Hallak Hana, Mantziaris Georgios, Pikis Stylianos, Islim Abdurrahman I, Peker Selcuk, Samanci Yavuz, Nabeel Ahmed M, Reda Wael A, Tawadros Sameh R, El-Shehaby Amr M N, Abdelkarim Khaled, Emad Reem M, Mathieu David, Lee Cheng-Chia, Liscak Roman, Alvarez Roberto Martinez, Kondziolka Douglas, Tripathi Manjul, Speckter Herwin, Bowden Greg N, Benveniste Ronald J, Lunsford Lawrence Dade, Jenkinson Michael D, Sheehan Jason
Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Neurological Surgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, USA.
Acta Neurochir (Wien). 2025 Feb 6;167(1):37. doi: 10.1007/s00701-025-06452-4.
Management for elderly patients (> 65yo) with incidental meningiomas remains unclear. This study aims to characterize the functional and tumor outcomes of expectant and stereotactic radiosurgery (SRS) management of asymptomatic meningioma elderly patients.
Using retrospectively collected data from 14 centers, SRS outcomes were compared to radiographic and clinical observation of asymptomatic meningiomas in elderly patients following propensity score matching.
Following propensity score matching, 114 patients were in each cohort. Tumor control was achieved at 97.37% in the SRS cohort, and no meningioma growth was seen 71.93% of the observation cohorts (p < 0.01; OR 14.44 [95% CI 4.27-48.78]). New neurological deficits developed in 1.39% of the SRS cohort but in none of the patients managed conservatively. 3.5% of patients underwent resection in the active surveillance matched cohort compared to 0.9% of patients in the SRS cohort (p = 0.063; OR 0.135 [95% CI 0.163-1.117]). The all-cause mortality rate was almost half in the SRS group (9.65%) compared to the observation group (18.42%) (p = 0.06; OR 0.47 [95% CI .22-1.03]).
SRS achieves superior radiological tumor control compared to surveillance but with a slightly increased the risk of new SRS-related neurological deficits in elderly patients with asymptomatic meningiomas. Although SRS reduces meningioma progression, the need for of an open neurosurgical procedure and mortality were not significantly reduced. Furthermore, mortality in the observation group was not directly related to the meningioma in any of the patients.
老年（>65岁）偶然发现的脑膜瘤患者的管理仍不明确。本研究旨在描述无症状脑膜瘤老年患者采用观察等待和立体定向放射外科治疗（SRS）的功能和肿瘤结局。
利用从14个中心回顾性收集的数据，在倾向评分匹配后，将SRS治疗结果与老年患者无症状脑膜瘤的影像学和临床观察结果进行比较。
倾向评分匹配后，每个队列有114例患者。SRS队列的肿瘤控制率为97.37%，观察队列中71.93%未见脑膜瘤生长（p<0.01；OR 14.44[95%CI 4.27 - 48.78]）。SRS队列中有1.39%出现新的神经功能缺损，而保守治疗的患者均未出现。主动监测匹配队列中有3.5%的患者接受了手术切除，而SRS队列中这一比例为0.9%（p = 0.063；OR 0.135[95%CI 0.163 - 1.117]）。SRS组的全因死亡率（9.65%）几乎是观察组（18.42%）的一半（p = 0.06；OR 0.47[95%CI 0.22 - 1.03]）。
与观察等待相比，SRS在放射学肿瘤控制方面更优，但无症状脑膜瘤老年患者出现新的SRS相关神经功能缺损的风险略有增加。虽然SRS减少了脑膜瘤进展，但开颅手术的需求和死亡率并未显著降低。此外，观察组中任何患者的死亡均与脑膜瘤无直接关系。
