{"product_id":"treating-brain-meningiomas-in-elderly-patients-what-a-major-italian-study-and-global-research-reveal","title":"Treating Brain Meningiomas in Elderly Patients: What a Major Italian Study and Global Research Reveal","description":"\u003cp\u003eThis study combined a national survey of 51 Italian neurosurgical centers with a systematic review and meta-analysis of 18 studies covering 17,199 patients to examine how brain meningiomas are treated in elderly patients. The survey found wide variation in practice, largely because standardized guidelines do not exist, though most centers support a multidisciplinary approach. The meta-analysis showed that elderly patients (65 years and older) had significantly higher risks than younger patients for permanent neurological deficits, postoperative infections, hemorrhage, perioperative death, and medical complications. The authors conclude that prospective studies are needed to build stronger evidence for this growing patient group.\u003c\/p\u003e\n\n\u003ch1\u003eTreating Brain Meningiomas in Elderly Patients: What a Major Italian Study and Global Research Reveal\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n\u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#methods\"\u003eHow the Research Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#survey-results\"\u003eSurvey Results: How Italian Neurosurgical Centers Treat Elderly Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#caseload\"\u003eHow Caseload Size Affects Treatment Decisions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#literature\"\u003eLiterature Review: What the Published Studies Show\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#meta-analysis\"\u003eMeta-Analysis Findings: Risks in Elderly vs. Younger Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#implications\"\u003eClinical Implications: What This Means for Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations: What the Study Could Not Prove\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations and Future Directions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eA survey of 51 Italian neurosurgical centers found wide variation in how elderly meningioma patients are treated, largely because standardized guidelines do not exist.\u003c\/li\u003e\n\u003cli\u003eA meta-analysis of 18 studies covering 17,199 patients found that those aged 65 and older had significantly higher risks of permanent deficits, infections, hemorrhage, perioperative death, and medical complications.\u003c\/li\u003e\n\u003cli\u003eIn the survey, 76.4% of centers said age alone did not influence the surgical decision; age mattered mainly when preoperative comorbidity risk was high.\u003c\/li\u003e\n\u003cli\u003eAll responding centers (100%) chose a 'wait and scan' approach for elderly patients with asymptomatic incidental meningiomas without edema.\u003c\/li\u003e\n\u003cli\u003eThe researchers conclude that prospective studies are needed to build stronger evidence for treating this growing patient group.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why This Research Matters\u003c\/h2\u003e\n\n\u003cp\u003eMeningiomas are tumors that grow from the membranes covering the brain and spinal cord. They account for \u003cstrong\u003e16% to 36% of all intracranial tumors in adults\u003c\/strong\u003e. These tumors are the most common type of primary brain tumor.\u003c\/p\u003e\n\n\u003cp\u003eThe incidence of meningioma is about \u003cstrong\u003e1 case per 12,500 individuals\u003c\/strong\u003e in the general population. However, this rate increases significantly with age. In people over 80 years old, the incidence reaches \u003cstrong\u003e1 case per 2,000 individuals\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003cp\u003eBetter diagnostic technology and longer life expectancy have led to more cases of both symptomatic and incidental meningiomas being discovered. This means more elderly patients are being diagnosed with these tumors. The growing demand for neurosurgical treatment in older patients raises important questions about the best balance between treatment benefits and risks.\u003c\/p\u003e\n\n\u003cp\u003eTraditionally, surgical removal (resection) has been the gold standard of treatment for large, symptomatic lesions and for tumors that are growing rapidly under observation. The primary goal of surgery is to remove as much of the tumor as possible while minimizing complications and death.\u003c\/p\u003e\n\n\u003cp\u003eHowever, existing literature on elderly meningioma patients (often abbreviated as MEP) has shown a very broad range of outcomes. Reported mortality rates range from \u003cstrong\u003e0% to 45%\u003c\/strong\u003e, and complication rates vary from \u003cstrong\u003e10% to 39%\u003c\/strong\u003e. Several studies comparing elderly and younger patients have indicated that surgery in elderly patients carries a higher risk of death and complications.\u003c\/p\u003e\n\n\u003cp\u003eThe shorter life expectancy of older patients and their higher rate of other medical conditions (comorbidities) have led some doctors to consider subtotal resection. Subtotal resection means removing most but not all of the tumor. Some doctors consider subtotal resection as an alternative to gross-total resection. Gross-total resection means removing the entire visible tumor. Subtotal resection is often combined with adjuvant radiotherapy (radiation treatment) or stereotactic radiosurgery (a precise, focused form of radiation), especially for meningiomas at the base of the skull.\u003c\/p\u003e\n\n\u003cp\u003eA \"wait and see\" strategy may also be preferred for patients with other medical conditions and minimally symptomatic tumors. However, research has shown that elderly patients who chose conservative treatment had higher tumor-related mortality rates compared to those who underwent surgical removal. Additionally, elderly patients appear to develop atypical and anaplastic meningiomas (more aggressive, faster-growing tumor types) more frequently than younger patients. These aggressive tumors can complicate the clinical course.\u003c\/p\u003e\n\n\u003cp\u003eNo consensus has been reached on the best surgical approach for elderly meningioma patients. There are also limited established predictors of outcomes for this patient group. This leads to important questions: Is initial surgical intervention equally effective for older patients as it is for younger adults? Are postoperative outcomes, complications, surgical morbidity, and mortality comparable between these two age groups?