Black P, Kathiresan S, Chung W
Brain Tumor Center, Brigham and Women's Hospital, Boston, Ma., USA.
Acta Neurochir (Wien). 1998;140(10):1013-6; discussion 1016-7. doi: 10.1007/s007010050209.
To assess the morbidity and mortality of meningioma surgery in patients over age 65 and compare our results with matched controls and with the present literature on meningioma surgery in the elderly.
An evaluation of 114 patients undergoing meningioma resection divided into two groups: 57 patients aged 65-87, and a control group of 57 patients aged 25-64 matched by ASA status and tumor site. Operative complications, 30-day mortality, and pre- and postoperative neurologic status were assessed with follow up one to three months.
Complication rates in the two groups were similar and were low. Four out of fifty-seven elderly patients (7.0%) had a surgical complication compared with five younger patients (8.8%) Excluding asymptomatic DVT detected by screening, three elderly patients had medical complications (5.2%) compared with two controls (3.5%). The vast majority of patients-93% of the elderly group and 89.4% in the controls--experienced either improvement or no change in neurologic status at followup one to three months after surgery. There was one death among elderly patients within thirty days for a mortality rate of 1.8% compared with no mortality in the case control group. The elderly patient who died was an 80-year old man who died of pneumonia in a rehabilitation hospital three weeks after surgery. Our study group of 57 patients was compared by tumor site and preoperative general health status to other series in the literature. In a review from the literature of 417 patients over age 65 who underwent meningioma surgery, the average 30-day mortality was 16%. The complication rate averaged 39%.
Our lower morbidity and mortality rates after meningioma surgery in the elderly may be a result of patient selection, surgical technique, or excellent pre- and post-operative care by the resident staff, anesthesiologists, and nurses. It suggests, however, that elderly patients can have meningioma surgery safely.
评估65岁以上患者脑膜瘤手术的发病率和死亡率，并将我们的结果与匹配的对照组以及当前关于老年脑膜瘤手术的文献进行比较。
对114例行脑膜瘤切除术的患者进行评估，分为两组：57例年龄在65 - 87岁之间，以及57例年龄在25 - 64岁之间的对照组，两组按美国麻醉医师协会（ASA）分级和肿瘤部位进行匹配。评估手术并发症、30天死亡率以及术前和术后的神经状态，并进行1至3个月的随访。
两组的并发症发生率相似且较低。57例老年患者中有4例（7.0%）发生手术并发症，而年轻患者中有5例（8.8%）。排除筛查发现的无症状深静脉血栓形成（DVT），3例老年患者有医疗并发症（5.2%），而对照组有2例（3.5%）。绝大多数患者——老年组的93%和对照组的89.4%——在术后1至3个月的随访中神经状态有所改善或无变化。老年患者中有1例在30天内死亡，死亡率为1.8%，而病例对照组无死亡。死亡的老年患者是一名80岁男性，术后三周在康复医院死于肺炎。我们的57例患者研究组按肿瘤部位和术前总体健康状况与文献中的其他系列进行了比较。在对417例65岁以上接受脑膜瘤手术患者的文献综述中，平均30天死亡率为16%。并发症发生率平均为39%。
我们老年患者脑膜瘤手术后较低的发病率和死亡率可能是患者选择、手术技术的结果，或者是住院医生、麻醉医生和护士出色的术前和术后护理的结果。然而，这表明老年患者可以安全地进行脑膜瘤手术。
