Abstract
Surgical treatment of elderly patients with meningioma is has proved to be safe, especially when patients are selected using dedicated surgical scores. These scores take into account tumor size, edema, location and patient’s co-morbidities. Neuropsychological functioning (NPF) of this kind of patients has been poorly studied in literature and it is not taken into account by these scores. Aim of our study was to describe the long-term outcome in terms of NPF of elderly patients undergoing surgery. Patients older than 70 years of age affected by intracranial meningioma and selected with the Clinical-Radiological Grading Score were included in our study. Neuropsychological testing was performed using a dedicated battery of tests before surgery, 3 and 12 months after surgery. Clinical, neurological and radiological outcomes were studied as well. Forty-one patients with a median age of 74 years were included in this study. Preoperatively only 1/41 patients showed a normal NPF with all tests scoring normally. Four out of 39 patients showed a complete neuropsychological recovery after 3 months; while 10/37 patients had a complete recovery after 12 months. NPF showed a trend of progressive improvement after surgery. Our study is the first experience reported in literature describing a long term follow-up in elderly patients after surgery for intracranial meningioma. In our series, surgery determined an improvement of NPF over time; especially with a low complication rate related to the selection of patients obtained through the CRGS. Further studies need to be performed in order to understand how brain edema, tumor size, volume and tumor location affect NPF in both short and long term.
Similar content being viewed by others
References
Dolecek TA, Propp JM, Stroup NE, Kruchko C (2012) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005–2009. Neuro-Oncology 14(Suppl 5):v1–49. https://doi.org/10.1093/neuonc/nos218
Whittle IR, Smith C, Navoo P, Collie D (2004) Meningiomas. Lancet Lond Engl 363:1535–1543. https://doi.org/10.1016/S0140-6736(04)16153-9
Rockhill J, Mrugala M, Chamberlain MC (2007) Intracranial meningiomas: an overview of diagnosis and treatment. Neurosurg Focus 23:E1. https://doi.org/10.3171/FOC-07/10/E1
Louis D, Ohgaki H, Wiestler O et al (2007) The 2007 WHO Classification of tumours of the central nervous system. Acta Neuropathol (Berl) 114:97–109. https://doi.org/10.1007/s00401-007-0243-4
Wiemels J, Wrensch M, Claus EB (2010) Epidemiology and etiology of meningioma. J Neurooncol 99:307–314. https://doi.org/10.1007/s11060-010-0386-3
Waagemans ML, van Nieuwenhuizen D, Dijkstra M et al (2011) Long-term impact of cognitive deficits and epilepsy on quality of life in patients with low-grade meningiomas. Neurosurgery 69:72–79. https://doi.org/10.1227/NEU.0b013e318212badb
Caroli M, Locatelli M, Prada F et al (2005) Surgery for intracranial meningiomas in the elderly: a clinical-radiological grading system as a predictor of outcome. J Neurosurg 102:290–294. https://doi.org/10.3171/jns.2005.102.2.0290
Cohen-Inbar O, Soustiel JF, Zaaroor M (2010) Meningiomas in the elderly, the surgical benefit and a new scoring system. Acta Neurochir (Wien) 152:87–97. https://doi.org/10.1007/s00701-009-0552-6
Sacko O, Sesay M, Roux F-E et al (2007) Intracranial meningioma surgery in the ninth decade of life. Neurosurgery 61:950–955. https://doi.org/10.1227/01.neu.0000303190.80049.7d
D’Andrea G, Roperto R, Caroli E et al (2005) Thirty-seven cases of intracranial meningiomas in the ninth decade of life: our experience and review of the literature. Neurosurgery 56:956–961. (Discussion 956–961)
Konglund A, Rogne SG, Lund-Johansen M et al (2013) Outcome following surgery for intracranial meningiomas in the aging. Acta Neurol Scand 127:161–169. https://doi.org/10.1111/j.1600-0404.2012.01692.x
Grossman R, Mukherjee D, Chang DC et al (2011) Preoperative charlson comorbidity score predicts postoperative outcomes among older intracranial meningioma patients. World Neurosurg 75:279–285. https://doi.org/10.1016/j.wneu.2010.09.003
Gousias K, Schramm J, Simon M (2016) The Simpson grading revisited: aggressive surgery and its place in modern meningioma management. J Neurosurg 125:551–560. https://doi.org/10.3171/2015.9.JNS15754
Meskal I, Gehring K, Rutten G-JM, Sitskoorn MM (2016) Cognitive functioning in meningioma patients: a systematic review. J Neurooncol 128:195–205. https://doi.org/10.1007/s11060-016-2115-z
Tucha O, Smely C, Preier M, Lange KW (2000) Cognitive deficits before treatment among patients with brain tumors. Neurosurgery 47:324–333; (Discussion 333–334)
Tucha O, Smely C, Preier M et al (2003) Preoperative and postoperative cognitive functioning in patients with frontal meningiomas. J Neurosurg 98:21–31. https://doi.org/10.3171/jns.2003.98.1.0021
Tucha O, Smely C, Lange KW (2001) Effects of surgery on cognitive functioning of elderly patients with intracranial meningioma. Br J Neurosurg 15:184–188
van Nieuwenhuizen D, Ambachtsheer N, Heimans JJ et al (2013) Neurocognitive functioning and health-related quality of life in patients with radiologically suspected meningiomas. J Neurooncol 113:433–440. https://doi.org/10.1007/s11060-013-1132-4