\u003c\/p\u003e\n\n\u003cp\u003eThis investigation aimed to clarify the existing evidence and address the recognized challenges linked to treating meningiomas in elderly patients. The researchers also sought to describe the current clinical mindset of Italian neurosurgeons in light of recent literature data.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow the Research Was Conducted\u003c\/h2\u003e\n\n\u003cp\u003eThis study had two main parts: a national survey of Italian neurosurgical centers and a systematic review with meta-analysis of the published medical literature.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eSurvey Design and Participants\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe survey was designed by the Coordinators of the Neuro-oncology, Stereotactic Radiosurgery, and Neuroendoscopy Sections of the Italian Society of Neurosurgery (SINch). The survey was created using an online tool called Survey Monkey. The SINch members Board approved the survey before it was distributed.\u003c\/p\u003e\n\n\u003cp\u003eThe survey was sent by email to all Chiefs of Neurosurgical Departments in Italy. Each center was asked to provide a single representative to complete the survey. The survey remained open for responses from \u003cstrong\u003eMay 5, 2022, until November 21, 2022\u003c\/strong\u003e. All data were collected anonymously.\u003c\/p\u003e\n\n\u003cp\u003eThe survey included \u003cstrong\u003e31 questions\u003c\/strong\u003e organized into four domains:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003eDemographics and characteristics of the respondents\u003c\/li\u003e\n\u003cli\u003eHow \"elderly\" is defined and what risk assessment scales are used\u003c\/li\u003e\n\u003cli\u003eQuestions about treatment options\u003c\/li\u003e\n\u003cli\u003eQuestions about perioperative (around the time of surgery) and postoperative (after surgery) management\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eCompleting the entire survey took approximately 8 to 10 minutes.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eLiterature Review Methods\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe researchers conducted an extensive review of published studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This is a standardized method for conducting thorough literature reviews.\u003c\/p\u003e\n\n\u003cp\u003eThe review question was formulated using the PICO scheme (Patients, Intervention, Comparison, Outcomes). The specific question was: In newly diagnosed meningioma patients, has surgery in patients over age 70 proven effective compared to surgery in younger patients? This question concerns morbidity (complications) and mortality (death).\u003c\/p\u003e\n\n\u003cp\u003eThe search strategy combined medical subject headings (MeSH) and free text terms. The search included terms such as \"elderly,\" \"meningioma,\" \"surgery,\" \"postoperative deficits,\" \"postoperative mortality,\" \"postoperative morbidity,\" \"stereotactic radiosurgery,\" \"radiosurgery,\" and \"outcome.\"\u003c\/p\u003e\n\n\u003cp\u003eThe researchers included studies published from \u003cstrong\u003eJanuary 2000 to March 2023\u003c\/strong\u003e that compared outcomes in elderly meningioma patients (65 years and older) versus younger meningioma patients (under 65 years). The outcomes compared were:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eNeurological complications\u003c\/li\u003e\n\u003cli\u003eMedical complications\u003c\/li\u003e\n\u003cli\u003eMortality\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe researchers excluded case reports, review articles, meta-analyses, abstracts, reports of aggregated data, and studies where surgery was not the primary treatment. They also excluded studies not published in English, non-comparative studies, and studies without quantitative data.\u003c\/p\u003e\n\n\u003cp\u003eTwo authors independently reviewed paper titles and abstracts, removing duplicates. In a second review phase, they assessed papers for inclusion based on specific criteria. They also checked the references of included papers to find any missed studies. Any disagreements were resolved through consensus. The level of agreement between the two reviewers was measured using Cohen's kappa coefficient.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eQuality Assessment\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe researchers used the ROBINS-I tool to evaluate the risk of bias in non-randomized controlled trials. The overall risk of bias was categorized as critical, serious, moderate, low, or with no available information. Two investigators performed this assessment independently. They evaluated seven main domains for potential systematic errors:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eBias due to confounding factors\u003c\/li\u003e\n\u003cli\u003eBias in participant selection\u003c\/li\u003e\n\u003cli\u003eBias in how interventions were classified\u003c\/li\u003e\n\u003cli\u003eBias from deviations in intended interventions\u003c\/li\u003e\n\u003cli\u003eBias due to missing data\u003c\/li\u003e\n\u003cli\u003eBias in outcome measurement\u003c\/li\u003e\n\u003cli\u003eBias in result selection\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eCategorical variables were reported as absolute numbers and percentages. Continuous variables were reported as median values with standard deviation. The survey results were analyzed using Chi-square or Fisher's exact tests to compare categorical variables.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers specifically analyzed whether treatment strategies differed among centers with different caseloads. Centers were grouped into three categories:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eHigh caseload (more than 100 cases per year)\u003c\/li\u003e\n\u003cli\u003eIntermediate caseload (51 to 99 cases per year)\u003c\/li\u003e\n\u003cli\u003eLow caseload (fewer than 50 cases per year)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor the meta-analysis, the researchers collected raw data on patient demographics and outcomes. They calculated individual and pooled odds ratios (OR) for different outcomes using the Mantel-Haenszel fixed effect model. This model compared elderly versus young populations. For each outcome, they calculated 95% confidence intervals and two-sided p values. A p value less than 0.05 was considered statistically significant.\u003c\/p\u003e\n\n\u003cp\u003eHeterogeneity (how much the studies differed from each other) was evaluated using the I-squared statistic. An I-squared value greater than 50% was considered indicative of significant heterogeneity. Publication bias was assessed through visual inspection of funnel plots. The statistical analysis was performed using Cochrane Review Manager software, version 5.4.