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J Neurol Surg B Skull Base 2023; 84(02): 129-135
DOI: 10.1055/a-1771-0504
Original Article

Surgical Outcomes Following Vestibular Schwannoma Resection in Patients over the Age of Sixty-five

Ben A. Strickland
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Rob Rennert
2   Department of Neuro Otology, University of California San Diego, San Diego, California, United States
,
Gabriel Zada
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Shane Shahrestani 
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Jonathan J. Russin
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Rick A. Friedman
2   Department of Neuro Otology, University of California San Diego, San Diego, California, United States
,
Steven L. Giannotta
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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Abstract

Objective Vestibular schwannoma (VS) are benign, often slow growing neoplasms. Some institutions opt for radiosurgery in symptomatic patients of advanced age versus surgical resection. The aim of the study is to analyze surgical outcomes of VS in patients over the age of 65 who were either not candidates for or refused radiosurgery.

Methods This includes retrospective analysis of VS patients between 1988 and 2020. Demographics, tumor characteristics, surgical records, and clinical outcomes were recorded. Patient preference for surgery over radiosurgery was recorded in the event that patients were offered both. Facial nerve outcomes were quantified using House-Brackmann (HB) scores. Tumor growth was defined by increase in size of >2 mm.

Results In total, 64 patients were included of average age 72.4 years (65–84 years). Average maximum tumor diameter was 29 mm (13–55 mm). Forty-five patients were offered surgery or GKRS, and chose surgery commonly due to radiation aversion (48.4%). Gross total resection was achieved in 39.1% (n = 25), near total 32.8% (n = 21), and subtotal 28.1% (n = 18). Average hospitalization was 5 days [2–17] with 75% (n = 48) discharged home. Postoperative HB scores were good (HB1–2) in 43.8%, moderate (HB3–4) in 32.8%, and poor (HB5–6) in 23.4%. HB scores improved to good in 51.6%, moderate in 31.3%, and remained poor in 17.1%, marking a rate of facial nerve improvement of 10.9%. Tumor control was achieved in 95.3% of cases at an average follow-up time of 37.8 months.

Conclusion VS resection can be safely performed in patients over the age of 65. Advanced age should not preclude a symptomatic VS patient from being considered for surgical resection.

