da Silva Carlos Eduardo, de Freitas Paulo Eduardo Peixoto
Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles, Porto Alegre, Rio Grande do Sul, Brazil; Division of Anatomy, Department of Basic Sciences of Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles, Porto Alegre, Rio Grande do Sul, Brazil.
World Neurosurg. 2018 Dec;120:e1149-e1155. doi: 10.1016/j.wneu.2018.09.024. Epub 2018 Sep 12.
Meningiomas frequently occur in elderly patients, and surgical treatment is hazardous owing to multiple comorbidities. We report a series of elderly patients who were treated with surgical removal of meningiomas and compare them with a group of younger patients with similar tumors.
A retrospective study of elderly patients with symptomatic skull base meningiomas and a matched control group of younger patients was performed. Medical records, operative reports, radiologic examinations, and follow-up data were reviewed. Main outcome measures were morbidity, mortality, and Simpson grade.
The study included 46 patients (23 elderly [age >65 years], 23 younger [age <65 years]). Average age was 71 years in elderly patients and 48 years in younger patients. Mean follow-up period was 32 months and 49 months, respectively. Radical removal (Simpson grades I and II) was observed in 83% and 91%, respectively. Mortality was 8% and 4%, respectively. Definite cranial nerve lesions occurred in 8% and 26%, respectively; cerebrospinal fluid leaks occurred in 12.5% and 4%, respectively; hemiparesis occurred in 4% of patients in both groups. Glasgow Outcome Scale score of 5 was obtained in 87% and 65.2%, respectively.
Elderly patients with symptomatic skull base meningiomas should be considered for surgical treatment owing to acceptable morbidity and mortality compared with younger patients. Previous comorbidities and involvement of neurovascular structures are important factors in the decision regarding extent of surgical resection.
脑膜瘤常见于老年患者，由于多种合并症，手术治疗具有危险性。我们报告了一系列接受脑膜瘤手术切除治疗的老年患者，并将他们与一组患有相似肿瘤的年轻患者进行比较。
对有症状的颅底脑膜瘤老年患者及与之匹配的年轻患者对照组进行回顾性研究。查阅病历、手术报告、影像学检查及随访数据。主要观察指标为发病率、死亡率及辛普森分级。
该研究纳入46例患者（23例老年患者[年龄>65岁]，23例年轻患者[年龄<65岁]）。老年患者平均年龄为71岁，年轻患者平均年龄为48岁。平均随访时间分别为32个月和49个月。分别有83%和91%的患者实现了根治性切除（辛普森分级I和II级）。死亡率分别为8%和4%。明确的颅神经损伤分别发生在8%和26%的患者中；脑脊液漏分别发生在12.5%和4%的患者中；两组均有4%的患者出现偏瘫。格拉斯哥预后量表评分为5分的患者分别占87%和65.2%。
有症状的颅底脑膜瘤老年患者应考虑接受手术治疗，因为与年轻患者相比，其发病率和死亡率在可接受范围内。既往合并症及神经血管结构受累是决定手术切除范围的重要因素。