\u003c\/p\u003e\n\n\u003ch2 id=\"survey-results\"\u003eSurvey Results: How Italian Neurosurgical Centers Treat Elderly Patients\u003c\/h2\u003e\n\n\u003cp\u003eThe researchers contacted \u003cstrong\u003e120 Neurosurgical Centers\u003c\/strong\u003e electronically. Of these, \u003cstrong\u003e51 centers responded\u003c\/strong\u003e, giving a response rate of \u003cstrong\u003e42.5%\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eRespondent Characteristics\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eAmong the respondents:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e33.3%\u003c\/strong\u003e worked at academic hospitals, while \u003cstrong\u003e66.7%\u003c\/strong\u003e worked at public hospitals\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e41.2%\u003c\/strong\u003e were department chiefs, \u003cstrong\u003e15.6%\u003c\/strong\u003e were full-time professors, \u003cstrong\u003e5.8%\u003c\/strong\u003e were senior researchers, and \u003cstrong\u003e37.5%\u003c\/strong\u003e were hospital clinicians\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e66.7%\u003c\/strong\u003e had more than 15 years of experience in surgical management of cranial meningiomas, \u003cstrong\u003e13.7%\u003c\/strong\u003e had 10 to 15 years, and \u003cstrong\u003e19.6%\u003c\/strong\u003e had less than 10 years\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e37.3%\u003c\/strong\u003e were aged 35 to 45, \u003cstrong\u003e25.4%\u003c\/strong\u003e were aged 46 to 55, and \u003cstrong\u003e37.3%\u003c\/strong\u003e were over 55\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e88.2%\u003c\/strong\u003e were male and \u003cstrong\u003e11.8%\u003c\/strong\u003e were female\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e56.9%\u003c\/strong\u003e worked in northern Italy, \u003cstrong\u003e27.5%\u003c\/strong\u003e in central Italy, and \u003cstrong\u003e15.6%\u003c\/strong\u003e in southern Italy\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eCenter Caseload and Available Treatments\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eRegarding the number of meningioma patients treated each year:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e27.5%\u003c\/strong\u003e of centers treated fewer than 50 cases per year (low caseload)\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e49%\u003c\/strong\u003e treated 50 to 99 cases per year (intermediate caseload)\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e23.5%\u003c\/strong\u003e treated 100 or more cases per year (high caseload)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAvailable treatments varied across centers:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e70.6%\u003c\/strong\u003e offered endoscopic surgery\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e55.9%\u003c\/strong\u003e offered stereotactic radiosurgery\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e74.5%\u003c\/strong\u003e offered fractionated stereotactic radiotherapy\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor preoperative imaging, \u003cstrong\u003e88.2%\u003c\/strong\u003e of centers used an advanced imaging protocol, while \u003cstrong\u003e11.8%\u003c\/strong\u003e used standard MRI.\u003c\/p\u003e\n\n\u003cp\u003eIntraoperative tools available at responding centers included:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eNeuronavigation: \u003cstrong\u003e100%\u003c\/strong\u003e of centers\u003c\/li\u003e\n\u003cli\u003eElectrophysiological monitoring\/stimulation: \u003cstrong\u003e90.2%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eIntraoperative ultrasound: \u003cstrong\u003e60.8%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003e5-ALA (to evaluate bone infiltration): \u003cstrong\u003e27.5%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eIntraoperative CT: \u003cstrong\u003e19.6%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eIntraoperative laser: \u003cstrong\u003e11.8%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eDefining \"Elderly\" and Assessing Risk\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eWhen asked how they define an elderly patient:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e66.7%\u003c\/strong\u003e defined elderly as over 70 years\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e29.4%\u003c\/strong\u003e defined elderly as over 75 years\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e3.9%\u003c\/strong\u003e defined elderly as over 80 years\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor preoperative risk assessment, all centers (\u003cstrong\u003e100%\u003c\/strong\u003e) used the ASA (American Society of Anesthesiologists) grading system. Other tools were used less frequently:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eCCI (Charlson Comorbidity Index): \u003cstrong\u003e13.7%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eECOG (Eastern Cooperative Oncology Group performance status): \u003cstrong\u003e19.6%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eOther tools such as CRGS and Clinical Frailty Scale: \u003cstrong\u003e3.9%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eOnly \u003cstrong\u003e17.6%\u003c\/strong\u003e of centers routinely used specific predictive scores for functional outcomes.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eMultidisciplinary Discussion\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eWhen asked whether cases were discussed within a multidisciplinary group for risk stratification and treatment decisions:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e37.3%\u003c\/strong\u003e always discussed cases in a multidisciplinary group\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e52.9%\u003c\/strong\u003e discussed cases only in selected situations\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e9.8%\u003c\/strong\u003e never discussed cases in a multidisciplinary group\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAmong those who discussed cases only in selected situations, the reasons included:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eMidline lesions less than 3 cm in maximum diameter: \u003cstrong\u003e51.8%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eHigh comorbidity risk: \u003cstrong\u003e18.6%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eBoth reasons: \u003cstrong\u003e29.6%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eInfluence of Age on Treatment Decisions\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eIn the majority of centers (\u003cstrong\u003e76.4%\u003c\/strong\u003e), age by itself was not a factor influencing the surgical decision. Age influenced decisions only for cases with high preoperative comorbidity risk. For \u003cstrong\u003e21.5%\u003c\/strong\u003e of respondents, age always influenced the surgical indication, while \u003cstrong\u003e1.9%\u003c\/strong\u003e said age never influenced the decision.