scholarly journals Intracranial Meningiomas in the Elderly: Clinical, Surgical and Economic Evaluation. A Multicentric Experience

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2685
Author(s):  
Delia Cannizzaro ◽  
Maria Pia Tropeano ◽  
Ismail Zaed ◽  
Mario De Robertis ◽  
Simone Olei ◽  
...  
Keyword(s):  
Complication Rate ◽  
The Elderly ◽  
Patient Specific ◽  
Karnofsky Performance Scale ◽  
Intracranial Meningioma ◽  
Surgical Timing ◽  
Intracranial Meningiomas ◽  
Combined Strategy ◽  
Clinical Conditions

Meningioma is one of the most common intracranial tumors. It is benign and slow growing in the majority of cases. Given the increase in life expectancy and the number of radiological tests performed, the incidence in the elderly population (≥65 years) is continuously increasing. The surgical outcomes and prognostic factors in this age group are unclear. A retrospective analysis of all the patients treated for intracranial meningiomas in two different Italian institutions was performed. The clinical, radiological, surgical and follow-up data were retrospectively reviewed. Statistical analyses were performed to identify relationships between factors and outcomes. We also carried out an economic analysis. We analyzed 321 patients with intracranial meningioma. The mean age was 72.6 years (range, 65–90), with a female predominance (F/M, 1.41). Pre-operative deficits, cognitive impairment and seizures (p < 0.001) were associated with a worse post-operative Karnofsky performance scale (KPS) score (<80). A high pre-operative KPS score was associated with a good clinical and neurological outcome (p < 0.001). Being aged between 65 and 74 years, low surgical timing and Simpson removal grades of I and II were associated with a good outcome (p < 0.001). The length of hospitalization was significantly related to the outcome (p < 0.001). The complication rate was 14.3%. At 6-month follow-up, the mortality rate was 2.5%. The average cost was higher in patients with a pre-operative KPS score lower than 80. The outcome of intracranial-meningioma resection in elderly individuals is favorable when the pre-operative KPS score is >80. Treatment should be patient-specific, and additional factors should be considered. Patients with poor pre-operative clinical conditions might benefit from a combined strategy with partial resection and radiosurgery in order to reduce surgical timing and the complication rate.

scholarly journals Evaluation of surgical outcome of giant intracranial meningiomas

2020 ◽  
Vol 35 (1) ◽  
Author(s):  
Ramy Teama ◽  
Mohamed Adawy ◽  
Mohamed Emara
Keyword(s):  
Surgical Outcome ◽  
Intraoperative Complications ◽  
Intracranial Meningioma ◽  
Surgical Removal ◽  
Study Group ◽  
Main Body ◽  
Total Removal ◽  
Large Size ◽  
Intracranial Meningiomas

Abstract Background The surgery of giant intracranial meningiomas (GIM) is difficult due to its large size, prominent vascularity, including and limiting visualization of various neurovascular structures, and severe cerebral edema. In this study, we will evaluate the surgical outcome of giant meningiomas according to our experience at our hospital in management of giant intracranial meningioma. Main body A retrospective analysis of 48 patients with histologically proven meningioma (≥ 6-cm diameter) who underwent surgical treatment at Benha University hospitals over a period of 5 years (June 2014/June 2019) is presented. Details regarding clinical presentation, imaging findings, surgical results and complications, and follow-up status were collected. The study group was composed of 41 females and 7 males. The age of the study group ranged from 38 to 69 years with an average of 49 years. The mean follow-up period was 36 months. Different approaches were used according to tumor location with the aim of gross total removal. Gross total removal was achieved in 90% of cases (43 cases). There were 2 cases with intraoperative complications not related to surgery. Recurrence was present in 4 cases. Mortality in this series was 4% (2 cases) with no reported intraoperative mortality. Conclusion Management of giant intracranial meningioma is a relatively common practice in neurosurgical centers in developing countries with the aim of radical total surgical removal being the first and most optimum option. Large size makes surgery difficult, but young age, meticulous surgical techniques, proper localization, trying to minimize operative time, and Simpson grade are of special value. Interdisciplinary cooperation is essential to avoid the common complications like pulmonary embolism (PE), postoperative hematoma in tumor bed that leads to bad surgical outcome.

