Clinical features and surgical management of intracranial meningiomas in the elderly

Yamamoto,Junkoh; Takahashi,Mayu; Idei,Masaru; Nakano,Yoshiteru; Soejima,Yoshiteru; Akiba,Daisuke; Kitagawa,Takehiro; Ueta,Kunihiro; Miyaoka,Ryo; Nishizawa,Shigeru

doi:10.3892/ol.2017.6174

Clinical features and surgical management of intracranial meningiomas in the elderly

Authors:
- Junkoh Yamamoto
- Mayu Takahashi
- Masaru Idei
- Yoshiteru Nakano
- Yoshiteru Soejima
- Daisuke Akiba
- Takehiro Kitagawa
- Kunihiro Ueta
- Ryo Miyaoka
- Shigeru Nishizawa
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Affiliations: Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu 807‑8555, Japan
Published online on: May 16, 2017 https://doi.org/10.3892/ol.2017.6174
Pages: 909-917

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Abstract

Meningioma accounts for ~25% of all primary intracranial neoplasms and the incidence increases with age. Prvios population-based studies demonstrated that the annual incidence of intracranial meningiomas was 1.2-3.1/100,000 population. In particular, the incidence of this disease among the elderly is high. Recently, increased life expectancy and greater use of diagnostic radiological imaging led to an increased incidence in the diagnosis of intracranial meningiomas, both symptomatic and asymptomatic, in the elderly. Thus, neurosurgeons may be increasingly confronted with the management of intracranial meningiomas in the elderly. In practice, it is often difficult for physicians to determine whether traditional surgical resection is the optimal management strategy for intracranial meningiomas in the elderly. However, reported clinical studies about the outcome of surgical resection of intracranial meningiomas in the elderly are limited. Increased risk of mortality and morbidity associated with surgical treatment for intracranial meningiomas in the elderly compared with younger patients have been controversial. In the present study, the clinical features of intracranial meningiomas in 70 consecutive intracranial meningioma patients that underwent surgical treatment at the affiliated hospital of University of Occupational and Environmental Health between 2007 and 2013 were assessed. In addition, patient selection and surgical management of intracranial meningioma in elderly patients was discussed. Preoperative factors, including symptoms, tumor location, tumor size, Karnofsky Performance Scale (KPS) score and American Society of Anesthesiology (ASA) score, and postoperative factors, including pathological diagnosis, tumor proliferation index (Ki‑67), resection rate (Simpson grade), length of hospital stay and discharge destination were retrospectively analyzed in patients aged ≥75 years (n=16; elderly group) and <75 years (n=54; younger group). Outcomes were assessed 6 months after surgery. Multivariate logistic regression revealed that tumor resection rate (Simpson grade III‑V) was an important predictor of surgical complications (odds ratio, 5.662; 95% confidence interval, 1.323‑24.236; P=0.0194). Perioperative morbidity was not correlated with age (>75 years), tumor location, tumor size, KPS score or ASA score. Thus, the present study indicated that age is not associated with surgical outcome in elderly meningioma patients. Regardless of patient age, the decision to perform surgical resection should be made on an individual basis wherein tumor characteristics and the general health of the patient are considered.

