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
Authors: Ius Tamara , Raffa Giovanni , Aiudi Denis , Panciani Pier Paolo , Della Pepa Giuseppe Maria , Pessina Federico , Solari Domenico , Somma Teresa , Angileri Filippo Flavio , Nichelatti Michele , Cappabianca Paolo , Esposito Vincenzo , Fornari Maurizio , Iacopino Domenico Gerardo , Olivi Alessandro , Sala Francesco , Cavallo Luigi Maria , La Camera Alessandro , Barbagallo Giuseppe , Barbanera Andrea , Beggio Giacomo , Bellocchi Silvio Domenico , Bernucci Claudio , Caroli Manuela Anna , Cenzato Marco , Della Puppa Alessandro , Di Cristofori Andrea , Draghi Riccardo , Fioravanti Antonio , Fontanella Marco Maria , Frati Alessandro , Gagliardi Filippo , Garbossa Diego , Germanò Antonino , Iacoangeli Maurizio , Lattanzi Luigi Antonio , Legnani Federico , Locatelli Davide , Maiola Vincenza , Montemurro Nicola , Muscas Giovanni , Nicolato Antonio , Paolini Sergio , Pavesi Giacomo , Piparo Maurizio , Policicchio Domenico , Pompucci Angelo , Raco Antonino , Rossetto Marta , Sabatino Giovanni , Santoro Antonio , Sarubbo Silvio , Scerrati Alba , Signorelli Francesco , Spanu Fabio , Spena Giannantonio , Stefini Roberto , Telera Stefano , Tosatto Luigino , Trignani Roberto , Tumbiolo Silvana , Volpin Francesco , Zambon Giampaolo , Zotta Donato Carlo ,   SINch NeuroOncology Study Group
Published: July 2024

The management of meningioma in elderly patients (MEP) presents a complex and evolving challenge. Data available offer conflicting information on treatment options and complications. This survey aimed to examine the current approach to MEP, comparing the national profile to data in the current literature. A survey addressing the treatments options and management of meningioma in elderly was designed on behalf of SINch® (Società Italiana di Neurochirurgia) and sent via email to all Chiefs of Neurosurgical Departments. The survey remained open for responses from May 5th, 2022, until November 21st, 2022. A search of the literature published between January 2000 and March 2023, in accordance to PRISMA guidelines, was included. A total of 51 Neurosurgical centers participated in the survey. The caseload profile of each center influences the choice of treatment selection (Stereotactic Radiosurgery versus open surgery) (p = 0.01) and the consolidated practice of discussing cases within a multidisciplinary group (p = 0.02). The pooled meta-analysis demonstrated a significant increased risk in the elderly group for permanent deficits (p < 0.00001), postoperative infections (p = 0.0004) and hemorrhage (p = 0.0001), perioperative mortality (p < 0.00001), and medical complications (p < 0.00001) as compared to the young population. This study presents the initial comprehensive analysis of the existing trends in the surgical management of MEP in Italy. The significant variation in practices primarily stems from the absence of standardized guidelines. While most centers have adopted an integrated approach, there is a need to promote a multidisciplinary care model. Prospective studies are needed to gather robust evidence in this clinical setting.