Poon Michael Tin-Chung, Fung Linus Hing-Kai, Pu Jenny Kan-Suen, Leung Gilberto Ka-Kit
College of Medicine and Veterinary Medicine, The University of Edinburgh Medical School, UK.
J Neurooncol. 2013 Sep;114(2):219-27. doi: 10.1007/s11060-013-1173-8. Epub 2013 Jun 5.
Studies directly comparing the outcomes of intracranial meningioma resection between elderly and younger patients are currently limited. This study aimed to assess the perioperative complications, mortalities and functional outcomes in these two groups. Consecutive elderly patients (aged ≥ 65) and tumor-location-matched younger patients who underwent intracranial meningioma resections were retrospectively reviewed. Outcomes were assessed at 30-day, 90-day, 6-month and 1-year. We used a standardized classification of operative complications, and conducted subgroup analyses based on tumor location [convexity, parasagittal and falcine (CPF) as one group; skull base (SB) as another]. There were 92 patients in each group. The mean age was 74.6 ± 6.4 years in the elderly and 49.3 ± 10.1 years in the younger groups. The cumulative 30-day, 90-day and 1-year mortality rates were 0, 2.2 and 4.3 % for the elderly, respectively, and 1.1 % for all time points in the young. These differences were not statistically significant. Overall, the elderly suffered from more perioperative complications (P = 0.010), and these were mostly minor complications according to the classification of operative complications. However, these differences were observed only in the SB but not in the CPF subgroup. More elderly patients had impaired functional outcome 1-year after surgery. Significantly more elderly patients had new neurological deficits 1-year after surgery (26.1 vs. 6.6 %; P = 0.001). Comparable mortality rates were observed in elderly and younger patients. However, the elderly had more minor complications and poorer functional outcomes. Patient selection remains key to good clinical outcome.
目前,直接比较老年和年轻患者颅内脑膜瘤切除术后结果的研究有限。本研究旨在评估这两组患者的围手术期并发症、死亡率和功能结局。对接受颅内脑膜瘤切除术的连续老年患者(年龄≥65岁)和肿瘤位置匹配的年轻患者进行回顾性分析。在术后30天、90天、6个月和1年时评估结局。我们采用标准化的手术并发症分类,并根据肿瘤位置进行亚组分析[凸面、矢状窦旁和镰旁(CPF)为一组;颅底(SB)为另一组]。每组有92例患者。老年组的平均年龄为74.6±6.4岁,年轻组为49.3±10.1岁。老年患者的30天、90天和1年累积死亡率分别为0、2.2%和4.3%,年轻患者在所有时间点的死亡率为1.1%。这些差异无统计学意义。总体而言,老年患者围手术期并发症更多(P = 0.010),根据手术并发症分类,这些大多为轻微并发症。然而,这些差异仅在颅底亚组中观察到,而在凸面、矢状窦旁和镰旁亚组中未观察到。更多老年患者术后1年功能结局受损。术后1年,老年患者出现新神经功能缺损的比例显著更高(26.1%对6.6%;P = 0.001)。老年和年轻患者的死亡率相当。然而,老年患者有更多轻微并发症且功能结局较差。患者选择仍然是取得良好临床结局的关键。