Beyond Chronological Age: A Scoping Review of Neurosurgical Intervention for Central Nervous System Tumors in the Very Elderly

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.