Intracranial meningiomas in patients 80 years old and older: pathological features and surgical problems

Background: Patients older than 80 years-old frequently harbor intracranial meningiomas. This study discusses the pathological features, comorbidities, and surgical complications of this age group from a surgical series and the literature review. Methods: This study reviews a surgical series of 354 intracranial meningiomas and compares the oldest age group (≥ 80 years) of 17 patients with a group of 73 patients aged 70-79 years and a group of 264 aged < 70 years. From a literature review we selected 10 studies of meningiomas in patients ≥ 80 years. The analyzed factors include the patient sex, meningioma location, WHO grade, Ki67 MIB1, progesterone receptor (PR) expression, comorbidities, ASA (American Society of Anesthesiology) score, KPS (Karnofski Performance Status), postoperative complications and death. Results: Patients ≥ 80 years show higher rates of WHO grade II meningiomas, higher rates of cases with Ki67 > 4% and < 20% and PR expression < 15%. Among the postoperative complications only the neurological deficits and acute bronchopneumonia were significantly more frequent in patients ≥ 80 years. Intracerebral hematoma, lung embolism, acute heart ischemia and death rate were not significantly different between patients aged ≥ 80 years and those aged 70-79 years and < 70 years. Conclusion: Patients aged ≥ 80 years must be considered the true elderly group showing higher rates of comorbidities. The very old age is not a limitation to surgery; however, a careful patient selection is necessary. Besides, in this age group the surgical decision should not be delayed, because of the advancing age.