\u003c\/p\u003e\n\n\u003cp\u003eWhen deciding between an endoscopic approach and classic microsurgery:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e74.5%\u003c\/strong\u003e said age never played a role in this decision\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e19.6%\u003c\/strong\u003e said age played a role in selected cases\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e5.9%\u003c\/strong\u003e said age always played a role\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor selecting the endoscopic approach as the first option, respondents chose it for:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eMidline lesions with maximum diameter less than 3 cm: \u003cstrong\u003e76.4%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eCases with high preoperative comorbidity risk: \u003cstrong\u003e39.2%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eResidual tumor management: \u003cstrong\u003e66.7%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor median skull base meningiomas (tuberculum, planum, clivus), the endoscopic procedure was the first choice in:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eFewer than 10% of cases: \u003cstrong\u003e54.8%\u003c\/strong\u003e of centers\u003c\/li\u003e\n\u003cli\u003e11% to 30% of cases: \u003cstrong\u003e33.3%\u003c\/strong\u003e of centers\u003c\/li\u003e\n\u003cli\u003eMore than 31% of cases: \u003cstrong\u003e11.8%\u003c\/strong\u003e of centers\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eWhen deciding between stereotactic radiosurgery (SRS) and open surgery:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e62.8%\u003c\/strong\u003e said age influenced the choice in selected cases\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e29.4%\u003c\/strong\u003e said age never influenced the choice\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e7.8%\u003c\/strong\u003e said age always influenced the choice\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor selecting the radiosurgical approach as the first option, respondents chose it for:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eMidline lesions with maximum diameter less than 3 cm: \u003cstrong\u003e76.4%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eCases with high preoperative comorbidity risk: \u003cstrong\u003e39.2%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eResidual tumor management: \u003cstrong\u003e66.7%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eSurgical Techniques and Materials\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eFor convexity meningiomas associated with significant hyperostosis (bone thickening), \u003cstrong\u003e94%\u003c\/strong\u003e of centers performed cranioplasty (skull reconstruction) during the same surgical procedure. Only \u003cstrong\u003e6%\u003c\/strong\u003e did not.\u003c\/p\u003e\n\n\u003cp\u003eFor cranioplasty materials, among the 44 centers that responded:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eCustom-made implants: \u003cstrong\u003e29.5%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eAcrylic, alumina ceramics, or methyl-methacrylate: \u003cstrong\u003e61.4%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eTitanium: \u003cstrong\u003e9.1%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eManaging Incidental Meningiomas\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eFor elderly patients with asymptomatic incidental meningiomas without edema:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e100%\u003c\/strong\u003e of centers chose a \"wait and scan\" approach\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e0%\u003c\/strong\u003e chose preventive radiosurgery\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e0%\u003c\/strong\u003e chose preventive surgery\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor elderly patients with asymptomatic incidental meningiomas showing volumetric progression on MRI:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e64.6%\u003c\/strong\u003e chose surgery\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e23.6%\u003c\/strong\u003e chose wait and see with regular MRI follow-up\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e11.8%\u003c\/strong\u003e chose stereotactic radiosurgery\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003ePerioperative and Postoperative Management\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eFor preoperative angiography and embolization (blocking blood vessels to the tumor):\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e84.5%\u003c\/strong\u003e used it in selected cases\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e15.6%\u003c\/strong\u003e never used it\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e1.9%\u003c\/strong\u003e always used it\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAmong those who used it in selected cases, the reasons included:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eVascular encasement (tumor surrounding blood vessels): \u003cstrong\u003e35.7%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eSkull base lesions: \u003cstrong\u003e59.5%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eGiant supratentorial lesions: \u003cstrong\u003e16.7%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor postoperative treatment after incomplete removal based on WHO tumor grade:\u003c\/p\u003e\n\n\u003cp\u003eFor WHO grade I meningiomas with incomplete removal:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eWait and scan with regular MRI follow-up: \u003cstrong\u003e82.4%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eStereotactic radiosurgery: \u003cstrong\u003e17.6%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor WHO grade II meningiomas with incomplete removal:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eFractionated radiotherapy or stereotactic radiosurgery: \u003cstrong\u003e64.8%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eWait and scan with regular MRI follow-up: \u003cstrong\u003e33.3%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eRadiotherapy or proton therapy: \u003cstrong\u003e1.9%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor