Introducción: frecuentemente debe tomarse una decisión terapéutica para el manejo del meningioma en el paciente geriátrico. El presente estudio analiza factores pronósticos, así como la escala Clinical-Radiological Grading Score (CRGS) como auxiliar para la decisión terapéutica.
Métodos: se realizó un estudio retrospectivo entre 2009 y 2010. La población estudiada fue de 28 pacientes mayores de 65 años de edad. Se analizaron factores clínicos, imagenológicos e histopatológicos. Se utilizó la prueba chi cuadrada y la exacta de Fisher para variables cuantitativas y U de Mann-Whitney para variables cualitativas.
Resultados: la mortalidad global a los 3, 6 y 12 meses de seguimiento fue del 7.14, 10.71 y 14.28 %, respectivamente. El análisis reveló que el estado funcional con la escala de Karnofsky (p = 0.02), la localización de la lesión (p = 0.002), el grado de malignidad histopatológico (p = 0.038) y una puntuación menor de 10 en la escala CRGS (p = 0.003) se asocian con un mal pronóstico.
Conclusión: el manejo neuroquirúrgico del paciente geriátrico es una posibilidad terapéutica con un pronóstico favorable en pacientes con una puntuación igual o mayor de 10 y en aquellos con un adecuado estado funcional.
CBTRUS. CBTRUS Statistical Report: Primary brain and central nervous system tumors diagnosed in the United States in 2004-2007. Hinsdale, IL: Central Brain Tumor Registry of the United States, 2011. Texto libre en http://www.cbtrus.org/2011-NPCR-SEER/WEB-0407-Report-3-3-2011.pdf
Radhakrishnan K, Mokri B, Parisi JE, O’Fallon WM, Sunku J, Kurland LT. The trends in incidence of primary brain tumors in the population of Rochester, Minnesota. Ann Neurol. 1995;37(1):67-73.
Braunstein JB, Vick NA. Meningiomas: the decision not to operate. Neurology. 1997;48(5):1459-62.
Comu P, Chatellier G, Dagreou F, Clemenceau S, Foncin JF, Rivierez M, et al. Intracraneal meningiomas in elderly patients. Postoperative morbidity and mortality. Factors predictive of outcome. Acta Neurochir. 1990;102(3-4):98-102.
Dripps RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. JAMA. 1961;178:261-6.
Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957;20(1):22-39.
Louis DN, Cavenee WK, Ohgaki H, Wiestler OD, editors. WHO classification of tumours of the central nervous system. 4th ed. Lyon: International Agency for Research on Cancer; 2007.
Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975 Mar 1;1(7905):480-4.
Djindjian M, Caron JP, Athayde AA, Février MJ. Intracranial meningiomas in the elderly (over 70 years old). A retrospective study of 30 surgical cases. Acta Neurochir. 1988;90(3-4):121-3.
Mastronardi L, Ferrante L, Qasho R, Ferrari V, Tatarelli R, Fortuna A. Intracranial meningiomas in the 9th decade of life: a retrospective study of 17 surgical cases. Neurosurgery. 1995;36(2):270-4.
Sacko O, Sesay M, Roux FE, Riem T, Grenier B, Liguoro D, et al. Intracranial meningioma surgery in the ninth decade of life. Neurosurgery. 2007;61(5):950-4.
D’Andrea G, Roperto R, Caroli E, Crispo F, Ferrante L. Thirty-seven cases of intracranial meningiomas in the ninth decade of life: our experience and review of the literature. Neurosurgery. 2005;56(5):956-61.
Boviatsis EJ, Bouras TI, Kouyialis AT, Themistocleous MS, Sakas DE. Impact of age on complications and outcome in meningioma surgery. Surg Neurol. 2007;68(4):407-11.
Schneider AJ. Assessment of risk factors and surgical outcome. Surg Clin North Am. 1983;63(5):1113-26.
Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer. 1948;1(4):634-56.
Asano K, Nakano T, Takeda T, Ohkuma H. Risk factors for postoperative systemic complications in elderly patients with brain tumors. Clinical article. J Neurosurg. 2009;111(2):258-64.
Black P, Kathiresan S, Chung W. Meningioma surgery in the elderly: a case-control study assessing morbidity and mortality. Acta Neurochir. 1998;140(10):1013-7.
Bateman BT, Pile-Spellman J, Gutin PH, Berman MF. Meningioma resection in the elderly: nationwide inpatient sample, 1998-2002. Neurosurgery. 2005;57(5):866-72.
Caroli M, Locatelli M, Prada F, Beretta F, Martinelli-Boneschi F, Campanella R, et al. Surgery for intracranial meningiomas in the elderly: a clinical-radiological grading system as a predictor of outcome. J Neurosurg. 2005;102(2):290-4.
Arienta C, Caroli M, Crotti F, Villani R. Treatment of intracranial meningiomas in patients over 70 years old. Acta Neurochir. 1990;107(1):47-55.
Dujovny M, Charbel F, Berman SK, Diaz FG, Malik G, Ausman JI. Geriatric neurosurgery. Surg Neurol. 1987;28(1):10-6.
Kuratsu J, Takeshima H, Ushio Y. Trends in the incidence of primary intracranial tumors in Kumamoto, Japan. Int J Clin Oncol. 2001;6(4):183-91.
Nanda A, Javalkar V, Banerjee AD. Petroclival meningiomas: study on outcomes, complications and recurrence rates. J Neurosurg. 2011;114(5):1268-77.
Niiro M, Yatsushiro K, Nakamura K, Kawahara Y, Kuratsu J. Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry. 2000;68(1):25-8.
Oka K, Tsuda H, Kamikaseda K, Nakamura R, Fukui M, Nouzuka Y, et al. Meningiomas and hemorrhagic diathesis. J Neurosurg. 1988;69(3):356-60.
Tomita T, Raimondi AJ. Brain tumors in the elderly. JAMA. 1981;246(1):53-5.
Oka M, Hirazawa K, Yamamoto K, Iizuka N, Hazama S, Suzuki T, et al. Induction of Fas-mediated apoptosis on circulating lymphocytes by surgical stress. Ann Surg. 1996;223(4):434-40.
Decker D, Schondorf M, Bidlingmaier F, Hirner A, von Ruecker AA. Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma. Surgery. 1996;119(3):316-25.
Modha A, Gutin PH. Diagnosis and treatment of atypical and anaplastic meningiomas: a review. Neurosurgery. 2005;57(3):538-50.
Bondy M, Ligon BL. Epidemiology and etiology of intracranial meningiomas: a review. J Neurooncol. 1996;29(3):197-205.
Goodwin JW, Crowley J, Eyre HJ, Stafford B, Jaeckle KA, Townsend JJ. A phase II evaluation of tamoxifen in unresectable or refractory meningiomas: a Southwest Oncology Group Study. J Neurooncol. 1993;15(1):73-7.
Chamberlain MC, Glantz MJ. Interferon-alpha for recurrent World Health Organization grade 1 intracranial meningiomas. Cancer. 2008;113(8):2146-51.
Newton HB, Scott SR, Volpi C. Hydroxyurea chemotherapy for meningiomas: enlarged cohort with extended follow-up. Br J Neurosurg. 2004;18(5):495-9.
Chamberlain MC, Tsao-Wei DD, Groshen S. Salvage chemotherapy with CPT-11 for recurrent meningioma. J Neurooncol. 2006;78(3):271-6.
Chamberlain MC. Adjuvant combined modality therapy for malignant meningiomas. J Neurosurg. 1996;84(5):733-6.