Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Therapeutic Strategies of the Intracranial Meningioma in Elderly Patients

  • Song, Young-Jin (Department of Neurosurgery, Dong-A University College of Medicine) ;
  • Sung, Soon-Ki (Department of Neurosurgery, Dong-A University College of Medicine) ;
  • Noh, Seung-Jin (Department of Neurosurgery, Dong-A University College of Medicine) ;
  • Kim, Hyung-Dong (Department of Neurosurgery, Dong-A University College of Medicine)
  • Published : 2007.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The apparent increase in the incidence of the intracranial meningiomas in the elderly is due in part to improved diagnostic tools and improved span of life. The authors carried out a retrospect study to validate the use of the Clinical-Radiological Grading System [CRGS] as a clinical tool to orientate surgical decision making in elderly patients and to explore prognostic factors of survival. Methods : From January 1997 to January 2006, the authors consecutively recruited and surgically treated 20 patients older than 65 years of age with radiologic findings of intracranial meningiomas and a preoperative evaluation based on the CRGS. Results : High CRGS score was associated with a higher probability of good outcome [p=0.004] and a lower probability of postoperative complications [p=0.049]. Among the different subset items of the CRGS score, larger maximum tumor diameters [$D{\geqq}4cm$] and the presence of a severe peritumoral edema were associated with incidence rate of postoperative poor outcome and complications [p<0.05]. Additionally, the critical location of the tumor was also correlated with poor outcome [p<0.05]. Conclusion : A CRGS score higher than 13 is a good prognostic indication of survival. The CRGS score is a useful and practical tool for the selection of elderly patients affected by intracranial meningiomas as surgical candidates.

