Intracranial meningiomas in the elderly (over 70 years old). A retrospective study of 30 surgical cases.

The decision to operate on a patient older than 70 years for an intracranial meningioma is always difficult. Therefore a series of meningiomas treated surgically in 30 cases older than 70 years has been reconsidered and studied according to the following parameters: Karnofsky's rating scale, physiological status of the patient (A.S.A. criteria), perifocal oedema and mass effect. The locations of the meningiomas were: convexity 13, parasagittal 6, falx 2, pterion (sphenoid ridge) 5, orbito-cranial 3, jugum sphenoidale 1, tentorium (occipital) 1. Postoperative survival at day 30 shows a mortality rate of 23% which increases to 37% at day 90 including causes like decubitus ulcers and 3 cases of fatal pulmonary embolism. In a comparable series of 31 cases from 60 to 70 years, mortality rate was only 16% at day 90. Two parameters seem essential for quantifying surgical risk: clinical status, oedema and mass effect, evaluated by CT scan. The best conditions seem combined when Karnofsky rating scale is higher than or equal to 50 with no or only limited perifocal hypodensity and without mass effect. Although meningiomas may remain dormant for many years or can be kept under control medically for some time, their development is unpredictable. We think therefore that a reasonable surgical risk can be taken on patients with good physical status and favourable parameters at the time of diagnosis, particularly if the meningioma is located at the convexity where the risk of recurrence is minimal. On the other hand, patients with unfavourable parameters are not recommended for surgery.