Keywords

vestibular schwannoma - advanced age - microsurgery - radiosurgery


Publication History

Received: 14 June 2021

Accepted: 24 January 2022

Accepted Manuscript online:
14 February 2022

Article published online:
09 March 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Marinelli JP, Lohse CM, Grossardt BR, Lane JI, Carlson ML. Rising incidence of sporadic vestibular schwannoma: true biological shift versus simply greater detection. Otol Neurotol 2020; 41 (06) 813-847
    CrossrefPubMedGoogle Scholar
  • 2 Goldbrunner R, Weller M, Regis J. et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro-oncol 2020; 22 (01) 31-45
    CrossrefPubMedGoogle Scholar
  • 3 Olson JJ, Kalkanis SN, Ryken TC. Congress of neurological surgeons systematic review and evidence-based guidelines on the treatment of adults with vestibular schwannomas: executive summary. Neurosurgery 2018; 82 (02) 129-134
    CrossrefPubMedGoogle Scholar
  • 4 Starnoni D, Giammattei L, Cossu G. et al. Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 2020; 162 (11) 2595-2617
    CrossrefPubMedGoogle Scholar
  • 5 Schnurman Z, Nakamura A, McQuinn MW, Golfinos JG, Roland JT, Kondziolka D. Volumetric growth rates of untreated vestibular schwannomas. J Neurosurg 2019; Aug 2; 1-7
    PubMedGoogle Scholar
  • 6 Langenhuizen PPJH, Zinger S, Hanssens PEJ. et al. Influence of pretreatment growth rate on Gamma Knife treatment response for vestibular schwannoma: a volumetric analysis. J Neurosurg 2018; 131 (05) 1405-1412
    CrossrefPubMedGoogle Scholar
  • 7 Johnson S, Kano H, Faramand A. et al. Long term results of primary radiosurgery for vestibular schwannomas. J Neurooncol 2019; 145 (02) 247-255
    CrossrefPubMedGoogle Scholar
  • 8 Bloch DC, Oghalai JS, Jackler RK, Osofsky M, Pitts LH. The fate of the tumor remnant after less-than-complete acoustic neuroma resection. Otolaryngol Head Neck Surg 2004; 130 (01) 104-112
    CrossrefPubMedGoogle Scholar
  • 9 Schwartz MS, Kari E, Strickland BM. et al. Evaluation of the increased use of partial resection of large vestibular schwannomas: facial nerve outcomes and recurrence/regrowth rates. Otol Neurotol 2013; 34 (08) 1456-1464
    CrossrefPubMedGoogle Scholar
  • 10 Monfared A, Corrales CE, Theodosopoulos PV. et al. Facial nerve outcome and tumor control rate as a function of degree of resection in treatment of large acoustic neuromas: preliminary report of the Acoustic Neuroma Subtotal Resection Study (ANSRS). Neurosurgery 2016; 79 (02) 194-203
    CrossrefPubMedGoogle Scholar
  • 11 Leon J, Trifiletti DM, Waddle MR. et al. Trends in the initial management of vestibular schwannoma in the United States. J Clin Neurosci 2019; 68: 174-178
    CrossrefPubMedGoogle Scholar
  • 12 Silverstein H, McDaniel A, Norrell H, Wazen J. Conservative management of acoustic neuroma in the elderly patient. Laryngoscope 1985; 95 (7 Pt 1): 766-770
    CrossrefPubMedGoogle Scholar
  • 13 Samii M, Tatagiba M, Matthies C. Acoustic neurinoma in the elderly: factors predictive of postoperative outcome. Neurosurgery 1992; 31 (04) 615-619 , discussion 619–620
    PubMedGoogle Scholar
  • 14 Van Abel KM, Carlson ML, Driscoll CL, Neff BA, Link MJ. Vestibular schwannoma surgery in the elderly: a matched cohort study. J Neurosurg 2014; 120 (01) 207-217
    CrossrefPubMedGoogle Scholar
  • 15 Bowers CA, Gurgel RK, Brimley C. et al. Surgical treatment of vestibular schwannoma: does age matter?. World Neurosurg 2016; 96: 58-65
    CrossrefPubMedGoogle Scholar
  • 16 Jiang N, Wang Z, Chen W. et al. Microsurgical outcomes after gross total resection on vestibular schwannoma in elderly patients: a matched cohort study. World Neurosurg 2017; 101: 457-465
    CrossrefPubMedGoogle Scholar
  • 17 Strickland BA, Ravina K, Rennert RC. et al. Intentional subtotal resection of vestibular schwannoma: a reexamination. J Neurol Surg B Skull Base 2020; 81 (02) 136-141
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 McCutcheon BA, Grauberger J, Murphy M. et al; Mayo Clinic Neuro-Informatics Laboratory. Is patient age associated with perioperative outcomes after surgical resection of benign cranial nerve neoplasms?. World Neurosurg 2016; 89: 101-107
    CrossrefPubMedGoogle Scholar
  • 19 Barker II FG, Carter BS, Ojemann RG, Jyung RW, Poe DS, McKenna MJ. Surgical excision of acoustic neuroma: patient outcome and provider caseload. Laryngoscope 2003; 113 (08) 1332-1343
    CrossrefPubMedGoogle Scholar
  • 20 Huang CW, Tu HT, Chuang CY. et al. Gamma Knife radiosurgery for large vestibular schwannomas greater than 3 cm in diameter. J Neurosurg 2018; 128 (05) 1380-1387
    CrossrefPubMedGoogle Scholar
  • 21 Carlson ML, Tveiten OV, Driscoll CL. et al. Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. J Neurosurg 2015; 122 (04) 833-842
    CrossrefPubMedGoogle Scholar
  • 22 Chweya CM, Tombers NM, Lohse CM, Link MJ, Carlson ML. Disease-specific quality of life in vestibular schwannoma: a national cross-sectional study comparing microsurgery, radiosurgery, and observation. Otolaryngol Head Neck Surg 2021; 164 (03) 639-644
    CrossrefPubMedGoogle Scholar
  • 23 Carlson ML, Tveiten OV, Driscoll CL. et al. What drives quality of life in patients with sporadic vestibular schwannoma?. Laryngoscope 2015; 125 (07) 1697-1702
    CrossrefPubMedGoogle Scholar
  • 24 Link MJ, Lund-Johansen M, Lohse CM. et al. Quality of life in patients with vestibular schwannomas following gross total or less than gross total microsurgical resection: should we be taking the entire tumor out?. Neurosurgery 2018; 82 (04) 541-547
    CrossrefPubMedGoogle Scholar
  • 25 Moffat DA, Parker RA, Hardy DG, Macfarlane R. Factors affecting final facial nerve outcome following vestibular schwannoma surgery. J Laryngol Otol 2014; 128 (05) 406-415
    CrossrefPubMedGoogle Scholar
  • 26 Rivas A, Boahene KD, Bravo HC, Tan M, Tamargo RJ, Francis HW. A model for early prediction of facial nerve recovery after vestibular schwannoma surgery. Otol Neurotol 2011; 32 (05) 826-833
    CrossrefPubMedGoogle Scholar
  • 27 Torres R, Nguyen Y, Vanier A. et al. Multivariate analysis of factors influencing facial nerve outcome following microsurgical resection of vestibular schwannoma. Otolaryngol Head Neck Surg 2017; 156 (03) 525-533
    CrossrefPubMedGoogle Scholar
  • 28 Leong SC, Lesser TH. A national survey of facial paralysis on the quality of life of patients with acoustic neuroma. Otol Neurotol 2015; 36 (03) 503-509
    CrossrefPubMedGoogle Scholar