超越实际年龄：极老年中枢神经系统肿瘤神经外科干预的范围综述。

文献信息

中文摘要

背景： 75岁及以上成人越来越多地考虑接受原发性中枢神经系统肿瘤的神经外科治疗，但指导治疗选择的证据仍然零散。方法：我们对PubMed/MEDLINE、Ovid Embase、Scopus和Web of Science从数据库建库至2026年7月进行了范围综述。纳入标准为原始临床报告，且包含可单独提取的75岁及以上成人数据，这些成人正在接受或正在被评估接受针对原发性颅内、颅底、颅神经、脊髓、脑膜或原发性椎体肿瘤的肿瘤导向神经外科干预。数据使用标准化框架进行提取，并按肿瘤类型、治疗意图、患者选择因素和报告结局进行描述性综合。结果：共纳入80篇报告，其中37篇涉及胶质瘤或胶质母细胞瘤，25篇涉及颅内脑膜瘤；75篇为回顾性研究。在胶质瘤中，更广泛的切除常与更长的生存期相关，尽管次全切除的结果不一致，且术后治疗完成是重要的预后因素。在脑膜瘤中，功能保留和独立性是突出考虑因素，而鞍区、脊柱和前庭神经鞘瘤研究强调视力、神经功能和颅神经结局。生活质量、认知、照护者负担和居家时间很少被报告。结论：极老年患者的手术获益具有肿瘤特异性，未来研究应优先考虑前瞻性、以患者为中心的结局，而不是主要依赖生存期或实际年龄。

英文摘要

Adults aged 75 years or older are increasingly considered for neurosurgical treatment of primary central nervous system tumors, yet the evidence guiding treatment selection remains fragmented. We conducted a scoping review of PubMed/MEDLINE, Ovid Embase, Scopus, and Web of Science from database inception through July 2026. Original clinical reports were eligible when they included separately extractable data for adults aged 75 years or older undergoing or being evaluated for tumor-directed neurosurgical intervention for primary intracranial, skull-base, cranial-nerve, spinal cord, meningeal, or primary vertebral tumors. Data were charted using a standardized framework and synthesized descriptively by tumor type, treatment intent, patient-selection factors, and reported outcomes. Eighty reports were included, of which 37 addressed glioma or glioblastoma and 25 addressed intracranial meningioma; 75 were retrospective. In glioma, greater resection was frequently associated with longer survival, although findings for subtotal resection were inconsistent and postoperative treatment completion was an important prognostic factor. In meningioma, functional preservation and independence were prominent considerations, while sellar, spinal, and vestibular schwannoma studies emphasized vision, neurologic function, and cranial-nerve outcomes. Quality of life, cognition, caregiver burden, and time at home were rarely reported. Surgical benefit in very elderly patients is tumor-specific, and future studies should prioritize prospective, patient-centered outcomes rather than relying primarily on survival or chronological age.