The Research Front

Meningioma Surgery in Older Patients Has High Rate of Success Neurosurgeons at Pacific Neuroscience Institute are among the world’s leaders in the minimally invasive removal of a type of benign brain tumor called a meningioma. In October, a group of surgeons led by PNI cofounder Daniel F. Kelly, MD, published a paper describing excellent outcomes using minimally invasive surgery for meningiomas in patients 65 and older.

The paper, published in Neurosurgery Focus, describes a study of 291 patients of various ages treated with either minimally invasive surgery, conventional surgical approaches or nonsurgical management. The minimally invasive approaches included endonasal (reaching the tumor through nasal cavity) and supraorbital (making a small incision through the eyebrow).

When compared by age, the study showed that minimally invasive surgery resulted in excellent outcomes in people ages 65 and older when the patients were carefully selected. The rate of successful removal of the tumor was similar for minimally invasive surgery and conventional surgery. Overall, hospital readmission was necessary in only 4% of the patients 65 and up.

The study is important because meningiomas are the most common type of primary brain tumor, and half occur in people who are 65 and older. Previous research has questioned whether elderly patients with meningiomas should undergo surgery.

“In our experience, for both young and old patients, use of smaller incisions, more focused craniotomies and less expansive brain exposure not only promotes a greater likelihood of operative site healing and excellent cosmesis but also is associated with less postoperative pain and a greater willingness by patients to mobilize and leave the hospital,” the authors wrote.

In a similar study of older patients, Dr. Kelly and his colleagues found that carefully selected patients ages 65 and older can undergo endoscopic endonasal removal of pituitary adenomas, the third most common primary brain tumor. That study, published in the journal Pituitary, found excellent shortterm outcomes including high resection rates, low complication rates and short length of stay for elderly patients treated with endoscopic surgery.

Publications e

Other publications of note from Saint John’s faculty include: Santosh Kesari, MD, PhD, chair of the department of translational neurosciences at the John Wayne Cancer Institute, is a coauthor of a paper published in August in the journal Biochimica et Biophysica Acta – Reviews on Cancer on the treatment of cancer patients who develop COVID-19 and prevention of the viral infection in cancer patients. The paper highlights the particular dangers that exist for cancer patients who contract COVID-19 and that the early symptoms of the viral infection can be mistaken for cancer-related or cancer treatment-related side effects.

Janie Grumley, MD, director of the Comprehensive Breast Program at the Margie Petersen Breast Center and associate professor of surgical oncology at the John Wayne Cancer Institute, is the corresponding author of a paper published September 15 in the Annals of Surgical Oncology on the advantages of breast oncoplastic surgery to facilitate breast conservation and more judicious use of chemotherapy.