• Murat Şakir Ekşi, Çağrı Canbolat, Ahmet Akbaş, Berk Barış Özmen, Ebubekir Akpınar, Murat İmre Usseli, Abuzer Güngör, Mustafa Güdük, Mehmet Hacıhanefioğlu, Erşen Danyeli Ayça A Department of Pathology, Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, Turkey., Koray Özduman, and M Necmettin Pamir.
• Department of Neurosurgery, Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, Turkey. Electronic address: muratsakireksi@gmail.com.
• World Neurosurg. 2019 Dec 1; 132: e350-e365.

BackgroundImproved life expectancy and advanced diagnostic tools including computed tomography and magnetic resonance imaging have increased the awareness and diagnosis of intracranial meningiomas in the elderly population. The risk/benefit ratio of surgery in elderly patients with intracranial meningioma has not been clearly defined because of the lack of objective measurement tools. We aimed to understand the risk factors associated with postsurgical outcomes and how these risk factors affected postsurgical outcomes in elderly patients with intracranial meningioma.MethodsWe retrospectively evaluated 1372 patients, who were operated on for intracranial meningioma, using our prospectively collected database. The same senior author operated on all patients at 2 different tertiary clinics. Patients' clinical charts, presurgical postcontrast T1-weighted magnetic resonance images, operative reports, and pathology reports were reviewed. The relevant literature was also reviewed.ResultsHigher age, higher American Society of Anesthesiologists class, presence of comorbidities, tumor location, larger initial tumor size, and presence of peritumoral edema were all associated with postsurgical complications in elderly patients with intracranial meningioma. Age ≥50 years was the strongest predictor of postsurgical systemic complications, whereas higher American Society of Anesthesiologists class was the strongest predictor of postsurgical neurologic complications. A literature review showed higher morbidity and mortality of elderly patients with intracranial meningioma. Initial tumor size and postsurgical MIB-1 labeling index were higher in the elderly patients, both of which were predictors of tumor growth.ConclusionsEven though elderly patients operated on for intracranial meningioma had higher morbidity and mortality compared with younger patients, surgery is still much more beneficial than wait-and-see strategy in elderly patients.Copyright © 2019 Elsevier Inc. All rights reserved.

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