Cochlear Implantation in the Elderly: Results and Quality-of-Life Assessment

2002 ◽  
Vol 111 (10) ◽  
pp. 890-895 ◽  
Author(s):  
Hamid R. Djalilian ◽  
Sharon L. Smith ◽  
Timothy A. King ◽  
Samuel C. Levine
Keyword(s):  
Quality Of Life ◽  
Complication Rate ◽  
Cochlear Implantation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Life Assessment ◽  
Test Results

To assess the efficacy, quality of life, and complication rate of cochlear implantation in patients over 60 years of age, we performed a retrospective chart review of 31 cochlear implant patients more than 60 years old at the time of surgery (mean, 70 years; range, 62 to 86 years). All patients had improvement in their audiological test results after operation. Twenty-eight patients (93%) are regular implant users at a median follow-up of 12 months. Major complications occurred in 2 patients (6%). We conclude that cochlear implantation in the elderly population has excellent results, with a complication rate similar to that in patients less than 60 years old, and yields an improved quality of life.

Enhancing precision of the 16-item Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-16) using Rasch methodology

2021 ◽  
pp. 1-11
Author(s):  
Quoc Cuong Truong ◽  
Carol Choo ◽  
Katya Numbers ◽  
Alexander G. Merkin ◽  
Perminder S. Sachdev ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Rasch Model ◽  
Interval Data ◽  
The Elderly ◽  
Community Dwelling ◽  
Model Fit ◽  
Level Scale ◽  
Clinical Conditions ◽  
Community Dwelling Older Adults

Abstract Objective: This study aimed to investigate psychometric properties and enhance precision of the 16-item Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-16) up to interval-level scale using Rasch methodology. Design: Partial Credit Rasch model was applied to the IQCODE-16 scores using longitudinal data spanning 10 years of biennial follow-up. Setting: Community-dwelling older adults aged 70–90 years and their informants, living in Sydney, Australia, participated in the longitudinal Sydney Memory and Ageing Study (MAS). Participants: The sample included 400 participants of the MAS aged 70 years and older, 109 out of those were diagnosed with dementia 10 years after the baseline assessment. Measurements: The IQCODE-16. Results: Initial analysis indicated excellent reliability of the IQCODE-16, Person Separation Index (PSI) = 0.92, but there were four misfitting items and local dependency issues. Combining locally dependent items into four super-items resulted in the best Rasch model fit with no misfitting or locally dependent items, strict unidimensionality, strong reliability, and invariance across person factors such as participants’ diagnosis and relationship to their informants, as well as informants’ age and sex. This permitted the generation of conversion algorithms to transform ordinal scores into interval data to enhance precision of measurement. Conclusions: The IQCODE-16 demonstrated strong reliability and satisfied expectations of the unidimensional Rasch model after minor modifications. Ordinal-to-interval transformation tables published here can be used to increase accuracy of the IQCODE-16 without altering its current format. These findings could contribute to enhancement of precision in assessing clinical conditions such as cognitive decline in older people.

scholarly journals Pre-Operative Factors Affecting Resectability of Giant Intracranial Meningiomas

2009 ◽  
Vol 36 (5) ◽  
pp. 623-630 ◽  
Author(s):  
Alfredo Quiñones-Hinojosa ◽  
Tania Kaprealian ◽  
Kaisorn L. Chaichana ◽  
Nader Sanai ◽  
Andrew T. Parsa ◽  
...  
Keyword(s):  
San Francisco ◽  
Superior Sagittal Sinus ◽  
Perioperative Complications ◽  
Radical Resection ◽  
Intracranial Meningioma ◽  
Preoperative Embolization ◽  
Factors Affecting ◽  
Sagittal Sinus ◽  
Intracranial Meningiomas

