Safety and efficacy of microsurgery for complex cranial pathologies in the ultra-geriatric population.

OBJECTIVE: The global increase in the "ultra-geriatric" population (aged 80 years and older) has led to higher demand for neurosurgical procedures in this vulnerable population. The objective was to evaluate the safety and efficacy of advanced microsurgical procedures on ultra-geriatric patients, in our modern era of neurosurgery, anesthesiology, and advanced medical care. METHODS: The study examined 66 complex cranial procedures, performed on 65 ultra-geriatric patients, who constituted 3.8% of the 4461 consecutive neurosurgical procedures performed by a single neurosurgeon over 14-years in a tertiary care university hospital. Excluded from this study were intra- or extra-axial spontaneous hematomas or traumatic brain injuries, infections, biopsy-only cases and carotid endarterectomies. RESULTS: The most common indication for surgery for the 66 complex cranial procedures were meningiomas (23.9%), followed by gliomas (17.9%), and metastatic brain tumors (17.9%). Postoperative complications occurred in seven procedures (10.60%). No patient deaths were directly caused by intra- or postoperative events, and only one 30-day mortality occurred. All deceased patients had a statistically significant higher American Society of Anesthesiologists (ASA) class (p = 0.024). However, there was no significant correlation between ASA class and modified Rankin scale at discharge (p = 0.238). CONCLUSION: With the aging global population and increasing life expectancy, the number of ultra-geriatric patients with complex pathologies seeking advanced microsurgical treatment is growing. Therefore, neurosurgeons are confronting a growing number and variety of complex pathologies in ultra-geriatric patients in their daily practice. Regardless of advanced age, microsurgery provides safe and effective treatment, with age alone not being a barrier to proper neurosurgical treatment when other risk factors are adequately modified.

Malignant Transformation of Recurrent Residual Cerebellopontine Angle Epidermoid Tumor: Significance of Clinical Vigilance and Long-Term Surveillance.

Epidermoid tumors (ET) are slow-growing masses where malignant transformations occur extremely rarely. Malignant transformation warning signs are the rapid-onset, progression, and recurrence of symptoms. The radiologic evidence for malignant transformation is contrast enhancement with rapid growth, observed with magnetic resonance imaging (MRI) or computed tomography scans. Here, we provide a case report of a 68-year-old woman with a long-standing history of left-sided cerebellopontine angle ET who presented with a recent worsening of symptoms, and MRI observation of new ET contrast enhancement. Surgical re-exploration and histopathologic confirmation are mandatory in this setting of recent symptom worsening and MRI observation of rapid mass growth.