Perioperative Complication Profile of Skull Base Meningioma Resection in Older versus Younger Adult Patients

Abstract Objectives To better understand the risk-benefit profile of skull base meningioma resection in older patients, we compared perioperative complications among older and younger patients. Design Present study is based on retrospective outcomes comparison. Setting The study was conducted at a single neurosurgery institute at a quaternary center. Participants All older (age ≥ 65 years) and younger (<65 years) adult patients treated with World Health Organization grade 1 skull base meningiomas (2008–2017). Main Outcome Measures Perioperative complications and patient functional status are the primary outcomes of this study. Results The analysis included 287 patients, 102 older and 185 younger, with a mean (standard deviation [SD]) age of 72 (5) years and 51 (9) years (p < 0.01). Older patients were more likely to have hypertension (p < 0.01) and type 2 diabetes mellitus (p = 0.01) but other patient and tumor factors did not differ (p ≥ 0.14). Postoperative medical complications were not significantly different in older versus younger patients (10.8 [11/102] vs. 4.3% [8/185]; p = 0.06) nor were postoperative surgical complications (13.7 [14/102] vs. 10.8% [20/185]; p = 0.46). Following anterior skull base meningioma resection, diabetes insipidus (DI) was more common in older versus younger patients (14 [5/37] vs. 2% [1/64]; p = 0.01). Among older patients, a decreasing preoperative Karnofsky performance status score independently predicted perioperative complications by logistic regression analysis (p = 0.02). Permanent neurologic deficits were not significantly different in older versus younger patients (12.7 [13/102] vs. 10.3% [19/185]; p = 0.52). Conclusion The overall perioperative complication profile of older and younger patients was similar after skull base meningioma resection. Older patients were more likely to experience DI after anterior skull base meningioma resection. Decreasing functional status in older patients predicted perioperative complications.

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The Effect of Functional Status, Age, and Medical Comorbidities on the Perioperative Complication Profile of Skull Base Meningioma Resection in Elderly Patients

10.1055/s-0041-1725342 ◽

2021 ◽

Author(s):

Colin Przybylowski ◽

Christina Sarris ◽

Scott Brigeman ◽

Kristina Chapple ◽

Shawn Stevens ◽

...

Keyword(s):

Elderly Patients ◽

Functional Status ◽

Skull Base ◽

Medical Comorbidities ◽

Skull Base Meningioma ◽

Perioperative Complication

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Patterns of skull base meningioma progression after failed radiosurgery

Journal of Neurosurgery ◽

10.3171/jns.2007.106.1.30 ◽

2007 ◽

Vol 106 (1) ◽

pp. 30-35 ◽

Cited By ~ 45

Author(s):

William T. Couldwell ◽

Chad D. Cole ◽

Ossama Al-Mefty

Keyword(s):

Skull Base ◽

Stereotactic Radiosurgery ◽

Growth Patterns ◽

World Health ◽

Benign Tumors ◽

Subtotal Resection ◽

Surgical Removal ◽

Skull Base Meningioma ◽

Number Of Patients ◽

Health Organization

Object Stereotactic radiosurgery has been reported to be an effective alternative to surgical removal of small to medium benign meningiomas as well as an adjuvant treatment modality to reduce the risk of tumor progression after subtotal resection. Its efficacy has been proved by excellent short-term radiosurgically demonstrated control rates, which have been reported to approach or exceed 90% in many contemporary studies involving the use of either linear accelerator–based systems or the Gamma Knife. Little is known, however, regarding the growth patterns of meningiomas that fail to stabilize after radiosurgery. Methods The authors report 13 cases of benign skull base meningiomas (World Health Organization Grade I) that demonstrated progression after radiosurgical treatment as a primary or an adjuvant therapy. Several tumors demonstrated rapid growth immediately after radiosurgical treatment, whereas other lesions progressed in a very delayed manner in some patients (up to 14 years after treatment). Regardless of the interval after which it occurs, tumor growth can be quite aggressive once it has begun. Conclusions Skull base meningioma growth can be aggressive after failed radiosurgery in some patients, and treatment failure can occur at long intervals following treatment. Special attention must be devoted to such significant occurrences given the increasing number of patients undergoing stereotactic radiosurgery for benign tumors, and careful extended (> 10 years) follow up must be undertaken in all patients after radiosurgery.

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Results of Anterior Skull Base Surgery in Pediatric and Young Adult Patients

Skull Base ◽

10.1055/s-0029-1238215 ◽

2009 ◽

Vol 20 (02) ◽

pp. 075-081 ◽

Cited By ~ 3

Author(s):

Neil Gross ◽

Ian Ganly ◽

Snehal Patel ◽

Mark Bilsky ◽

Jatin Shah ◽

...

