, Maehlen J, Langmoen IA, Meling TR (2011) Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 68:1259–1268; discussion 1268-1259. https://doi.org/10.1227/NEU.0b013e31820c0441 CrossRefPubMed

34.

Lieu AS, Howng SL (1998) Surgical treatment of intracranial meningiomas in geriatric patients. Kaohsiung J Med Sci 14:498–503PubMed

35.

Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T (2005) Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery 56:546–559; discussion 546-559. https://doi.org/10.1227/01.NEU.0000153906.12640.62 CrossRefPubMed

36.

Mastronardi L, Ferrante L, Qasho R, Ferrari V, Tatarelli R, Fortuna A (1995) Intracranial meningiomas in the 9th decade of life: a retrospective study of 17 surgical cases. Neurosurgery 36:270–274CrossRef

37.

Maurice-Williams RS, Kitchen ND (1992) Intracranial tumours in the elderly: the effect of age on the outcome of first time surgery for meningiomas. Br J Neurosurg 6:131–137CrossRef

38.

McGrail KM, Ojemann RG (1994) The surgical management of benign intracranial meningiomas and acoustic neuromas in patients 70 years of age and older. Surg Neurol 42:2–7CrossRef

39.

Meling TR, Da Broi M, Scheie D, Helseth E (2018) Meningiomas: skull base versus non-skull base. Neurosurg Rev. https://doi.org/10.1007/s10143-018-0976-7

40.

Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL (1985) Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62:18–24. https://doi.org/10.3171/jns.1985.62.1.0018 CrossRefPubMed

41.

Morokoff AP, Zauberman J, Black PM (2008) Surgery for convexity meningiomas. Neurosurgery 63:427–433; discussion 433-424. https://doi.org/10.1227/01.neu.0000310692.80289.28 CrossRefPubMed

42.

Nakamura M, Struck M, Roser F, Vorkapic P, Samii M (2008) Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery 62:1224–1232. https://doi.org/10.1227/01.neu.0000333788.83349.1e CrossRefPubMed

43.

Natarajan SK, Sekhar LN, Schessel D, Morita A (2007) Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up. Neurosurgery 60:965–979; discussion 979-981. https://doi.org/10.1227/01.neu.0000255472.52882.d6 CrossRefPubMed

44.

NAV (2018) The Norwegian labour and welfare administration. https://www.nav.no/Forsiden. Accessed 19/04/2018 2018

45.

Nishizaki T, Kamiryo T, Fujisawa H, Ohshita N, Ishihara H, Ito H, Aoki H (1994) Prognostic implications of meningiomas in the elderly (over 70 years old) in the era of magnetic resonance imaging. Acta Neurochir 126:59–62CrossRef

46.

Ostrom QT, Gittleman H, Xu J, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS (2016) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009–2013. Neuro-Oncology 18:v1–v75. https://doi.org/10.1093/neuonc/now207 CrossRefPubMed

47.

Pallini R, Fernandez E, Lauretti L, Doglietto F, D’Alessandris QG, Montano N, Capo G, Meglio M, Maira G (2014) Olfactory groove meningioma: report of 99 cases surgically treated at the Catholic University School of Medicine, Rome. World Neurosurg 83:219–231.e211–213. doi:10.1016/j.wneu.2014.11.001

48.

Palmer JD, Sparrow OC, Iannotti F (1994) Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery 35:1061–1064 discussion 1064-1065CrossRef

49.

Papo I (1983) Intracranial meningiomas in the elderly in the CT scan era. Acta Neurochir 67:195–204CrossRef

50.

Patibandla MR, Lee CC, Sheehan J (2017) Stereotactic radiosurgery of central skull base meningioma’s—volumetric evaluation and long-term outcomes. World Neurosurg 108:176–184. https://doi.org/10.1016/j.wneu.2017.08.166 CrossRefPubMed

51.

Patil CG, Veeravagu A, Lad SP, Boakye M (2009) Craniotomy for resection of meningioma in the elderly: a multicentre, prospective analysis from the National Surgical Quality Improvement Program. J Neurol Neurosurg Psychiatry 81:502–505. https://doi.org/10.1136/jnnp.2009.185074 CrossRefPubMed

52.

Pietila TA, Stendel R, Hassler WE, Heimberger C, Ramsbacher J, Brock M (1999) Brain tumor surgery in geriatric patients: a critical analysis in 44 patients over 80 years. Surg Neurol 52:259–263 discussion 263-254CrossRef

53.

Pompili A, Callovini G, Delfini R, Domenicucci M, Occhipinti E (1998) Is surgery useful in very old patients with intracranial meningioma? Lancet 351(9099. England):337–338. https://doi.org/10.1016/s0140-6736(98)24005-0 CrossRefPubMed

54.

Poon MT, Fung LH, Pu JK, Leung GK (2013) Outcome comparison between younger and older patients undergoing intracranial meningioma resections. J Neuro-Oncol 114:219–227. https://doi.org/10.1007/s11060-013-1173-8 CrossRef

55.

Proust F, Verdure L, Toussaint P, Bellow F, Callonec F, Menard JF, Freger P (1997) Intracranial meningioma in the elderly. Postoperative mortality, morbidity and quality of life in a series of 39 patients over 70 years of age. Neuro-Chirurgie 43:15–20PubMed

56.

Roberti F, Sekhar LN, Kalavakonda C, Wright DC (2001) Posterior fossa meningiomas—surgical experience in 161 cases. Surg Neurol 56:8–20 discussion 20-21CrossRef

57.

