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.
