Surgical Management of Brain Metastases in Patients Aged 80 and Above: Observations From a Limited Case Series

Introduction Potentially surgical brain metastases are increasingly common in patients aged 80 and older, yet the risk-benefit profile of surgical resection in this population remains inadequately defined. Surgical intervention in octogenarians carries a high risk due to systemic issues associated with advanced age and prevalent comorbidities, and data on perioperative morbidity and functional outcomes are limited. Methods A retrospective case series including six patients aged 80 years and older who underwent craniotomy for the resection of brain metastases at a single tertiary care center was conducted. Preoperative and postoperative functional status were assessed. Surgical complications, discharge disposition, and survival outcomes were reviewed through detailed chart analysis and follow-up data. Due to the limited sample size (N=6), no formal statistical analysis was performed. Results Preoperative Karnofsky Performance Status (KPS) averaged 68, and postoperative KPS was 80. One (17%) patient experienced a postoperative hemorrhage necessitating reoperation. Discharge dispositions included two (33%) patients discharged home, three (50%) patients discharged to acute rehabilitation, and one (16%) patient discharged to a skilled nursing facility; all patients discharged to outside facilities ultimately returned home. The median survival time was 13 (range: 2-48) months. Conclusion Surgical resection in patients over 80 years undergoing craniotomy for brain metastases is associated with elevated systemic risk related to comorbidities and systemic disease burden. However, specific patients may benefit, particularly those with large lesions with well-controlled systemic disease and limited medical comorbidity. Deaths observed in this cohort were attributable to systemic disease unrelated to the surgical intervention or intracranial disease. Given the very small sample size, these findings are exploratory and require confirmation with larger studies. Surgical intervention for this population should be considered on a case-by-case basis, with a focus on patients who are neurologically symptomatic with good systemic disease control.