• Randy S D'Amico, Michael B Cloney, Adam M Sonabend, Brad Zacharia, Matthew N Nazarian, Fabio M Iwamoto, Michael B Sisti, Jeffrey N Bruce, and Guy M McKhann.
• Gabriele Bartoli Brain Tumor Research Laboratory, Columbia University College of Physicians and Surgeons, New York, New York, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
• World Neurosurg. 2015 Oct 1;84(4):913-9.

BackgroundGlioblastoma (GBM) occurs more commonly in elderly patients. However, these patients are often excluded from clinical trials. The absence of solid evidence has resulted in a nihilistic view of GBM in the elderly and a traditionally conservative treatment approach. In particular, the safety of surgical resection for both primary and recurrent GBM is poorly understood in elderly patients.MethodsIn a retrospective cohort of patients aged ≥65 years, we examined selection for biopsy, surgical resection, and reoperation for recurrent disease. We also analyzed complication rates after initial resection and reoperation for recurrent disease. We identified 319 elderly patients with pathologically proven GBM who underwent a total of 274 craniotomies at our institution between 2000 and 2012. Events were reported according to the methods used in the Glioma Outcomes Project.ResultsThe overall rate of complications after resection was 21.9%, with a rate of neurological complications of 7.7%. The rates of neurological, regional, and systemic complications were not significantly different after initial craniotomy and reoperation for GBM in elderly patients. Reoperations were not associated with an increased risk of complications. Low cardiovascular risk, improved functional status, and hemispheric GBM were associated with selection for more aggressive surgical treatment. Younger age and improved functional status were associated with a reduced likelihood of complications.ConclusionsWe conclude that in select patients, age alone should not preclude the decision to pursue aggressive surgical management.Copyright © 2015 Elsevier Inc. All rights reserved.

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