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1	Wiemels J, Wrensch M and Claus EB: Epidemiology and etiology of meningioma. J Neurooncol. 99:307–314. 2010. View Article : Google Scholar : PubMed/NCBI
2	Kurland LT, Schoenberg BS, Annegers JF, Okazaki H and Molgaard CA: The incidence of primary intracranial neoplasms in Rochester, Minnesota, 1935–1977. Ann NY Acad Sci. 381:6–16. 1982. View Article : Google Scholar : PubMed/NCBI
3	Matsutani M: Treatment for asymptomatic meningioma. No To Shinkei. 53:327–330. 2001.(In Japanese). PubMed/NCBI
4	Kuratsu J, Kochi M and Ushio Y: Incidence and clinical features of asymptomatic meningiomas. J Neurosurg. 92:766–770. 2000. View Article : Google Scholar : PubMed/NCBI
5	Onizuka M, Suyama K, Shibayama A, Hiura T, Horie N and Miyazaki H: Asymptomatic brain tumor detected at brain check-up. Neurol Med Chir (Tokyo). 41:431–435. 2001. View Article : Google Scholar : PubMed/NCBI
6	Patil CG, Veeravagu A, Lad SP and Boakye M: 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. 2010. View Article : Google Scholar : PubMed/NCBI
7	Poon MT, Fung LH, Pu JK and Leung GK: Outcome of elderly patients undergoing intracranial meningioma resection - a systematic review and meta-analysis. Br J Neurosurg. 28:303–309. 2014. View Article : Google Scholar : PubMed/NCBI
8	Bateman BT, Pile-Spellman J, Gutin PH and Berman MF: Meningioma resection in the elderly: Nationwide inpatient sample, 1998–2002. Neurosurgery. 57:866–872. 2005. View Article : Google Scholar : PubMed/NCBI
9	Cohen-Inbar O, Soustiel JF and Zaaroor M: Meningiomas in the elderly, the surgical benefit and a new scoring system. Acta Neurochir (Wien). 152:87–97. 2010. View Article : Google Scholar : PubMed/NCBI
10	Schul DB, Wolf S, Krammer MJ, Landscheidt JF, Tomasino A and Lumenta CB: Meningioma surgery in the elderly: Outcome and validation of 2 proposed grading score systems. Neurosurgery. 70:555–565. 2012. View Article : Google Scholar : PubMed/NCBI
11	Black P, Kathiresan S and Chung W: Meningioma surgery in the elderly: A case-control study assessing morbidity and mortality. Acta Neurochir (Wien). 140:1013–1017. 1998. View Article : Google Scholar : PubMed/NCBI
12	Maurice-Williams RS and Kitchen ND: Intracranial tumours in the elderly: The effect of age on the outcome of first time surgery for meningiomas. Br J Neurosurg. 6:131–137. 1992. View Article : Google Scholar : PubMed/NCBI
13	Kuratsu J and Ushio Y: Epidemiological study of primary intracranial tumours in elderly people. J Neurol Neurosurg Psychiatry. 63:116–118. 1997. View Article : Google Scholar : PubMed/NCBI
14	Papo I: Intracranial meningiomas in the elderly in the CT scan era. Acta Neurochir (Wien). 67:195–204. 1983. View Article : Google Scholar : PubMed/NCBI
15	Caroli M, Locatelli M, Prada F, Beretta F, Martinelli-Boneschi F, Campanella R and Arienta C: Surgery for intracranial meningiomas in the elderly: A clinical-radiological grading system as a predictor of outcome. J Neurosurg. 102:290–294. 2005. View Article : Google Scholar : PubMed/NCBI
16	Cohen-Inbar O, Sviri GE, Soustiel JF and Zaaroor M: The Geriatric Scoring System (GSS) in meningioma patients - validation. Acta Neurochir (Wien). 153:1501–1508. 2011. View Article : Google Scholar : PubMed/NCBI
17	Sacko O, Sesay M, Roux FE, Riem T, Grenier B, Liguoro D and Loiseau H: Intracranial meningioma surgery in the ninth decade of life. Neurosurgery. 61:950–955. 2007. View Article : Google Scholar : PubMed/NCBI
18	Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 20:22–39. 1957. View Article : Google Scholar : PubMed/NCBI
19	Perry A, Louis DN, Scheithauer BW, Budka H and von Deimling A: MeningiomasWHO Classification of Tumours of the Central Nervous System. Louis DN, Ohgaki H, Wiestler OD and Cavenee WK: 4th. IARC Press; Lyon: pp. 164–172. 2007
20	Helseth A, Mørk SJ, Johansen A and Tretli S: Neoplasms of the central nervous system in Norway. IV. A population-based epidemiological study of meningiomas. APMIS. 97:646–654. 1989. View Article : Google Scholar : PubMed/NCBI
21	Nakasu S, Hirano A, Shimura T and Llena JF: Incidental meningiomas in autopsy study. Surg Neurol. 27:319–322. 1987. View Article : Google Scholar : PubMed/NCBI
22	Sadetzki S, Modan B, Chetrit A and Freedman L: An iatrogenic epidemic of benign meningioma. Am J Epidemiol. 151:266–272. 2000. View Article : Google Scholar : PubMed/NCBI
23	Rohringer M, Sutherland GR, Louw DF and Sima AA: Incidence and clinicopathological features of meningioma. J Neurosurg. 71:665–672. 1989. View Article : Google Scholar : PubMed/NCBI
