Symptomatic peritumoral edema is associated with surgical outcome: a consecutive series of 72 supratentorial meningioma patients ≥ 80 years of age

• DOI: 10.1007/s11060-020-03501-z
• Publication Date: 2020-04-22T03:48:21Z
• Authors: Christoph Schwartz; Ilari Rautalin; Mika Niemelä; Miikka Korja
• Keywords: Male; Edema volume; SURGERY; Brain Edema; Neurology and psychiatry; BRAIN EDEMA; 03 medical and health sciences; Elderly; Postoperative Complications; 0302 clinical medicine; INTRACRANIAL MENINGIOMAS; Meningeal Neoplasms; Tumor volume; Humans; Karnofsky Performance Status; Outcome; Retrospective Studies; Aged, 80 and over; 9TH DECADE; Neurosciences; Supratentorial Neoplasms; Resection; 3. Good health; LIFE; Treatment Outcome; Female; Cancers; Meningioma

To assess the association of peritumoral brain edema (PTBE) with postoperative outcome in old (≥ 80 years) meningioma patients.All supratentorial meningioma patients (≥ 80 years old) who underwent surgery between 2010 and 2018 were retrospectively identified. Patients were classified into poor (≤ 40), intermediate (50-70), or good (≥ 80) preoperative Karnofsky Performance Status (KPS) subgroups. Outcome was evaluated at 3 months and at last follow-up within the first year after surgery, and categorized as improved, stable, or deteriorated. Three-dimensional volumetric assessment of tumor and PTBE volume was conducted. Volumes were categorized as small (< 10 cm3), medium (10-50 cm3), large (> 50 cm3).Seventy-two patients (mean age 83 ± 3 years, median 83; median follow-up 3 years) were included. The mean tumor volume was 39 ± 31 cm3 (median 27), and mean PTBE volume was 57 ± 79 cm3 (median 27). The mean preoperative KPS and at last follow-up was 58 ± 16 (median 60) and 59 ± 30 (median 70). Thirty-three patients were classified as improved, 16 as stable, and 23 deteriorated; eleven patients died within the first year. Large PTBE volume was more common for patients with poor preoperative status (p = 0.001). However, patients with large PTBE and poor preoperative status improved most frequently following surgery (p = 0.037 at 3 months, p = 0.074 at last follow-up). Large PTBE volume was not associated with treatment-associated complications (p = 0.538) or mortality (p = 0.721). A decision support tool to predict outcome was developed (p = 0.038).Elderly patients with large PTBE volumes usually had a poor preoperative performance status, but appeared to benefit most often from surgery.