WHO grade III meningiomas with incomplete removal:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eRadiotherapy or proton therapy: \u003cstrong\u003e56.9%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eFractionated radiotherapy or stereotactic radiosurgery: \u003cstrong\u003e43.1%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eVenous Thromboembolism Prophylaxis\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eAmong the 26 centers that responded to questions about blood clot prevention:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e92.4%\u003c\/strong\u003e performed early (within 24 hours) deep vein thrombosis and thromboembolism prophylaxis\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e7.6%\u003c\/strong\u003e did not perform early prophylaxis\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eMethods used for prophylaxis included:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eLow molecular weight heparin (24 hours after surgery): \u003cstrong\u003e92.4%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eEarly mobilization: \u003cstrong\u003e92.4%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003ePreoperative compression stockings: \u003cstrong\u003e73.1%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eIntraoperative intermittent pneumatic compression: \u003cstrong\u003e30.8%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eIdentifying patients at high risk for venous thromboembolism: \u003cstrong\u003e15.4%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003cli\u003eContinuous postoperative saturation monitoring for 48 hours after surgery: \u003cstrong\u003e7.7%\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eBefore starting prophylaxis, \u003cstrong\u003e73.1%\u003c\/strong\u003e of centers performed an early brain CT scan, while \u003cstrong\u003e26.9%\u003c\/strong\u003e did not.\u003c\/p\u003e\n\n\u003ch2 id=\"caseload\"\u003eHow Caseload Size Affects Treatment Decisions\u003c\/h2\u003e\n\n\u003cp\u003eThe researchers explored whether treatment strategies differed based on the caseload of the responding centers. Significant differences were mainly observed in two areas: the influence of age on surgical indications and the frequency of multidisciplinary discussions.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eInfluence of Age on Surgical Indications\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe factor of age had a significant impact on surgical indications in centers with high caseload. This difference was statistically significant compared to centers with intermediate and low caseload (\u003cstrong\u003ep = 0.02\u003c\/strong\u003e). This means there is a 2% probability that this finding occurred by chance.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eMultidisciplinary Discussion\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eCases were more frequently discussed within multidisciplinary teams for risk stratification and defining the best treatment option in centers with high and intermediate caseload compared to low caseload centers (\u003cstrong\u003ep = 0.01\u003c\/strong\u003e).\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eChoice Between Radiosurgery and Open Surgery\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe factor of age played a significant role in the choice between a stereotactic radiosurgery approach and open surgery in centers with high and intermediate caseload compared to those with low caseload (\u003cstrong\u003ep = 0.01\u003c\/strong\u003e).\u003c\/p\u003e\n\n\u003cp\u003eOther comparisons did not show statistically significant differences, including:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eWhether age influenced the choice between endoscopic and microsurgical approaches (p = 0.16)\u003c\/li\u003e\n\u003cli\u003eWhether cranioplasty was performed during the same procedure for convexity meningiomas with hyperostosis (p = 0.11)\u003c\/li\u003e\n\u003cli\u003ePostsurgical treatment choices for incomplete removal of WHO grade I, II, or III meningiomas (p values ranged from 0.38 to 0.97)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"literature\"\u003eLiterature Review: What the Published Studies Show\u003c\/h2\u003e\n\n\u003cp\u003eThe researchers identified \u003cstrong\u003e537 potentially relevant articles\u003c\/strong\u003e using their search strategy. After removing duplicates and papers published before 2000, \u003cstrong\u003e158 studies were excluded\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003cp\u003eOverall, \u003cstrong\u003e379 studies\u003c\/strong\u003e were screened by title and then by abstract. This led to the exclusion of \u003cstrong\u003e201 more studies\u003c\/strong\u003e. The agreement between the two reviewers during this phase was very high (Cohen's k coefficient = 0.91).\u003c\/p\u003e\n\n\u003cp\u003eStudies considered candidates for full-text reading numbered \u003cstrong\u003e178\u003c\/strong\u003e. Of these, \u003cstrong\u003e152 were removed\u003c\/strong\u003e according to exclusion criteria. The agreement between reviewers during this phase was also very high (Cohen's k coefficient = 0.97).\u003c\/p\u003e\n\n\u003cp\u003eThe remaining \u003cstrong\u003e26 studies\u003c\/strong\u003e underwent further selection by strict application of inclusion criteria. In the end, \u003cstrong\u003e18 retrospective comparative studies\u003c\/strong\u003e were selected for the meta-analysis.\u003c\/p\u003e\n\n\u003cp\u003eThese 18 studies included a total of \u003cstrong\u003e17,199 patients\u003c\/strong\u003e who underwent surgery for intracranial meningiomas. Of these:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003e4,164 patients\u003c\/strong\u003e were in the Elderly-Meningioma group (MEP, the experimental group)\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003e13,035 patients\u003c\/strong\u003e were in the Young-Meningioma group (YMG, the control group)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"meta-analysis\"\u003eMeta-Analysis Findings: Risks in Elderly vs. Younger Patients\u003c\/h2\u003e\n\n\u003cp\u003eThe pooled meta-analysis demonstrated that elderly patients had significantly increased risks compared to younger patients for several serious outcomes. All of these differences were statistically significant.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePermanent Neurological Deficits\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eElderly patients had a significantly increased risk of permanent deficits compared to younger patients (\u003cstrong\u003ep \u0026lt; 0.00001\u003c\/strong\u003e). This means there is less than a 0.001% probability that this finding occurred by chance. The result is highly statistically significant.