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Intracranial Meningiomas in the Elderly: Clinical, Surgical and Economic Evaluation. A Multicentric Experience

1
Neurosurgery Department, Humanitas Clinical and Research Center—IRCCS, via Manzoni 56, 20089 Rozzano Mi, Italy
2
Neurosurgical Unit, University Hospital of Udine (ASUFC), Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy
3
Department of Neuroradiology, University Hospital of Udine (ASUFC), Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(9), 2685; https://doi.org/10.3390/cancers12092685
Received: 29 July 2020 / Revised: 2 September 2020 / Accepted: 16 September 2020 / Published: 20 September 2020
(This article belongs to the Special Issue Meningiomas and Low Grade Gliomas)
Meningiomas are the most common intracranial tumors. Given the increase in life expectancy and the widespread access and use of brain imaging, the incidence in the elderly population (≥65 years) is continuously increasing. The risk/benefit ratio of surgery in elderly patients with intracranial meningioma has not been clearly defined because of the lack of objective measurement tools. The aim of our work to understand the risk factors associated with postsurgical outcomes and how these risk factors affected postsurgical outcomes in elderly patients with intracranial meningioma.
Meningioma is one of the most common intracranial tumors. It is benign and slow growing in the majority of cases. Given the increase in life expectancy and the number of radiological tests performed, the incidence in the elderly population (≥65 years) is continuously increasing. The surgical outcomes and prognostic factors in this age group are unclear. A retrospective analysis of all the patients treated for intracranial meningiomas in two different Italian institutions was performed. The clinical, radiological, surgical and follow-up data were retrospectively reviewed. Statistical analyses were performed to identify relationships between factors and outcomes. We also carried out an economic analysis. We analyzed 321 patients with intracranial meningioma. The mean age was 72.6 years (range, 65–90), with a female predominance (F/M, 1.41). Pre-operative deficits, cognitive impairment and seizures (p < 0.001) were associated with a worse post-operative Karnofsky performance scale (KPS) score (<80). A high pre-operative KPS score was associated with a good clinical and neurological outcome (p < 0.001). Being aged between 65 and 74 years, low surgical timing and Simpson removal grades of I and II were associated with a good outcome (p < 0.001). The length of hospitalization was significantly related to the outcome (p < 0.001). The complication rate was 14.3%. At 6-month follow-up, the mortality rate was 2.5%. The average cost was higher in patients with a pre-operative KPS score lower than 80. The outcome of intracranial-meningioma resection in elderly individuals is favorable when the pre-operative KPS score is >80. Treatment should be patient-specific, and additional factors should be considered. Patients with poor pre-operative clinical conditions might benefit from a combined strategy with partial resection and radiosurgery in order to reduce surgical timing and the complication rate. View Full-Text
Keywords: elderly patient; intracranial meningioma; neurosurgery; neurological outcome elderly patient; intracranial meningioma; neurosurgery; neurological outcome
MDPI and ACS Style

Cannizzaro, D.; Tropeano, M.P.; Zaed, I.; De Robertis, M.; Olei, S.; Vindigni, M.; Pegolo, E.; Bagatto, D.; Cardia, A.; Maira, G.; Fornari, M.; Skrap, M.; Ius, T. Intracranial Meningiomas in the Elderly: Clinical, Surgical and Economic Evaluation. A Multicentric Experience. Cancers 2020, 12, 2685.

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