Rogne SG, Konglund A, Meling TR, Scheie D, Johannesen TB, Ronning P, Helseth E (2009) Intracranial tumor surgery in patients > 70 years of age: is clinical practice worthwhile or futile? Acta Neurol Scand 120:288–294. https://doi.org/10.1111/j.1600-0404.2009.01157.x CrossRefPubMed

58.

Roser M (2015) Life expectancy. https://ourworldindata.org/. Accessed 19/04/2018 2018

59.

Roser F, Ebner FH, Ritz R, Samii M, Tatagiba MS, Nakamura M (2007) Management of skull based meningiomas in the elderly patient. J Clin Neurosci 14:224–228. https://doi.org/10.1016/j.jocn.2005.12.004 CrossRefPubMed

60.

Sacko O, Sesay M, Roux FE, Riem T, Grenier B, Liguoro D, Loiseau H (2007) Intracranial meningioma surgery in the ninth decade of life. Neurosurgery 61:950–954; discussion 955. https://doi.org/10.1227/01.neu.0000303190.80049.7d CrossRefPubMed

61.

Savardekar AR, Patra DP, Bir S, Thakur JD, Mohammed N, Bollam P, Georgescu MM, Nanda A (2017) Differential tumor progression patterns in skull base versus non-skull base meningiomas: a critical analysis from a long-term follow-up study and review of literature. World Neurosurg 112:e74–e83. https://doi.org/10.1016/j.wneu.2017.12.035 CrossRefPubMed

62.

Scheitzach J, Schebesch KM, Brawanski A, Proescholdt MA (2013) Skull base meningiomas: neurological outcome after microsurgical resection. J Neuro-Oncol 116:381–386. https://doi.org/10.1007/s11060-013-1309-x CrossRef

63.

Schick U, Bleyen J, Bani A, Hassler W (2006) Management of meningiomas en plaque of the sphenoid wing. J Neurosurg 104:208–214. https://doi.org/10.3171/jns.2006.104.2.208 CrossRefPubMed

64.

Schul DB, Wolf S, Krammer MJ, Landscheidt JF, Tomasino A, Lumenta CB (2011) Meningioma surgery in the elderly: outcome and validation of 2 proposed grading score systems. Neurosurgery 70:555–565. https://doi.org/10.1227/NEU.0b013e318233a99a CrossRef

65.

Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39. https://doi.org/10.1136/jnnp.20.1.22 CrossRefPubMedPubMedCentral

66.

Spektor S, Valarezo J, Fliss DM, Gil Z, Cohen J, Goldman J, Umansky F (2005) Olfactory groove meningiomas from neurosurgical and ear, nose, and throat perspectives: approaches, techniques, and outcomes. Neurosurgery 57:268–280; discussion 268-280. https://doi.org/10.1227/01.NEU.0000176409.70668.EB CrossRefPubMed

67.

Starke RM, Williams BJ, Hiles C, Nguyen JH, Elsharkawy MY, Sheehan JP (2011) Gamma knife surgery for skull base meningiomas. J Neurosurg 116:588–597. https://doi.org/10.3171/2011.11.jns11530 CrossRefPubMed

68.

Umansky F, Ashkenazi E, Gertel M, Shalit MN (1992) Surgical outcome in an elderly population with intracranial meningioma. J Neurol Neurosurg Psychiatry 55:481–485CrossRef

69.

van Alkemade H, de Leau M, Dieleman EM, Kardaun JW, van Os R, Vandertop WP, van Furth WR, Stalpers LJ (2012) Impaired survival and long-term neurological problems in benign meningioma. Neuro-Oncology 14:658–666. https://doi.org/10.1093/neuonc/nos013 CrossRefPubMedPubMedCentral

70.

Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A (2007) Incidental findings on brain MRI in the general population. N Engl J Med 357:1821–1828. https://doi.org/10.1056/NEJMoa070972

71.

Voss KM, Spille DC, Sauerland C, Suero Molina E, Brokinkel C, Paulus W, Stummer W, Holling M, Jeibmann A, Brokinkel B (2017) The Simpson grading in meningioma surgery: does the tumor location influence the prognostic value? J Neuro-Oncol 133:641–651. https://doi.org/10.1007/s11060-017-2481-1 CrossRef

72.

Zouaoui S, Darlix A, Rigau V, Mathieu-Daude H, Bauchet F, Bessaoud F, Fabbro-Peray P, Tretarre B, Figarella-Branger D, Taillandier L, Loiseau H, Bauchet L (2015) Descriptive epidemiology of 13,038 newly diagnosed and histologically confirmed meningiomas in France: 2006–2010. Neuro-Chirurgie. https://doi.org/10.1016/j.neuchi.2014.11.013

Title: Skull base versus non-skull base meningioma surgery in the elderly
Authors: Torstein R. Meling
Michele Da Broi
David Scheie
Eirik Helseth
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Published in: Neurosurgical Review / Issue 4/2019
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-018-1005-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Skull base versus non-skull base meningioma surgery in the elderly

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2019

Is it all a matter of size? Impact of maximization of surgical resection in cerebral tumors

Vasospasm of the basilar artery following spontaneous SAH—clinical observations and implications for vascular research

A literature review concerning contralateral approaches to paraclinoid internal carotid artery aneurysms

Patterns of short-term and long-term surgical outcomes and prognostic factors for cervical ossification of the posterior longitudinal ligament between anterior cervical corpectomy and fusion and posterior laminoplasty

Safe and bloodless exposure of the third segment of the vertebral artery: a step-by-step overview based on over 50 personal cases

Cervical medullary syndrome secondary to craniocervical instability and ventral brainstem compression in hereditary hypermobility connective tissue disorders: 5-year follow-up after craniocervical reduction, fusion, and stabilization