Spinal meningioma surgery in the elderly: who benefits?

BACKGROUND: With increasing life expectancy and increasing demands on quality of life more spinal meningiomas will limit quality of life in elderly in the coming decades. We investigated whether elderly can improve neurologically and gain self-dependence postoperatively.

METHODS: Medical records of consecutive spinal meningioma patients from 2004 - 2015 were retrospectively analyzed. Age, gender, preoperative duration and quality of symptoms, pre- and postoperative McCormick score, Karnofsky Performace Status (KPS), American Society of Anesthesiologists Physical Status (ASA), modified Clinical Scoring System (mCSS) and tumor characteristics were included. Elderly were defined by ≥ 70 years.

RESULTS: 129 patients were included, of which 44 ≥ 70 years. Younger patients were significantly better preoperatively in McCormick, KPS, ASA and mCSS within the first postoperative year. Both younger and elderly patients improved significantly postoperatively in McCormick, KPS and mCSS. Surgical complication rate was similar for younger and elderly patients (5.9 vs. 6.8%, resp.). Systemic complication rate was higher in elderly (0 vs. 6.8%, resp.).

CONCLUSIONS: Surgery for spinal meningioma in elderly (KPS ≥ 40 and ASA ≤ 3) leads to a significant improvement of McCormick, KPS and mCSS postoperatively. This leads to a higher rate of self-dependency and thereby probably to an improvement of quality of life in elderly. However, special attention for systemic complications is necessary.