Functional Gait Assessment in Geriatric Patients Following Vestibular Schwannoma Resection

Background: Vestibular schwannomas (VS) are benign, slow-growing tumors located in the cerebellopontine angle (CPA), or internal auditory canal (IAC). Options for management of VS include observation with serial imaging, radiation, and microsurgical resection via middle cranial fossa, translabyrinthine, and retrosigmoid approaches. The translabyrinthine approach is most suitable for resection of large tumors in which hearing may have already been compromised or preservation is not a concern. In older patients with vestibular schwannoma, and poor functional mobility, age can often have a significant impact on the decision to proceed with observation, radiation, or microsurgical resection. When considering surgical resection vs radiation, fear of worsened disability can dictate patient decision making, particularly in the geriatric population. It is important to consider the most accurate and up to date treatment outcomes to best determine the most appropriate treatment option.

Objective: The objective of this study is to evaluate the impact of functional mobility in the geriatric population that undergoes translabyrinthine approach for VS resection.

Study Design: Cross-sectional.

Setting: Academic tertiary care skull base surgery program.

Methods: Patients with vestibular schwannoma who sought microsurgical resection at a single, tertiary-care academic center were retrospectively reviewed spanning from November 2017 to August 2022. Only patients over the age of 60 were included. Those with poor functional mobility pre op were distinguished by a functional gait assessment score (FGA) worse than the 95 percentile for age group using age-based population norms.

Results: In total, 43 patients were included who met inclusion criteria. All patients underwent a translabyrinthine approach for VS resection. In total, 12 patients had an average or above average FGA score for their age (mean: 28) indicating good function pre-operatively. Conversely, 31 patients had an average FGA of 22, indicating poor functional mobility according to age (p < 0.001). No difference in tumor dimension, (23 vs. 24 mm; p = 0.3), rates of gross total resection (58 vs. 54%; p = 0.9), or length of stay (3.2 vs. 3.3 days; p = 0.2) for the average FGA vs below baseline FGA group respectively was detected. Postoperatively, FGA was not significantly different between the two groups with an average score of 22.5 and 21.5 for average functional mobility and poor mobility outcomes normalized to age-based values (p = 0.5).

Conclusion: Older patients with poor functional mobility often consider radiation therapy. Our preliminary findings suggest older adults with poor balance preoperative have an improvement in symptoms with microsurgical resection.

Publication History

Article published online:
01 February 2023