Keywords

References

  1. Arienta C, Caroli M, Crotti F, Villani R : Treatment of intracranial meningiomas in patients over 70 years old. Acta Neurochir (Wien) 107 : 47-55, 1990 https://doi.org/10.1007/BF01402612
  2. Awad IA, Kalfas I, Hahn JF, Little JR : Intracranial meningiomas in the aged : surgical outcome in the era of computed tomography. Neurosurgery 24 : 557-560, 1989 https://doi.org/10.1227/00006123-198904000-00011
  3. Bateman BT, Pile-Spellman J, Gutin PH, Berman MF : Meningioma resection in the elderly : nationwide inpatient sample, 1998-2002. Neurosurgery 57 : 866-872, 2005 https://doi.org/10.1227/01.NEU.0000179923.66729.87
  4. Black P, Kathiresan S, Chung W : Meningioma surgery in the elderly : a case-control study assessing morbidity and mortality. Acta Neurochir (Wien) 140 : 1013-1016, 1998 https://doi.org/10.1007/s007010050209
  5. Britz GW, Winn HR : Meningioma : Youmans Neurological Surgery, 5th. ed. Saunders Co., 2004, pp1099-1131
  6. Buhl R, Hasan A, Behnke A, Mehdorn HM : Results in the operative treatment of elderly patients with intracranial meningioma. Neurosurg Rev 23 : 25-29, 2000 https://doi.org/10.1007/s101430050027
  7. Caroli M, Locatelli M, Prada F, Beretta F, Martinelli-Boneschi F, Campanella R, et al : Surgery for intracranial meningiomas in the elderly : a clinical-radiological grading system as a predictor of outcome. J Neurosurg 102 : 290-294, 2005 https://doi.org/10.3171/jns.2005.102.2.0290
  8. Chang JH, Chang JW, Choi JY, Park YG, Chung SS : Complications after gamma knife radiosurgery for benign meningiomas. J Neurol Neurosurg Psychiatry 74 : 226-230, 2003 https://doi.org/10.1136/jnnp.74.2.226
  9. Cornu P, Chatellier G, Dagreou F, Clemenceau S, Foncin JF, Rivierez M, et al : Intracranial meningiomas in elderly patients. Postoperative morbidity and mortality. Factors predictive of outcome. Acta Neurochir (Wien) 102 : 98-102, 1990 https://doi.org/10.1007/BF01405421
  10. D'Andrea G, Roperto R, Caroli E, Crispo F, Ferrante L : Thirty-seven cases of intracranial meningiomas in the ninth decade of life : our experience and review of the literature. Neurosurgery 56 : 956-961, 2005
  11. DiBiase SJ, Kwok Y, Yovino S, Arena C, Naqvi S, Temple R, et al : Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 60 : 1515-1519, 2004 https://doi.org/10.1016/j.ijrobp.2004.05.073
  12. Djindjian M, Caron JP, Athayde AA, Fevrier MJ : Intracranial meningiomas in the elderly(over 70 years old). A retrospective study of 30 surgical cases. Acta Neurochir(Wien) 90 : 121-123, 1988 https://doi.org/10.1007/BF01560565
  13. Gijtenbeek JM, Hop WC, Braakman R, Avezaat CJ : Surgery for intracranial meningiomas in elderly patients. Clin Nerol Neurosurg 95 : 291-295, 1993 https://doi.org/10.1016/0303-8467(93)90104-O
  14. Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH : The use of th nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer 1 : 634- 656, 1948 https://doi.org/10.1002/1097-0142(194811)1:4<634::AID-CNCR2820010410>3.0.CO;2-L
  15. Kim JE, Kim DG, Chung HT, Paek SH, Jung HW : Gamma knife radiosurgery for skull base meningiomas. J Korean Neurosurg Soc 33 : 363-369, 2003
  16. Kobayashi T, Kida Y, Mori Y : Long-term results of stereotactic gamma radiosurgery of meningiomas. Surg Neurol 55 : 326-331, 2001
  17. Mastronardi L, Ferrante L, Qasho R, Ferrari V, Tatarelli R, Fortuna A : Intracranial meningiomas in the 9th decade of life : a retrospective study of 17 surgical cases. Neurosurgery 36 : 270-274, 1995 https://doi.org/10.1227/00006123-199502000-00005
  18. Maurice-Williams RS, Kitchen ND : Intracranial tumours in the elderly : the effective of age on the outcome of first time surgery for meningiomas. Br J Neurosurg 6 : 131-137, 1992 https://doi.org/10.3109/02688699209002915
  19. McGrail KM, Ojemann R : The surgical management of benign intracranial meningiomas and acoustic neuromas in patients 70 years of age and older. Surg Neurol 42 : 2-7, 1994 https://doi.org/10.1016/0090-3019(94)90241-0
  20. Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL : Meningioma : analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62 : 18-24, 1985 https://doi.org/10.3171/jns.1985.62.1.0018
  21. Papo I : Intracranial meningiomas in the elderly in the CT scan era. Acta Neurosurg 44 : 211-217, 1983
  22. Proust F, Verdure L, Toussaint P, Bellow F, Callonec F, Menard JF, Freger P : Intracranial meningioma in the elderly. Postoperative over70 years of age. Neurochirurgie 43 : 15-20, 1997
  23. Rohringer M, Sutherland GR, Louw DF, Sima AA : Incidence and clinicopathological features of meningioma. J Neurosurg 71 : 665- 672, 1989 https://doi.org/10.3171/jns.1989.71.5.0665
  24. Schneider AJL : Assessment of risk factors and surgical outcome. Surg Clin North Am 63 : 1113-1126, 1983 https://doi.org/10.1016/S0039-6109(16)43141-5
  25. Sonoda Y, Sakurada K, Saino M, Kondo R, Sato S, Kayama T : Multimodal strategy for managing meningiomas in the elderly. Acta Neurochir (Wien) 147 : 131-136, 2005 https://doi.org/10.1007/s00701-004-0391-4
  26. Umansky F, Ashkenazi E, Gertel M, Shalit MN : Surgical outcome in an elderly population with intracranial meningioma. J Neurol Neurosurg Psychiatry 55 : 481-485, 1992 https://doi.org/10.1136/jnnp.55.6.481