Keyword(s):

Young Adult ◽

Skull Base ◽

Skull Base Surgery ◽

Anterior Skull Base ◽

Adult Patients

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Functional outcomes of older adults treated with radical cystectomy for muscle-invasive bladder cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e17010 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e17010-e17010

Author(s):

Chelsea K. Osterman ◽

Allison Mary Deal ◽

Kirsten A. Nyrop ◽

Matthew I. Milowsky ◽

Hyman B. Muss ◽

...

Keyword(s):

Bladder Cancer ◽

Functional Status ◽

Physical Function ◽

Older Patients ◽

Social Activity ◽

Time Frame ◽

Muscle Invasive Bladder Cancer ◽

Younger Patients ◽

Significant Difference ◽

Muscle Invasive

e17010 Background: Older patients with muscle-invasive bladder cancer (MIBC) may not be offered standard of care treatment with neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) based on their chronological age and concern for functional decline following therapy. Age-based differences in post-RC functional status or time to recovery are unknown. Methods: A total of 80 patients were included in this study. Patients ≥ 70 years were categorized as “older” and < 70 years as “younger.” To measure functional status, patients completed an initial geriatric assessment (GA) post-NAC and pre-RC, which was repeated at 1, 3, and 12 months post-RC. Results: Median age was 62 years for younger patients (41-69 years; n = 42) and 75 years for older patients (70-83 years; n = 38). Clinical stage at presentation was not different between groups, but older patients were significantly less likely to receive NAC (63% vs 83%, p = 0.047). There was no significant difference between groups in any physical function measure at baseline. At 1 month post-RC, older patients had significantly lower clinician (c) and patient (p) rated Karnofsky Performance Status (KPS) than younger patients (cKPS: 70 vs 80, p = 0.02; pKPS 60 vs 80, p = 0.03), with a significantly greater decrease from baseline (20 points vs 0 points) in both KPS scores compared to younger patients (cKPS p = 0.001; pKPS p = 0.005). Both groups had a significant decline in ability to complete instrumental activities of daily living (IADLs), but older patients also had significantly increased social activity limitations. At 3 months post-RC, older patients took significantly longer to complete the timed up and go test than younger patients (10.2 secs vs 9 secs, p = 0.02), but had no other differences in physical function measures. Older patients had no significant difference in any measure at 3 months post-RC compared to baseline, while younger patients had a significant improvement in social activity over this time frame. Conclusions: Older patients with MIBC experience a greater short-term decline in functional status post-RC compared to younger patients. However, they return to their baseline status within the same time frame as younger patients.

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Anterior Skull Base Meningioma: Surgical approach and complication avoidance

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/a-1733-9320 ◽

2022 ◽

Author(s):

Bhawan Nangarwal ◽

Jaskaran Singh Gosal ◽

Kuntal Kanti Das ◽

Deepak Khatri ◽

Kamlesh Singh Bhaisora ◽

...

Keyword(s):

Skull Base ◽

Tumor Resection ◽

Vascular Complications ◽

Good Alternative ◽

Anterior Skull Base ◽

Csf Leak ◽

Medical Complication ◽

Endoscopic Endonasal ◽

Olfactory Groove ◽

Skull Base Meningioma

Background: Endoscopic endonasal approach (EEA) and keyhole transcranial approaches are being increasingly used in anterior skull base meningioma (ASBM) surgery. Objective: We compare tumor resection rates and complication profiles of EEA and supraorbital key hole approach (SOKHA) against conventional transcranial approaches (TCA). Methods: Fifty-four patients with ASBM [olfactory groove (OGM), n=19 and planum sphenoidale/tuberculum sellae (PS/TSM), n=35) operated at a single centre over 7 years were retrospectively analyzed. Results: The overall rate of GTR was higher in OGM (15/19, 78.9%) than PS-TSM group (23/35, 65.7%, p=0.37). GTR rate with OGM was 90% and 75% with TCA and EEA. Death (n=1) following medical complication (TCA) and CSF leak requiring re-exploration (n=2, one each in TCA and EEA) accounted for the major complications in OGM. For the PS/TSM group, the GTR rates were 73.3% (n=11/15), 53.8% (n=7/13) and 71.4% (n=5/7) with TCA, EEA and SOKHA respectively. Seven patients (20%) of PS-TSM developed major postoperative complications including 4 deaths (one each in TCA, SOKHA and 2 in EEA group) and 3 visual deteriorations. Direct and indirect vascular complications were common in lesser invasive approaches to PS-TSM especially if the tumor has encased intracranial arteries. Conclusions: No single approach is applicable to all ASBMs. TCA is still the best approach to obtain GTR but has tissue trauma related problems. SOKHA may be a good alternative to TCA in selected PS-TSMs while EEA may be an alternate option in some OGMs. A meticulous patient selection is needed to derive reported results of EEA for PS-TSM.