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePostoperative Infections\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe risk of postoperative infections was significantly higher in elderly patients (\u003cstrong\u003ep = 0.0004\u003c\/strong\u003e). This means there is a 0.04% probability that this finding occurred by chance.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eHemorrhage (Bleeding)\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eElderly patients had a significantly increased risk of hemorrhage after surgery (\u003cstrong\u003ep = 0.0001\u003c\/strong\u003e). This means there is a 0.01% probability that this finding occurred by chance.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePerioperative Mortality (Death Around the Time of Surgery)\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe risk of dying around the time of surgery was significantly higher in elderly patients (\u003cstrong\u003ep \u0026lt; 0.00001\u003c\/strong\u003e). This result is highly statistically significant.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eMedical Complications\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eElderly patients experienced significantly more medical complications compared to younger patients (\u003cstrong\u003ep \u0026lt; 0.00001\u003c\/strong\u003e). Medical complications are health problems not directly related to the brain surgery itself, such as heart problems, lung infections, or blood clots. This result is also highly statistically significant.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers used the I-squared statistic to evaluate heterogeneity (how much the studies differed from each other). An I-squared value greater than 50% was considered indicative of significant heterogeneity. Publication bias was assessed through visual inspection of funnel plots for each outcome.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eClinical Implications: What This Means for Patients\u003c\/h2\u003e\n\n\u003cp\u003eThis study provides the first comprehensive analysis of existing trends in the surgical management of meningiomas in elderly patients in Italy. The findings have several important implications for patient care.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eLack of Standardized Guidelines Leads to Variation in Care\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe significant variation in practices across Italian neurosurgical centers primarily stems from the absence of standardized guidelines. This means that where a patient receives treatment may influence what treatment they receive. The survey revealed substantial differences in how centers approach elderly meningioma patients.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eMultidisciplinary Care Is Not Yet Universal\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eWhile most centers have adopted some form of integrated approach, only \u003cstrong\u003e37.3%\u003c\/strong\u003e always discuss cases within a multidisciplinary group. More than half (\u003cstrong\u003e52.9%\u003c\/strong\u003e) discuss cases only in selected situations, and nearly \u003cstrong\u003e10%\u003c\/strong\u003e never discuss cases in a multidisciplinary group. The researchers emphasize the need to promote a multidisciplinary care model as the standard approach.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eElderly Patients Face Higher Risks\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe meta-analysis clearly demonstrates that elderly patients face significantly higher risks of serious complications after meningioma surgery compared to younger patients. These risks include:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003ePermanent neurological deficits\u003c\/li\u003e\n\u003cli\u003ePostoperative infections\u003c\/li\u003e\n\u003cli\u003eHemorrhage (bleeding)\u003c\/li\u003e\n\u003cli\u003ePerioperative death\u003c\/li\u003e\n\u003cli\u003eMedical complications\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese findings underscore the importance of careful patient selection and thorough preoperative risk assessment when considering surgery for elderly patients.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAge Alone Should Not Determine Treatment\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eIn the majority of Italian centers (\u003cstrong\u003e76.4%\u003c\/strong\u003e), age by itself was not a factor influencing the surgical decision. Age influenced decisions only for cases with high preoperative comorbidity risk. This aligns with the understanding that biological age and overall health status matter more than chronological age.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eTreatment Options Are Expanding\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe endoscopic and stereotactic radiosurgery approaches are emerging as important options in the management of elderly meningioma patients. These less invasive approaches may offer alternatives for patients who are not good candidates for traditional open surgery.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eWait and Scan Is Standard for Incidental Tumors\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eAll responding centers (\u003cstrong\u003e100%\u003c\/strong\u003e) agreed on a \"wait and scan\" approach for elderly patients with asymptomatic incidental meningiomas without edema. This conservative approach avoids unnecessary intervention for tumors that may never cause problems.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePostoperative Management Is Generally Consistent\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eOverall, postoperative management options related to venous thromboembolism prophylaxis and adjuvant treatments were consistent with current literature data. However, the selection of adjuvant postoperative treatment was heterogeneous, especially for WHO grade II meningiomas with subtotal resection.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations: What the Study Could Not Prove\u003c\/h2\u003e\n\n\u003cp\u003eThis study has several limitations that patients and clinicians should consider when interpreting the findings.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eSurvey Limitations\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe survey had a response rate of \u003cstrong\u003e42.5%\u003c\/strong\u003e, meaning that 51 of 120 contacted centers participated. The practices at non-responding centers may differ from those that responded. Additionally, the survey collected data anonymously, so the researchers could not verify the accuracy of individual responses.