Microsurgical resection of intracranial meningiomas in patients aged 80 years old or more: A systematic review and meta-analysis

Introduction: The incidence of intracranial meningiomas rises with advancing age, raising the question of whether similar surgical outcomes in morbidity and mortality can be expected compared to younger population. We conducted a systematic review and meta-analysis of research examining microsurgical outcomes in those aged 80 years or older. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we reviewed articles published between January 1995 and January 2024, referenced in PubMed or Embase. Inclusion criteria were peer-reviewed clinical studies of series reporting microsurgical resection of intracranial meningiomas in patients aged 80 years or more, written in English. Primary outcome was EOR (extend of resection), classified as tumor total resection versus partial resection. Secondary outcomes were morbidity and mortality. Results: Ten studies reported 690 patients. Total tumor resection was achieved in 88% of cases (range 85-91; I-2 = 56; p heterogeneity = 0.02; p < 0.01). Tumor partial resection was achieved in 12% (range 9-15; I2 = 56; p heterogeneity = 0.02 and p < 0.001). Postsurgical intracerebral hemorrhage was encountered in 1% of cases (range 0-2; I2 = 69; p heterogeneity = < 0.01). Surgical mortality was encountered in 5% of cases (range 3-7; I2 = 61; p heterogeneity = < 0.01). Conclusion: Current data suggests that achieving high total resection rates, up to 88%, is feasible. The surgical mortality rate was 5%. A key unresolved neurosurgical dilemma is whether to operate on patients over 80 years old. Future studies are essential to assess all relevant risk factors comprehensively.