24	Heshmat MY, Kovi J, Simpson C, Kennedy J and Fan KJ: Neoplasms of the central nervous system. Incidence and population selectivity in the Washington DC, metropolitan area. Cancer. 38:2135–2142. 1976. View Article : Google Scholar : PubMed/NCBI
25	Barker DJ, Weller RO and Garfield JS: Epidemiology of primary tumours of the brain and spinal cord: A regional survey in southern England. J Neurol Neurosurg Psychiatry. 39:290–296. 1976. View Article : Google Scholar : PubMed/NCBI
26	Claus EB, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M and Black PM: Epidemiology of intracranial meningioma. Neurosurgery. 57:1088–1095. 2005. View Article : Google Scholar : PubMed/NCBI
27	Olivero WC, Lister JR and Elwood PW: The natural history and growth rate of asymptomatic meningiomas: A review of 60 patients. J Neurosurg. 83:222–224. 1995. View Article : Google Scholar : PubMed/NCBI
28	Niiro M, Yatsushiro K, Nakamura K, Kawahara Y and Kuratsu J: Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry. 68:25–28. 2000. View Article : Google Scholar : PubMed/NCBI
29	Yoneoka Y, Fujii Y and Tanaka R: Growth of incidental meningiomas. Acta Neurochir (Wien). 142:507–511. 2000. View Article : Google Scholar : PubMed/NCBI
30	Hashimoto N, Rabo CS, Okita Y, Kinoshita M, Kagawa N, Fujimoto Y, Morii E, Kishima H, Maruno M, Kato A and Yoshimine T: Slower growth of skull base meningiomas compared with non-skull base meningiomas based on volumetric and biological studies. J Neurosurg. 116:574–580. 2012. View Article : Google Scholar : PubMed/NCBI
31	Hashiba T, Hashimoto N, Izumoto S, Suzuki T, Kagawa N, Maruno M, Kato A and Yoshimine T: Serial volumetric assessment of the natural history and growth pattern of incidentally discovered meningiomas. J Neurosurg. 110:675–684. 2009. View Article : Google Scholar : PubMed/NCBI
32	Torp SH, Lindboe CF, Grønberg BH, Lydersen S and Sundstrøm S: Prognostic significance of Ki-67/MIB-1 proliferation index in meningiomas. Clin Neuropathol. 24:170–174. 2005.PubMed/NCBI
33	Hus CY, Ho DM, Yang CF and Chiang H: Interobserver reproducibility of MIB-1 labeling index in astrocytic tumors using different counting methods. Mod Pathol. 16:951–957. 2003. View Article : Google Scholar : PubMed/NCBI
34	Kasuya H, Kubo O, Tanaka M, Amano K, Kato K and Hori T: Clinical and radiological features related to the growth potential of meningioma. Neurosurg Rev. 29:293–297. 2006. View Article : Google Scholar : PubMed/NCBI
35	McGovern SL, Aldape KD, Munsell MF, Mahajan A, DeMonte F and Woo SY: A comparison of World Health Organization tumor grades at recurrence in patients with non-skull base and skull base meningiomas. J Neurosurg. 112:925–933. 2010. View Article : Google Scholar : PubMed/NCBI
36	Rubin G, Herscovici Z, Laviv Y, Jackson S and Rappaport ZH: Outcome of untreated meningiomas. Isr Med Assoc J. 13:157–160. 2011.PubMed/NCBI
37	Committee of Brain Tumor Registry of Japan, . Report of Brain Tumor Registry of Japan (2001–2004), Vol. 13. Neurol Med Chir (Tokyo). 54:1–102. 2014.
38	D'Andrea G, Roperto R, Caroli E, Crispo F and 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.PubMed/NCBI
39	Cahill KS and Claus EB: Treatment and survival of patients with nonmalignant intracranial meningioma: Results from the Surveillance, Epidemiology and End Results Program of the National Cancer Institute. Clinical article. J Neurosurg. 115:259–267. 2011. View Article : Google Scholar : PubMed/NCBI
40	Sankila R, Kallio M, Jääskeläinen J and Hakulinen T: Long-term survival of 1986 patients with intracranial meningioma diagnosed from 1953 to 1984 in Finland. Comparison of the observed and expected survival rates in a population-based series. Cancer. 70:1568–1576. 1992. View Article : Google Scholar : PubMed/NCBI
41	Adachi K, Kawase T, Yoshida K, Yazaki T and Onozuka S: ABC Surgical risk scale for skull base meningioma: A new scoring system for predicting the extent of tumor removal and neurological outcome. Clinical article. J Neurosurg. 111:1053–1061. 2009. View Article : Google Scholar : PubMed/NCBI
42	Yamamoto J, Kakeda S, Takahashi M, Aoyama Y, Soejima Y, Saito T, Akiba D, Korogi Y and Nishizawa S: Dural attachment of intracranial meningiomas: Evaluation with contrast-enhanced three-dimensional fast imaging with steady-state acquisition (FIESTA) at 3 T. Neuroradiology. 53:413–423. 2011. View Article : Google Scholar : PubMed/NCBI