\u003c\/p\u003e\n\n\u003cp\u003eThe survey relied on self-reporting by a single representative from each center. This representative's views may not fully reflect the actual practices of the entire department.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eMeta-Analysis Limitations\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eAll 18 studies included in the meta-analysis were retrospective. This means they looked back at existing data rather than following patients forward in time. Retrospective studies are generally considered weaker evidence than prospective studies or randomized controlled trials.\u003c\/p\u003e\n\n\u003cp\u003eThe studies included in the meta-analysis may have varied in how they defined \"elderly,\" what surgical techniques they used, and how they measured outcomes. This heterogeneity could affect the reliability of the pooled results.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers used the ROBINS-I tool to assess risk of bias in the included studies. The overall risk of bias was categorized as critical, serious, moderate, low, or with no available information. The presence of bias in some studies could affect the validity of the meta-analysis findings.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eGeneralizability\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe survey portion of this study was limited to Italian neurosurgical centers. The practices and outcomes observed in Italy may not be representative of practices in other countries with different healthcare systems and training approaches.\u003c\/p\u003e\n\n\u003cp\u003eThe meta-analysis included studies from multiple countries, which may improve generalizability. However, differences in healthcare systems, patient populations, and surgical techniques across countries could affect the applicability of the findings to any specific setting.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations and Future Directions\u003c\/h2\u003e\n\n\u003cp\u003eBased on their findings, the researchers make several recommendations for clinical practice and future research.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFor Clinical Practice\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003ePromote multidisciplinary care: The researchers emphasize the need to promote a multidisciplinary care model as the standard approach for managing elderly meningioma patients. This means bringing together neurosurgeons, radiation oncologists, medical oncologists, geriatricians, and other specialists to discuss each case.\u003c\/li\u003e\n\u003cli\u003eUse standardized risk assessment: While all centers used the ASA grading system, other validated tools such as the Charlson Comorbidity Index and ECOG performance status were used less frequently. Broader adoption of these tools could improve risk stratification.\u003c\/li\u003e\n\u003cli\u003eConsider less invasive options: Endoscopic surgery and stereotactic radiosurgery are emerging as important alternatives for elderly patients. These approaches may offer better risk-benefit profiles for selected patients.\u003c\/li\u003e\n\u003cli\u003eIndividualize treatment decisions: Age alone should not determine treatment. The decision should consider the patient's overall health status, comorbidities, tumor characteristics, and preferences.\u003c\/li\u003e\n\u003cli\u003eMaintain vigilance for complications: Given the higher risks of complications in elderly patients, careful monitoring and preventive measures are essential.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003e\u003cstrong\u003eFor Future Research\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe researchers state that prospective studies are needed to gather robust evidence in this clinical setting. Prospective studies follow patients forward in time and can provide stronger evidence than retrospective studies.\u003c\/p\u003e\n\n\u003cp\u003eSpecific research priorities include:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eDeveloping and validating predictive tools specifically for elderly meningioma patients\u003c\/li\u003e\n\u003cli\u003eComparing different treatment approaches (surgery, radiosurgery, observation) in randomized controlled trials\u003c\/li\u003e\n\u003cli\u003eIdentifying which elderly patients are most likely to benefit from surgery versus other approaches\u003c\/li\u003e\n\u003cli\u003eStudying quality of life outcomes in addition to survival and complication rates\u003c\/li\u003e\n\u003cli\u003eEvaluating the role of frailty assessments in treatment decision-making\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eKey Takeaways for Patients and Families\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eIf you or a loved one is an elderly patient facing a meningioma diagnosis, this study suggests several important points to discuss with your medical team:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003eAsk whether your case will be discussed by a multidisciplinary team. This collaborative approach is recommended but not universally practiced.\u003c\/li\u003e\n\u003cli\u003eDiscuss all available treatment options, including observation, surgery, and radiosurgery. Each option has different risks and benefits.\u003c\/li\u003e\n\u003cli\u003eUnderstand that age alone should not determine your treatment. Your overall health, other medical conditions, and the specific characteristics of your tumor are equally important.\u003c\/li\u003e\n\u003cli\u003eAsk about the experience and caseload of the center where you are being treated. The survey found that caseload influences treatment decisions.\u003c\/li\u003e\n\u003cli\u003eBe aware that elderly patients face higher risks of complications after surgery. Discuss these risks thoroughly with your surgeon.\u003c\/li\u003e\n\u003cli\u003eFor incidental tumors without symptoms, a \"wait and scan\" approach is the standard recommendation. Regular MRI follow-up can monitor the tumor without immediate intervention.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eThe researchers conclude that while most centers have adopted an integrated approach to treating elderly meningioma patients, there is a clear need to promote a multidisciplinary care model. The significant variation in practices across centers highlights the importance of developing standardized guidelines based on robust evidence. Until such evidence is available, treatment decisions should be individualized and made collaboratively between patients, families, and multidisciplinary medical teams.