INTRODUCTION: Management for elderly patients (> 65yo) with incidental meningiomas remains unclear. This study aims to characterize the functional and tumor outcomes of expectant and stereotactic radiosurgery (SRS) management of asymptomatic meningioma elderly patients. METHODS: Using retrospectively collected data from 14 centers, SRS outcomes were compared to radiographic and clinical observation of asymptomatic meningiomas in elderly patients following propensity score matching. RESULTS: Following propensity score matching, 114 patients were in each cohort. Tumor control was achieved at 97.37% in the SRS cohort, and no meningioma growth was seen 71.93% of the observation cohorts (p < 0.01; OR 14.44 [95% CI 4.27-48.78]). New neurological deficits developed in 1.39% of the SRS cohort but in none of the patients managed conservatively. 3.5% of patients underwent resection in the active surveillance matched cohort compared to 0.9% of patients in the SRS cohort (p = 0.063; OR 0.135 [95% CI 0.163-1.117]). The all-cause mortality rate was almost half in the SRS group (9.65%) compared to the observation group (18.42%) (p = 0.06; OR 0.47 [95% CI .22-1.03]). CONCLUSION: SRS achieves superior radiological tumor control compared to surveillance but with a slightly increased the risk of new SRS-related neurological deficits in elderly patients with asymptomatic meningiomas. Although SRS reduces meningioma progression, the need for of an open neurosurgical procedure and mortality were not significantly reduced. Furthermore, mortality in the observation group was not directly related to the meningioma in any of the patients.

Department of Neurological Surgery Mayo Clinic Rochester MN USA

Department of Neurological Surgery University of Virginia P O Box 800212 Charlottesville VA USA

Department of Neurosurgery and Radiotherapy Nehru Hospital Postgraduate Institute of Medical Education and Research Sector 12 Chandigarh India

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery New York University New York NY USA

Department of Neurosurgery School of Medicine Neurological Institute Taipei Veteran General Hospital Taipei Taiwan

Department of Neurosurgery University of Alberta Edmonton AB Canada

Department of Neurosurgery University of Miami Miller School of Medicine Miami FL USA

Department of Neurosurgery University of Pittsburgh Pittsburgh PA USA

Department of Radiation and Stereotactic Neurosurgery Na Homolce Hospital Prague Czech Republic

Department of Radiation Oncology New York University New York NY USA

Department of Radiology Dominican Gamma Knife Centerand CEDIMAT Santo Domingo Pepillo Salcedo Dominican Republic

Department of Radiosurgery Rúber International Hospital Madrid Spain

Division of Neurosurgery Université de Sherbrooke Centre de Recherche du CHUS Sherbrooke QC Canada

Gamma Knife Center Cairo Nasser Institute Benha University Benha Egypt

TheWalton Centre NHS Foundation Trust Liverpool UK

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