Objective:Larger intracranial tumors require extended operating times and may be associated with increased perioperative complications. There are few reports describing the experience of resecting large meningiomas ≥5cm in a variety of locations. As a group, it remains largely unknown whether these relatively rare lesions are amenable to radical resection, and what factors influence their resectability.Methods:Sixty-seven patients undergoing surgery for a large intracranial meningioma (≥5cm in the longest dimension) between 1998 and 2004 were retrospectively reviewed. The surgeries were performed at a single institution University of California at San Francisco. Predictors of resectability were assessed via multivariate logistical regression analysis.Results:Thirty-nine (58%) patients underwent gross total resection (GTR) (Simpson grades I/II). There were no cases of perioperative mortality. At last follow-up, symptoms improved in 39 (58%) patients, remained unchanged in 20 (30%), and were aggravated in 8 (12%). In the multivariate model for all large meningiomas, age>45 years [OR(95%CI);0.127 (0.026-0.616),p=0.01] and superior sagittal sinus involvement [OR(95%CI);0.160 (0.026-0.976),p=0.05] were negative predictors of GTR, while preoperative embolization [OR(95%CI);8.087(1.719-38.044),p=0.008] was positively associated with GTR. For only supratentorial meningiomas, superior sagittal sinus involvement [OR (95%CI);0.077 (0.010-0.571),p=0.01] and preoperative embolization [OR(95%CI);10.492(1.961-56.135),p=0.006] were independently associated with GTR.Conclusions:This study evaluated a subset of large intracranial meningiomas ≥5cm. The results indicate that GTR can be achieved in the majority of cases with limited morbidity and mortality, where symptoms will likely improve and recurrences seldom occur. This study may provide useful insights for patients undergoing surgery for large intracranial meningiomas.

WP1-14 A systematic review to evaluate different management strategies for incidental intracranial meningiomas

2019 ◽  
Vol 90 (3) ◽  
pp. e5.2-e5
Author(s):  
M Mohan ◽  
A Islim ◽  
RDC Moon ◽  
N Srikandarajah ◽  
AR Brodbelt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Management Strategies ◽  
Intracranial Meningioma ◽  
Radiological Progression ◽  
Active Monitoring ◽  
Intracranial Meningiomas ◽  
Benign Histology ◽  
Definition Of

ObjectivesEvaluate the outcomes of differing management strategies for incidental intracranial meningiomas.DesignSystematic review.SubjectsStudies with ≥10 patients≥16 years of age diagnosed radiologically with an incidental intracranial meningioma.MethodsPRISMA compliant methods were used to scan 6 databases up to September 2017. PROSPERO ID: CRD42017077928.ResultsTwenty retrospective studies (n=2130 patients) were included. Initial management strategies at diagnosis were: 27% (n=560) surgery, 22% (n=450) SRS and 51% (n=1040) active monitroing with a mean follow-up of 49.5 months (SD=29.3). 21% (n=220) of patients in the active monitoring cohort eventually had or were recommended an intervention due to: radiological progression (n=153), development of symptoms (n=66) and patient preference (n=1). Mean time-to-intervention was 24.8 months (SD=18.2). 94% (n=207) of interventions were within 5 years. The definition of ‘growth’ and the radiological surveillance regimens varied widely. Morbidity rates following surgery and SRS, accounting for cross over, were 15% and 22% respectively. Surgery revealed benign histology in 94% of the cases. Quality of life is improperly examined.ConclusionsThe management of patients with incidental intracranial meningiomas varies widely. Most patients who develop clinical or radiological progression will do so within 5 years of diagnosis. Intervention at diagnosis may result in unnecessary overtreatment. Prospective data is needed to develop a risk calculator for managing incidental meningioma.

scholarly journals P09.02 Surgical treatment for intracranial meningiomas in elderly patients growing during follow-up study

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii39-iii39
Author(s):  
M Okuma
Keyword(s):  
Surgical Treatment ◽  
Life Expectancy ◽  
Elderly Patients ◽  
High Intensity ◽  
The Elderly ◽  
Who Grade ◽  
Follow Up Study ◽  
Intracranial Meningiomas ◽  
Antiplatelet Medication