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is a meningioma?\u003c\/h3\u003e\n\u003cp\u003eA meningioma is a tumor that grows from the membranes covering the brain and spinal cord. These tumors are the most common type of primary brain tumor and account for 16% to 36% of all intracranial tumors in adults. Their incidence increases with age, reaching about 1 case per 2,000 people over 80 years old.\u003c\/p\u003e\n\u003ch3\u003eHow did this research examine meningioma treatment in elderly patients?\u003c\/h3\u003e\n\u003cp\u003eThe research combined a national survey of 51 Italian neurosurgical centers with a systematic review and meta-analysis of 18 studies covering 17,199 patients. The survey asked how centers define elderly patients and make treatment decisions, while the meta-analysis compared surgical outcomes between patients aged 65 and older and younger patients.\u003c\/p\u003e\n\u003ch3\u003eWhat risks did the meta-analysis find for elderly patients after meningioma surgery?\u003c\/h3\u003e\n\u003cp\u003eThe meta-analysis of 18 studies found that patients aged 65 and older had significantly higher risks than younger patients for permanent neurological deficits, postoperative infections, hemorrhage, perioperative death, and medical complications. All of these differences were statistically significant. These findings highlight the importance of careful patient selection and thorough preoperative risk assessment.\u003c\/p\u003e\n\u003ch3\u003eDoes age alone determine whether an elderly patient receives surgery for a meningioma?\u003c\/h3\u003e\n\u003cp\u003eIn the survey, 76.4% of Italian centers said age by itself did not influence the surgical decision; age mattered mainly when there was a high preoperative comorbidity risk. Only 21.5% said age always influenced the surgical indication. This aligns with the understanding that overall health status matters more than chronological age.\u003c\/p\u003e\n\u003ch3\u003eWhat is the recommended approach for an incidental meningioma without symptoms in an elderly patient?\u003c\/h3\u003e\n\u003cp\u003eAll 51 responding Italian centers (100%) chose a 'wait and scan' approach for elderly patients with asymptomatic incidental meningiomas without edema. None chose preventive radiosurgery or preventive surgery. Regular MRI follow-up can monitor the tumor without immediate intervention. If the tumor shows volumetric progression on MRI, 64.6% of centers then chose surgery.\u003c\/p\u003e\n\u003ch3\u003eWhat does it mean that a result was statistically significant in this research?\u003c\/h3\u003e\n\u003cp\u003eA statistically significant result means the finding is unlikely to have occurred by chance. For example, the higher risk of permanent neurological deficits in elderly patients had a p value less than 0.00001, meaning less than a 0.001% probability the finding was due to chance. This indicates a highly reliable difference between the groups.\u003c\/p\u003e\n\u003ch3\u003eWhat are the limitations of this research on meningioma treatment in elderly patients?\u003c\/h3\u003e\n\u003cp\u003eThe survey had a 42.5% response rate, and practices at non-responding centers may differ. All 18 studies in the meta-analysis were retrospective, which is generally weaker evidence than prospective studies. The studies also varied in how they defined 'elderly' and measured outcomes. The survey was limited to Italian centers, so findings may not apply everywhere.\u003c\/p\u003e\n\u003ch3\u003eShould an elderly patient with a meningioma get a second opinion before surgery?\u003c\/h3\u003e\n\u003cp\u003eA second opinion is reasonable when surgery is proposed for an elderly patient with a meningioma. Reported mortality ranges from 0% to 45% and complication rates from 10% to 39%, and elderly patients face significantly higher risks of permanent neurological deficits, postoperative infections, hemorrhage, perioperative death, and medical complications. Practice varies widely because standardized guidelines do not exist, and only 37.3% of centers always discuss cases in a multidisciplinary group. A second opinion can clarify whether observation, surgery, or radiosurgery fits your health status and tumor. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal Article Title:\u003c\/strong\u003e From data to practice: brain meningioma treatment in elderly patients - a survey of the Italian Society of Neurosurgery (SINch®) and systematic review and meta-analysis.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e Neurosurgical review\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eLicense:\u003c\/strong\u003e CC BY (open access)\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Tamara Ius, Giovanni Raffa, Denis Aiudi, Pier Paolo Panciani, Giuseppe Maria Della Pepa, Federico Pessina, Domenico Solari, Teresa Somma, Filippo Flavio Angileri, Michele Nichelatti, Paolo Cappabianca, Vincenzo Esposito, Maurizio Fornari, Domenico Gerardo Iacopino, Alessandro Olivi, Francesco Sala, Luigi Maria Cavallo, Alessandro La Camera, and the SINch NeuroOncology Study Group\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication:\u003c\/strong\u003e Neurosurgical Review (2024) 47:373\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e https:\/\/doi.org\/10.1007\/s10143-024-02524-8\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eReceived:\u003c\/strong\u003e February 21, 2024\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eRevised:\u003c\/strong\u003e May 2, 2024\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAccepted:\u003c\/strong\u003e June 17, 2024\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublished online:\u003c\/strong\u003e July 31, 2024\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublisher:\u003c\/strong\u003e The Author(s) 2024\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research. The original study was published in Neurosurgical Review, a peer-reviewed medical journal. The findings described here represent the results of a survey of Italian neurosurgical centers and a systematic review and meta-analysis of previously published studies. Individual patient circumstances may vary, and treatment decisions should always be made in consultation with qualified healthcare providers.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47807390843036,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"url":"https:\/\/diagnosticdetectives.com\/products\/treating-brain-meningiomas-in-elderly-patients-what-a-major-italian-study-and-global-research-reveal","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}