Elsevier

Surgical Neurology

Volume 52, Issue 3, September 1999, Pages 259-264
Surgical Neurology

Neoplasm
Brain tumor surgery in geriatric patients: a critical analysis in 44 patients over 80 years

https://doi.org/10.1016/S0090-3019(99)00075-0Get rights and content

Abstract

BACKGROUND

The decision of whether to operate on brain tumors in elderly patients has not been made easier despite diagnostic and therapeutic advances facilitating their diagnosis. Little is known about the outcome of brain tumor surgery in patients 80 years or older probably because the number of these patients, although increasing, is still small.

METHODS

The results of brain tumor surgery in 44 patients aged 80–86 years (mean age 83 years) were analyzed to determine which factors are relevant in the evaluation of the operative risk. The following parameters were analyzed with regard to the outcome: tumor volume, location, histopathology, preoperative condition, and concomitant diseases.

RESULTS

At discharge 19 patients (43%) had improved while 14 (32%) remained unchanged. Nevertheless, the overall results were unsatisfactory in 10 patients (23%), of whom 5 died in hospital. Tumor location, volume, and histopathology did not correlate with the outcome. The preoperative cerebrovascular condition and the existence of multiple concomitant diseases were clearly the determining factors for the outcome.

CONCLUSIONS

These results indicate that patients with life-threatening tumors or those causing persistent and intolerable brain dysfunction suffering from symptomatic cerebrovascular atherosclerosis as well as from multiple treatment requiring concomitant diseases did definitely not benefit from surgery.

Section snippets

Patients and methods

Forty-four patients (13 male, 31 female) with a mean age of 83 years (80–86 years) who underwent brain tumor surgery were included in the study. The following parameters were analyzed with regard to the outcome: tumor volume, location, histopathology, preoperative condition, and concomitant diseases. Cases involving only tumor biopsy or tumor cyst puncture were excluded. All patients underwent craniotomy. Complete macroscopic extirpation was achieved in 33 cases and subtotal removal in 11

Complications and causes of death

A total of 5 patients died during the hospitalization. Symptomatic cerebral atherosclerosis was diagnosed preoperatively in 3 of these 5 patients. One patient died on the first postoperative day due to secondary hemorrhage; two patients died on the 8th and 14th postoperative days due to progressive deterioration following cerebral infarction. One patient died on the 16th postoperative day due to cardiocirculatory failure following aspiration pneumonia, and one patient died of pneumonia on the

Discussion

In this study, the perioperative mortality of patients aged from 80 to 86 years was 11%, that is about 9% higher than the mortality of all other patients undergoing brain tumor surgery [35]. Most of the patients in this study had severe life-threatening symptoms before surgery, and none were asymptomatic.

Due to the biased preoperative patient selection, it is difficult to compare the outcome of this study with that of others performed with a younger patient population. Moreover, there is also a

References (35)

  • J Barker

    Postoperative care of the neurosurgical patient

    Br J Anaesth

    (1976)
  • M Dujovny et al.

    Geriatric neurosurgery

    Surg Neurol

    (1987)
  • D.F Kelly

    Neurosurgical postoperative care

    Neurosurg Clin N Am

    (1994)
  • Y.S Kim et al.

    Infections in the neurosurgical intensive care unit

    Neurosurg Clin N Am

    (1994)
  • F Ampil et al.

    Intracranial astrocytoma in elderly patients

    J Neurooncol

    (1992)
  • D Avidan et al.

    Neurosurgical approach to the aging patient

    Mt Sinai Med

    (1987)
  • M Bach et al.

    Quality of life and mortality following major neurosurgical interventions in advanced age

    Z Gerontol

    (1988)
  • R.J Boland

    Outcomes in elderly patients after intensive care

    JAMA

    (1993)
  • L Campan et al.

    Age and other factors in the prognosis and operative indications for brain surgery

    Ann Anesthesiol Fr

    (1977)
  • R Chacornac et al.

    Is age a criterion for admission into intensive care unit in neurosurgery?

    Minerva Anestesiol

    (1993)
  • S.M Fridriksson et al.

    Intracranial aneurysm surgery in the 8th and 9th decades of lifeimpact on population based management outcome

    Neurosurgery

    (1995)
  • H Friedman et al.

    Expanding intracranial lesions in geriatric patients

    Geriatrics

    (1972)
  • A Harenko

    Brain tumors in geriatric patients

    Duodecim

    (1970)
  • H.D Herrmann et al.

    Changes in cerebral perfusion after brain operations

    Acta Neurochir

    (1967)
  • J Horn et al.

    Intensive care medicine in geriatrics - an assessment of current status

    Internist

    (1991)
  • F Kockerling et al.

    Intensive care of geriatric patients in surgery

    Fortschr Med

    (1992)
  • R Laumer et al.

    Intensive therapy of elderly patients in neurosurgery. Specifics of the postoperative phase in advanced age

    Fortschr Med

    (1992)

    • Cited by (0)

    View full text
    Copyright © 1999 Elsevier Science Inc. All rights reserved.