Age-specific clinical results in spinal meningioma surgery: should age still be considered detrimental to satisfactory outcomes?

Objective: Spinal meningiomas (SMs) are relatively rare primary spinal neoplasms, and the increasingly growing mean age and number of older patients presenting with spinal neoplasms raise questions concerning the costs and benefits of proposing surgical intervention. The aim of this study was to analyze the outcomes and complications of a large cohort of older patients with SMs to define the real benefit of surgery in these patients.

Methods: A total of 261 SMs were operated on between 1976 and December 2021, and 156 matched the inclusion criteria for the final cohort. Patients were divided into three groups according to age: < 50 years (group A), between 51 and 74 years (group B), and > 75 years (group C). Neurological and clinical outcomes, resection grade, complications, histology, and possible recurrences were evaluated.

Results: The final cohort comprised 156 patients (126 females, 30 males) with a mean ± SD age of 55.93 ± 14.80 years. The mean follow-up was 41.5 ± 11.4 months. Group A was found to have a significantly higher Frankel score at follow-up; there was no significant difference between mean scores for groups B and C. Nevertheless, there was no significant difference between the subgroups in patients who showed improvement from their preoperative neurological condition. Only 3 recurrences were recorded, all in group A. Axial topography, level of the lesions, and preoperative symptoms, including impairment of the sphincter functions, demonstrated no statistically significant interaction in the subgroups.

Conclusions: The present study supports the concept that older age might not be a contraindication for surgical treatment in SMs because of the important improvements in functional status and quality of life achieved in this population subgroup. Older patients can benefit from prompt assessment and early surgery in cases of acute onset, with a complication rate not higher than that of younger patients.