Background/Objectives: Spinal ependymoma is the most common intramedullary spinal cord tumor in adults, and maximal safe resection is the cornerstone of treatment. Patients aged 75 years and older are underrepresented in surgical neuro-oncology cohorts. We sought to characterize treatment patterns and identify predictors of overall survival in very elderly patients with spinal ependymoma. Methods: We performed a retrospective cohort study of patients aged 65 years or older with spinal ependymoma using the National Cancer Database. The primary cohort was patients aged 75 years or older (very elderly); patients aged 65–74 years served as a comparison cohort. Multivariable Cox proportional-hazards models were fit within each cohort, and a surgery-by-age-cohort interaction was tested. Results: Of 1497 eligible patients aged 65 years or older with spinal ependymoma, 422 patients (28.2%) met criteria for the final analytic cohort. Intramedullary versus extramedullary tumor status was not available in the NCDB PUF and therefore could not be characterized. Very elderly patients were less likely to undergo surgery than the comparison cohort (70% vs. 85%; p < 0.001) despite similar tumor characteristics. Among very elderly patients, median overall survival was 59.7 months without surgery and 106.0 months with surgery, an approximately 46-month difference favoring surgery. Surgery was independently associated with lower mortality (HR 0.46; 95% CI, 0.24–0.89; p = 0.021). Increasing age (HR 1.15 per year; 95% CI, 1.07–1.22; p < 0.001), Charlson–Deyo score ≥ 2 (HR 4.41; 95% CI, 1.65–11.79; p = 0.003), and increasing tumor size (HR 1.02 per mm; 95% CI, 1.01–1.04; p < 0.001) were also independently associated with worse survival. In the 65–74 cohort, no significant association between surgery and overall survival was detected (HR 1.23; 95% CI, 0.54–2.81; p = 0.623), though statistical power was limited by only 7 deaths in the no-surgery arm. The surgery-by-age-cohort interaction was significant (HR 0.37; p = 0.043). Conclusions: Surgical resection was independently associated with improved overall survival in very elderly patients with spinal ependymoma despite lower utilization. Chronological age alone may be an imperfect basis for excluding older adults from surgical consideration.

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.

Glioblastoma (GBM) is devastating both in prognosis and in patient impact. Differing from other solid tumors, GBM produces significant, often rapid, neurologic decline necessitating intense caregiving. This care usually falls to an intimate partner or family member. Early studies in GBM patient–caregiver dyads confirm substantial caregiver needs. Most caregivers report significant distress, with nearly 40% reporting depression and anxiety. Educational initiatives, early palliative care, and psychotherapy have increased caregiver preparedness. However, current healthcare delivery is organized primarily around the patient, and few systems offer caregiver-specific interventions. Early evidence suggests that focused efforts to improve caregiver quality of life may improve patient survival and healthcare utilization, incentivizing the healthcare team to further investigate how to best support the patient–caregiver dyad. The literature in other tumor types suggests dyad-based interventions may also reduce distress more effectively than caregiver or patient-based interventions alone. Further research is needed to design an optimal supportive-care model for GBM dyads. Across each stage of the disease course (from diagnosis and treatment to surveillance, progression, and bereavement), the needs of the dyad are dynamic. This requires targeted and adaptive interventions such as nurse-led navigation, structured education, anticipatory guidance, and clinical supportive-care programs or clinical trials aimed at improving dyadic physical and psychological well-being at different time points during the disease course. Ultimately, future studies evaluating caregiver support in GBM are needed and should assess not only psychological benefits and patient survival, but also programmatic implementation, clinical trial participation, and healthcare utilization efficiency.