title: Multimodal strategy for managing meningiomas in the elderly.
abstract: BACKGROUND
  The incidence of brain tumors in elderly patients is increasing. It has become possible to treat meningiomas in the elderly by several modalities. We developed a successful multimodal strategy to treat these patients.
  
  
  METHODS
  We registered 35 patients with meningiomas. Symptomatic meningiomas were treated surgically at the time of diagnosis (n=19). Of the 16 asymptomatic meningiomas, 5 were removed at the time of diagnosis. The other asymptomatic meningiomas (n=11) were treated conservatively and when the tumors increased in size, surgical treatment was considered. "Operated" patients with residual or recurrent tumors underwent radiosurgery with a gamma knife.
  
  
  RESULTS
  Surgical mortality and morbidity were 4% and 16%, respectively. Of the 25 "operated" patients, 21 (84.0%) had a good Karnofsky scale (> or =80%) at discharge. In all but two of the 11 patients with asymptomatic, conservatively treated meningiomas, the tumors did not increase during the follow-up period. Gamma knife radiosurgery, performed to treat 3 residual and 1 recurrent tumor, resulted in very good tumor control and none of the tumors increased after gamma knife surgery.
  
  
  CONCLUSIONS
  Meningiomas in elderly patients require a multimodal approach. Our strategy, which includes surgery, radiosurgery, and conservative treatment, resulted in good tumor control and made it possible for patients to pursue their activities of daily life.
authors.affiliation: Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sonoda
authors.forename: K
authors.initials: K
authors.lastname: Sakurada
authors.forename: M
authors.initials: M
authors.lastname: Saino
authors.forename: R
authors.initials: R
authors.lastname: Kondo
authors.forename: S
authors.initials: S
authors.lastname: Sato
authors.forename: T
authors.initials: T
authors.lastname: Kayama
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000706:statistics & numerical data / Q000639:trends; D003663:Decision Trees; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D008579:Meningioma / Q000532:radiotherapy* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D016634:Radiosurgery / Q000706:statistics & numerical data; D016896:Treatment Outcome