Abstract BACKGROUND In Japan in which life expectancy exceeds 85 years old, there are many elderly people who have sufficient healthy life even over 75 years of age and maintain social activities. With the increase in life expectancy and widespread use of magnetic resonance imaging (MRI), it is estimated that the number of asymptomatic meningioma diagnosed in elderly patients will increase. They are often followed up for the elderly, but they often become symptomatic as the tumor grows. Considering the inherent complications of the elderly and the patient’s life expectancy, it is often difficult to decide whether to operate. Here, we report the results of surgical treatment for intracranial meningiomas in elderly patients growing during follow-up study. MATERIAL AND METHODS Between January 2010 and December 2018, we treated 322 meningioma patients, including 18 patients older than 75 years old who had grown during follow-up. We performed a retrospective analysis of the 18 patients and measured Tumor doubling time (TDT) using CT scan or MRI image. We mainly examined the relationship between TDT and WHO classification, MIB-1 index, edema and calcification, intensity on MRI T2 weighted-imaging. RESULTS 5 were male and 13 were female. There were 6 cases of skull base meningioma and 13 cases in which the tumor showed high intensity on the MRI T2 weighted-imaging. 4 cases showed intratumoral hemorrhage. 8 cases had edema. 11 cases were symptomatic meningiomas and 7 cases were asymptomatic meningiomas. There were 7 cases of WHO grade I meningioma and 11 cases of WHO grade II or III meningiomas. TDT was an average of 1.82 year (0.37–3.74). 9 patients have taken anticoagulant or antiplatelet medication. CONCLUSION In following up elderly meningioma patients, MRI should be performed at periodic intervals if the tumor showed high intensity on the MRI T2 weighted-imaging or had edema. In case of surgical treatment, we should pay attention to taking anticoagulant or antiplatelet medication, and treatment strategy is needed to avoid complications with sufficiently preoperative examination.

Evaluation of R-CHOP and R-CVP in the treatment of elderly patient with non-Hodgkin lymphoma

MedPharmRes ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 1-6
Author(s):  
Truc Phan ◽  
Tram Huynh ◽  
Tuan Q. Tran ◽  
Dung Co ◽  
Khoi M. Tran
Keyword(s):  
Elderly Patients ◽  
Hodgkin Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
The Elderly ◽  
Free Survival ◽  
Non Hodgkin Lymphoma ◽  
Common Sign ◽  
Related Mortality

Introduction: Little information is available on the outcomes of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) and R-CVP (rituximab with cyclophosphamide, vincristine and prednisone) in treatment of the elderly patients with non-Hodgkin lymphoma (NHL), especially in Vietnam. Material and methods: All patients were newly diagnosed with CD20-positive non-Hodgkin lymphoma (NHL) at Blood Transfusion and Hematology Hospital, Ho Chi Minh city (BTH) between 01/2013 and 01/2018 who were age 60 years or older at diagnosis. A retrospective analysis of these patients was perfomed. Results: Twenty-one Vietnamese patients (6 males and 15 females) were identified and the median age was 68.9 (range 60-80). Most of patients have comorbidities and intermediate-risk. The most common sign was lymphadenopathy (over 95%). The proportion of diffuse large B cell lymphoma (DLBCL) was highest (71%). The percentage of patients reaching complete response (CR) after six cycle of chemotherapy was 76.2%. The median follow-up was 26 months, event-free survival (EFS) was 60% and overall survival (OS) was 75%. Adverse effects of rituximab were unremarkable, treatment-related mortality accounted for less than 10%. There was no difference in drug toxicity between two regimens. Conclusions: R-CHOP, R-CVP yielded a good result and acceptable toxicity in treatment of elderly patients with non-Hodgkin lymphoma. In patients with known cardiac history, omission of anthracyclines is reasonable and R-CVP provides a competitive complete response rate.

The New Geriatric Syndromes

2019 ◽  
Vol 15 (1) ◽  
pp. 33-36
Author(s):  
Animesh Gupta ◽  
Soumya K. Inamadar ◽  
Ashish Goel
Keyword(s):  
Health Outcomes ◽  
Sleep Disorders ◽  
Elderly Population ◽  
Oropharyngeal Dysphagia ◽  
The Elderly ◽  
Present Review ◽  
Social Deficits ◽  
Geriatric Syndromes ◽  
Adverse Health Outcomes ◽  
Clinical Conditions

Geriatric syndromes consist of common clinical conditions affecting the elderly population. They lead to multiple, interacting medical and social deficits that increase the risk of adverse health outcomes, including dependence, institutionalization and also death. Research over the last few decades, in this area of medicine, has led to evolution of newer syndromes that pose a greater challenge to the physician. The present review aims to provide a synopsis of some of the newer syndromes like frailty, osteosarcopenia, sleep disorders and oropharyngeal dysphagia that have emerged in geriatric literature in recent times.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

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