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Anterior Skull Base Meningioma

Rhinology and Anterior Skull Base Surgery ◽

10.1007/978-3-030-66865-5_34 ◽

2021 ◽

pp. 179-186

Author(s):

Jason Yuen ◽

Arif Janjua ◽

Peter Gooderham ◽

Vinay Varadarajan ◽

Samiul Muquit

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Skull Base Meningioma

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Do Older Patients With Moderate-Severe Chronic Graft-Versus-Host Disease Differ From Younger Patients?

Blood ◽

10.1182/blood.v122.21.725.725 ◽

2013 ◽

Vol 122 (21) ◽

pp. 725-725

Author(s):

Areej El-Jawahri ◽

Joseph Pidala ◽

Xiaoyu Chai ◽

William A. Wood ◽

Nandita Khera ◽

...

Keyword(s):

Overall Survival ◽

Functional Status ◽

Physical Functioning ◽

Older Patients ◽

Chronic Gvhd ◽

Symptom Burden ◽

Middle Aged ◽

Aged Patients ◽

Younger Patients ◽

Sf 36

Abstract Introduction Older patients undergoing allogeneic stem cell transplantation may experience a higher degree of morbidity and limitations from transplant related complications. Chronic graft-versus –host disease (GVHD) causes a significant reduction in patients’ quality of life (QOL), physical functioning, and functional status. However, it is not known if moderate to severe chronic GVHD has a worse impact on QOL, or survival outcomes for older patients. Methods We analyzed data of patients with moderate or severe chronic GVHD (N=522, 1661 follow-up visits, a total of 2,183 visits) from the Chronic GVHD Consortium, a prospective observational multicenter cohort. Moderate or severe chronic GVHD was defined by the National Institutes of Health global severity score at the time of enrollment. We examined the relationship between age group (adolescent and young adult “AYA” 18-40, “middle-aged” 41-59, and “older” ≥ 60 years) and clinical manifestations of chronic GVHD, patient-reported outcomes, functional status, non-relapse mortality and overall survival. Clinical manifestations of chronic GVHD were determined by the clinician-reported individual organ scores. Patient-reported outcomes included (1) QOL as measured by Functional Assessment of Cancer Therapy Bone Marrow Transplantation (FACT-BMT) and the Medical Outcome Short-Form Health Survey (SF-36) (2) chronic GVHD symptom burden as measured by the Lee Symptom Scale; and (3) physical fitness as measured by the Human Activity Profile (HAP). Functional status was assessed using the 2-minute walk test (2MWT). Because of multiple testing, p-values <0.01 were considered significant. Results There were 115 (22%) AYA, 279 (53%) middle-aged and 128 (25%) older patients with moderate (58%) or severe (42%) chronic GVHD included. At study enrollment, older patients (≥60) were similar to younger patients in sex, time from transplant (median 12 months), prior acute GVHD, percentage of severe chronic GVHD, and current co-morbidity scores but differed in disease distribution and conditioning regimen intensity. At enrollment, in unadjusted analyses using all available data, older patients had similar rates and severity of global and organ-specific manifestations of chronic GVHD compared to younger patients, except for genital involvement, which was more prevalent and severe in AYA patients. Although older patients reported worse physical functioning [SF-36 Physical Functioning (p=0.01)], shorter 2MWT (p=0.002), and lower HAP scores (p=0.001) than AYA and middle-aged patients suggesting they have more physical limitations, older patients had better QOL [FACT-BMT (p=0.01)] scores compared to middle-aged patients and similar to AYA patients. Older patients had better psychological [Lee Psychological Scale (p<0.001), SF-36 Mental Health (p=0.01)] and emotional functioning [FACT-Emotional Well-being (p=0.001)] and less pain [SF-36 Bodily Pain (p=0.006)] than AYA and middle-aged patients but similar chronic GVHD symptom burden [Lee Symptom Scale (p=0.47)]. In multivariable linear mixed models utilizing all visit data and adjusted for clinical covariates, older patients had QOL (FACT-BMT) that was comparable to AYA patients (estimate -0.04, p=0.99) and better than middle-aged patients (estimate 5.7, p=0.004), while the SF36 physical and mental component scores and symptom burden were not different between the groups. Non-relapse mortality and overall survival were similar between the age groups in unadjusted analyses (p=0.23, p=0.17) and after adjusting for clinical covariates (p=0.17, p=0.15) in Cox models. In a subgroup analysis, we found that there were no differences in overall and organ-specific chronic GVHD manifestations, QOL and survival between patients in the 60-64 (n=73), 65-70 (n=39), and >70 (n=16) age groups, except for more moderate-severe skin involvement in the 65-70 year olds. Conclusion Despite higher physical and functional limitations, older patients with moderate or severe chronic GVHD have preserved QOL, comparable disease manifestations and symptom burden, and similar overall survival and non-relapse mortality when compared to younger patients. Therefore we did not find evidence that older age itself is associated with worse QOL or survival in patients with moderate or severe chronic GVHD. Disclosures: No relevant conflicts of interest to declare.