Di Cristofori A, Zarino B, Fanizzi C et al (2017) Analysis of factors influencing the access to concomitant chemo-radiotherapy in elderly patients with high grade gliomas: role of MMSE, age and tumor volume. J Neurooncol. https://doi.org/10.1007/s11060-017-2537-2
Habets EJJ, Kloet A, Walchenbach R et al (2014) Tumour and surgery effects on cognitive functioning in high-grade glioma patients. Acta Neurochir (Wien) 156:1451–1459. https://doi.org/10.1007/s00701-014-2115-8
Meskal I, Gehring K, van der Linden SD et al (2015) Cognitive improvement in meningioma patients after surgery: clinical relevance of computerized testing. J Neurooncol 121:617–625. https://doi.org/10.1007/s11060-014-1679-8
Lezak MD (1994) Domains of behavior from a neuropsychological perspective: the whole story. Neb Symp Motiv 41:23–55
Capitani E (1997) Normative data and neuropsychological assessment. Common problems in clinical practice research. Neuropsychol Rehabil 7:295–310. https://doi.org/10.1080/713755543
Capitani E, Laiacona M (1997) Composite neuropsychological batteries and demographic correction: standardization based on equivalent scores, with a review of published data. J Clin Exp Neuropsychol 19:795–809. https://doi.org/10.1080/01688639708403761
Lageman SK, Cerhan JH, Locke DEC et al (2010) Comparing neuropsychological tasks to optimize brief cognitive batteries for brain tumor clinical trials. J Neurooncol 96:271–276. https://doi.org/10.1007/s11060-009-9960-y
De Renzi E, Faglioni P (1978) Normative data and screening power of a shortened version of the token test. Cortex 14:41–49
Catricalà E, Della Rosa PA, Ginex V et al (2013) An Italian battery for the assessment of semantic memory disorders. Neurol Sci 34:985–993. https://doi.org/10.1007/s10072-012-1181-z
Orsini A, Grossi D, Capitani E et al (1987) Verbal and spatial immediate memory span: normative data from 1355 adults and 1112 children. Ital J Neurol Sci 8:539–548
Carlesimo GA, De Risi M, Monaco M et al (2014) Normative data for measuring performance change on parallel forms of a 15-word list recall test. Neurol Sci 35:663–668. https://doi.org/10.1007/s10072-013-1573-8
Spinnler H (1987) Italian standardization and classification of Neuropsychological tests. The Italian Group on the Neuropsychological Study of Aging. Ital J Neurol Sci 8:1–120
Caffarra P, Vezzadini G, Dieci F et al (2002) A short version of the Stroop test: normative data in an Italian population sample. Nuova Riv Neurol 12:111–115
Monaco M, Costa A, Caltagirone C, Carlesimo GA (2013) Forward and backward span for verbal and visuo-spatial data: standardization and normative data from an Italian adult population. Neurol Sci 34:749–754. https://doi.org/10.1007/s10072-012-1130-x
Basso A, Capitani E, Laiacona M (1987) Raven’s coloured progressive matrices: normative values on 305 adult normal controls. Funct Neurol 2:189–194
Novelli G, Papagno C, Capitani E et al (1986) Tre test clinici di ricerca e produzione lessicale. Taratura su soggetti normali. Arch Psicol Neurol Psichiatr 47:477–506
Caffarra P, Vezzadini G, Dieci F et al (2002) Rey-Osterrieth complex figure: normative values in an Italian population sample. Neurol Sci 22:443–447. https://doi.org/10.1007/s100720200003
Casarotti A, Papagno C, Zarino B (2014) Modified Taylor complex figure: normative data from 290 adults. J Neuropsychol 8:186–198. https://doi.org/10.1111/jnp.12019
De Renzi E, Motti F, Nichelli P (1980) Imitating gestures. A quantitative approach to ideomotor apraxia. Arch Neurol 37:6–10
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatr 20:22–39
Cornu P, Chatellier G, Dagreou F et al (1990) Intracranial meningiomas in elderly patients. Postoperative morbidity and mortality. Factors predictive of outcome. Acta Neurochir (Wien) 102:98–102
Schul DB, Wolf S, Krammer MJ et al (2012) Meningioma surgery in the elderly: outcome and validation of 2 proposed grading score systems. Neurosurgery 70:555–565. https://doi.org/10.1227/NEU.0b013e318233a99a
Cohen-Inbar O, Sviri GE, Soustiel JF, Zaaroor M (2011) The geriatric scoring system (GSS) in meningioma patients—validation. Acta Neurochir (Wien) 153:1501–1508. https://doi.org/10.1007/s00701-011-1034-1
Sacko O, Sesay M, Roux F-E et al (2007) Intracranial meningioma surgery in the ninth decade of life. Neurosurgery 61:950–954. https://doi.org/10.1227/01.neu.0000303190.80049.7d. (Discussion 955).
Steinvorth S, Welzel G, Fuss M et al (2003) Neuropsychological outcome after fractionated stereotactic radiotherapy (FSRT) for base of skull meningiomas: a prospective 1-year follow-up. Radiother Oncol 69:177–182. https://doi.org/10.1016/S0167-8140(03)00204-4
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Andrea Di Cristofori and Barbara Zarino have equally contributed to this work.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Di Cristofori, A., Zarino, B., Bertani, G. et al. Surgery in elderly patients with intracranial meningioma: neuropsychological functioning during a long term follow-up. J Neurooncol 137, 611–619 (2018). https://doi.org/10.1007/s11060-018-2754-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-018-2754-3