Meningioma surgery in younger and older adults: patient profile and surgical outcomes

Background Due to increasing life expectancy, the number of older patients harboring a meningioma is expected to increase. We determined whether preoperative variables and postoperative clinical outcome differ between younger and older adults. Methods Medical records of meningioma patients were retrospectively analyzed. Preoperative variables were age, gender, neurological symptoms, Karnofsky Performance Status (KPS), American Society of Anesthesiologists Physical Status (ASA)-classification and tumor characteristics. Clinical outcome was assessed using complication rates, length of hospital stay and destination after discharge. After 6-12 and 12-18-month KPS, neurological symptoms and Glasgow Outcome Scale (GOS) scores were assessed for older (age ≥ 65 years) and younger adults (18-65 years) using Mann-Whitney U, T test, Pearson's Chi square or Fisher's exact. Results 89 patients were included (23 ≥ 65 years). Before surgery, older patients scored higher on ASA classification (p = 0.003) and lower on KPS (p = 0.017). There was no significant difference postoperatively in mortality, complications and duration of hospital stay. Less older patients were discharged directly to home compared to younger adults (52 vs 80%, respectively; p = 0.004). In surviving patients, less older subjects had a good recovery (GOS 4-5) at 6-12 months' follow-up compared to younger subjects (64 vs 93%, respectively; p = 0.035). At 12-18 months, there was no significant difference in good recovery between both age groups (82 vs 92%). Conclusion In this cohort, outcome was worse for patients ≥ 65 years old in terms of discharge destination and good recovery at 6-12 months. At 12-18 months follow-up, older subjects performed not significantly different from younger ones. Careful patient selection seems essential to reach good results in meningioma surgery for patients ≥ 65 years old.