Case Series of Skull Base Meningioma Resections in the Octogenarian Population

Introduction/Hypothesis: With an aging population, the octogenarian patients are increasingly seen by neurosurgeons for consultation. Although these patients present with a variety of cranial and spinal pathologies, meningiomas are a comparatively common pathology, given that the prevalence of incidentally found tumors in elderly patients is 1.6%.[1]

Unfortunately, though octogenarian patients with meningiomas are increasing seen in neurosurgical clinics, providers do not have clear data to help guide their decision making. In particular, the data for skull base lesions are scarce. Current research in the elderly looks at a wide range of age groups, classifying anyone above 65 as “elderly.” In the studies looking at patients in their seventh or eighth decade of life, mortality for skull base procedures ranged from 0 to 29%.[2] However, these studies were inconsistent in their capture of comorbidities and morbidities. This article strives to clarify the experiences and outcomes of patients in their eighth decade of life.

Methods: This retrospective series reviews all octogenarian skull base tumor surgeries performed at a single academic institution over the past 15 years. Records are reviewed for surgical indications, preoperative neurologic deficits; perioperative wound healing and neurologic recovery. Specific attention is focused on requirement of tracheostomy or gastrostomy after surgery, sepsis, respiratory infections, and withdrawal of care or early death within 30 days of the operation. Multivariate logistic regression is performed to identify relevant perioperative and medical characteristics that increases the risk of these adverse events.

Results: Fourteen patients underwent craniotomies for skull base procedures in our series with an average age of 84.5. Of the patients, 79% had serious comorbidities and the same number was either on antiplatelet agents or systemic anticoagulation. Though two of the patients expired before 30 days postop, only one patient required a tracheostomy on discharge and approximately half were able to either go home or inpatient rehab after their procedure. On statistical analysis, there were no noted patient characteristics that predisposed any of our patients to a poorer outcome.

Conclusion: In our series, extremely elderly patients were able to tolerate the surgeries for resection of skull base meningioma. However, the decision to pursue surgery was often forced by acute neurologic decline refractory to medical therapy. In spite of often being in extremis, the patients did not seem to be at higher risk for a tracheostomy or a feeding tube postoperative. ultimately, the decision making regarding octogenarian surgeries is complex, and this series shows that the patients in their eighth decade of life can still be valid surgical candidates.

• References

• Vernooij MW, Ikram MA, Tanghe HL, et al. Incidental findings on brain MRI in the general population. N Engl J Med 2007; 357 (18) 1821-1828
• Meling TR, Da Broi M, Scheie D, Helseth E. Skull base versus non-skull base meningioma surgery in the elderly. Neurosurg Rev 2019; 42 (04) 961-972