Ziechmann Robert, Ricci Samuel L, Shepard Scott
Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, USA.
Neurosurgery, Temple University Hospital, Philadelphia, USA.
Cureus. 2025 Aug 8;17(8):e89602. doi: 10.7759/cureus.89602. eCollection 2025 Aug.
Introduction Potentially surgical brain metastases are increasingly common in patients aged 80 and older, yet the risk-benefit profile of surgical resection in this population remains inadequately defined. Surgical intervention in octogenarians carries a high risk due to systemic issues associated with advanced age and prevalent comorbidities, and data on perioperative morbidity and functional outcomes are limited. Methods A retrospective case series including six patients aged 80 years and older who underwent craniotomy for the resection of brain metastases at a single tertiary care center was conducted. Preoperative and postoperative functional status were assessed. Surgical complications, discharge disposition, and survival outcomes were reviewed through detailed chart analysis and follow-up data. Due to the limited sample size (N=6), no formal statistical analysis was performed. Results Preoperative Karnofsky Performance Status (KPS) averaged 68, and postoperative KPS was 80. One (17%) patient experienced a postoperative hemorrhage necessitating reoperation. Discharge dispositions included two (33%) patients discharged home, three (50%) patients discharged to acute rehabilitation, and one (16%) patient discharged to a skilled nursing facility; all patients discharged to outside facilities ultimately returned home. The median survival time was 13 (range: 2-48) months. Conclusion Surgical resection in patients over 80 years undergoing craniotomy for brain metastases is associated with elevated systemic risk related to comorbidities and systemic disease burden. However, specific patients may benefit, particularly those with large lesions with well-controlled systemic disease and limited medical comorbidity. Deaths observed in this cohort were attributable to systemic disease unrelated to the surgical intervention or intracranial disease. Given the very small sample size, these findings are exploratory and require confirmation with larger studies. Surgical intervention for this population should be considered on a case-by-case basis, with a focus on patients who are neurologically symptomatic with good systemic disease control.
潜在可手术切除的脑转移瘤在80岁及以上的患者中越来越常见，但该人群手术切除的风险效益情况仍未得到充分界定。由于与高龄和常见合并症相关的全身问题，对八旬老人进行手术干预风险很高，且围手术期发病率和功能结局的数据有限。
进行了一项回顾性病例系列研究，纳入了6例80岁及以上在单一三级医疗中心接受开颅手术切除脑转移瘤的患者。评估术前和术后的功能状态。通过详细的病历分析和随访数据回顾手术并发症、出院处置和生存结局。由于样本量有限（N = 6），未进行正式的统计分析。
术前卡氏功能状态评分（KPS）平均为68分，术后为80分。1例（17%）患者术后发生出血需要再次手术。出院处置包括2例（33%）患者出院回家，3例（50%）患者出院接受急性康复治疗，1例（16%）患者出院至专业护理机构；所有出院至外部机构的患者最终都回到了家中。中位生存时间为13（范围：2 - 48）个月。
80岁以上接受开颅手术切除脑转移瘤的患者，手术切除与合并症和全身疾病负担相关的全身风险升高有关。然而，特定患者可能会受益，特别是那些全身疾病控制良好且合并症有限的大病灶患者。该队列中观察到的死亡归因于与手术干预或颅内疾病无关的全身疾病。鉴于样本量非常小，这些发现具有探索性，需要更大规模的研究予以证实。对于该人群的手术干预应逐案考虑，重点关注神经系统有症状且全身疾病控制良好的患者。
