Meningiomas in Elderly Patients: Epidemiology, Clinical Characteristics, Prognostic Factors, and Personalized Treatment Strategies

As the global population ages, the incidence of meningiomas rises, and the demand for clinical management of elderly patients also rises. Meningiomas are common intracranial tumors, and their incidence increases with age. Elderly patients with meningiomas are prone to comorbidities, reduced reserve function, atypical manifestations, increased perioperative risks, and impaired functional recovery, making management more difficult. The application of neuroimaging leads to more elderly patients with asymptomatic or incidentally discovered meningiomas. Choosing the best strategy among monitoring, surgery, radiotherapy, and other strategies is therefore key to clinical decision-making. For asymptomatic, small, and radiologically low-risk meningiomas in elderly patients, active surveillance is generally the preferred initial strategy. Surgery is more appropriate for symptomatic tumors, lesions with mass effect, documented growth, progressive peritumoral edema, neurological deterioration, or other high-risk clinical and radiological features. However, the treatment goal for elderly patients should emphasize symptom relief, preservation of neurological function, and quality of life more than pursuing gross total resection as routine. Stereotactic radiosurgery and fractionated radiotherapy provide important supplementary treatments for very elderly patients, high surgical risk patients, and postoperative residual lesions. This article reviews recent advances in understanding meningiomas in elderly and very elderly patients, focuses on epidemiology, clinical characteristics, prognostic factors, and treatment strategies, and also discusses the core principles of individualized management for this population to guide clinical practice.