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NCOG-23. PATTERNS OF DISTRESS IN OLDER PATIENTS WITH GLIOBLASTOMA: A FOLLOW-UP TO A SINGLE INSTITUTION CROSS-SECTIONAL STUDY OF DISTRESS IN PRIMARY BRAIN TUMOR PATIENTS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.561 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii134-ii134

Author(s):

Margaret Johnson ◽

James Herndon ◽

Eric Lipp ◽

Mary Affronti ◽

Annick Desjardins ◽

...

Keyword(s):

Older Patients ◽

Absolute Number ◽

Cross Sectional Study ◽

Adult Patients ◽

Problem List ◽

Sectional Study ◽

Cross Sectional ◽

Younger Patients ◽

Original Dataset

Abstract INTRODUCTION We previously reported to SNO, high levels of psychosocial distress in adult patients with primary brain tumors (PBTs), particularly during the first 6 months following diagnosis. The purpose of this follow-up study was to identify patterns of distress among older (≥ 65 years) patients with glioblastoma (GBM) compared to their younger (ages 18-64) counterparts. METHODS In our initial cross-sectional study, we collected the National Comprehensive Cancer Network’s Distress Thermometer (NCCN-DT) and problem list from adult patients with PBTs (WHO grades I-IV) seen at our institution between December 2013 and February 2016. We performed subsequent analyses on a subset of patients with GBM. RESULTS We identified 343 patients with GBM from the original dataset, of which 23.0% (n= 78) were ≥ 65 years old. The proportion of patients ≥ 65 years old with elevated distress (i.e. DT ≥ 4) was greater than the proportion of younger patients reporting elevated distress (47.4% vs 30.6%; p= 0.0068). Elevated distress was significantly greater during the first 6 months post diagnosis for all ages (p= 0.008). In subgroup analyses, a decrease in distress beyond 6 months was seen in younger patients (45.7% vs 27.4%; p= 0.021), but not in older patients. In older patients, a greater number of problems were selected on the NCCN DT and problem list tool: emotional and physical concerns were reported more frequently compared to their younger counterparts. Older patients were more likely to report difficulty with “bathing” and “getting around” (p= 0.009, p< 0.001, respectively). There were no differences in older versus younger GBM patients with regard to housing, transportation, treatment decisions, depression, fatigue, or memory. CONCLUSIONS In contrast to their younger counterparts, older patients with GBM experienced elevated levels of distress and a greater absolute number of specific psychosocial problems, mostly related to emotional and physical concerns.

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Curative effect and Safety in Anteromedial Osteoarthritis Patients over 80 Years Old Undergoing Oxford Unicompartmental Knee Arthroplasty (UKA) in China: A Single-Center Retrospective Study

10.21203/rs.2.17839/v1 ◽

2019 ◽

Author(s):

Jingbo Cheng ◽

Mingli Feng ◽

Guanglei Cao ◽

Zheng Li ◽

Shuai An ◽

...

Keyword(s):

Elderly Patients ◽

Older Patients ◽

Perioperative Complications ◽

Womac Score ◽

Younger Patients ◽

Group 2 ◽

Hss Score ◽

Oxford Unicompartmental Knee Arthroplasty ◽

Group 1

Abstract Background: Oxford Unicompartmental Knee Arthroplasty (UKA) has increased rapidly around the world, and the effectiveness and safety of a minimally invasive surgical approach for it demonstrate excellent outcome. Oxford UKA represents an interesting solution for older patients. The aim of our study is to evaluate the perioperative complications and short-term clinical outcome and analyze the safety for older patients who undergo Oxford UKA.Methods: A retrospective review was performed of all patients who underwent Oxford UKA between June 2015 and January 2018. We divided all patients into two groups (ages 60–80; age over 80). We used the HSS score and WOMAC score to evaluate the general condition of the patients’ knees. We also recorded perioperative complications and long-term complications. Result:130 patients (139 knees) between the ages of 60 and 80 (Group 1) and 65 patients (70 knees) over 80 years old (Group 2) were included in the study. The mean follow-up was 22.04 ± 11.04 and 21.76 ± 10.20 months in Group 1 and 2, respectively. At last follow-up, the patients in Group 2 showed lower function scores, but both the HSS score and the WOMAC score were significantly improved in both groups after surgery. The rate of perioperative complications and other complications in elderly patients is the same as in younger patients. Conclusion: Oxford UKA showed validity and safety for elderly patients in China. The knee joint pain symptoms of the elderly patients are relieved and the function is well restored, but the function is still poor compared with the younger patients.

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