Impact of age on complications and outcome in meningioma surgery

Background: Surgery for benign brain tumors in elderly patients without severe general health problems is an acceptable practice, as results are comparable with the ones of younger patients. Nevertheless, the hypothesis that operative complications and perioperative incidents could differ between the 2 age groups should be controlled; and age-specific strategies in operative technique and perioperative care may be useful. Methods: Medical records of 348 patients were reviewed. Demographic data (age, sex), rate of excision, complications of the immediate postoperative period, neurological outcome, and mortality were recorded; and statistical evaluation comparing 2 age groups (19-64 and 65-84 years of age) was performed. Results: The young age group consisted of 240 patients, whereas the elderly one had 108. Tumor removal rate was not significantly different in the 2 groups. The elderly age group included significantly more complicated cases. Regarding each complication, postoperative hematoma, infections, and deep vein thrombosis were more frequent in elderly patients, presenting various degrees of statistical significance, whereas postoperative brain edema, hydrocephalus, and cardiorespiratory incidents presented no statistically significant difference. Finally, more elderly patients presented neurological deterioration, although mortality was not significantly different. Conclusions: Operation for intracranial meningioma in elderly patients is justified as long as detailed preoperative evaluation is performed. Planning of modified protocols including intraoperative technical aspects, careful use of steroids, antibiotics and prophylactic low molecular weight heparin, and early mobilization is necessary for optimizing operative outcome of elderly patients. (C) 2007 Elsevier Inc. All rights reserved.