Article
Functional outcome after microsurgical total removal of vestibular schwannoma in elderly patients
Auswirkung einer vollständigen (mikrochirurgischen) Entfernung eines vestibulären Schwannoms bei älteren Patienten
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Published: | May 8, 2019 |
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Objective: We evaluate the outcome of vestibular schwannoma (VS) surgery in elderly patients.
Methods: We report the findings of a retrospective case-control analysis of all the patients older than 65 years who had undergone microsurgical VS resection in our institute. Patients were classified into an “elder” cohort if they were ≥70 years old (n=24), and into an “intermediate” cohort if the were 65-69 years old (n=34). A control group was selected randomly from the whole pool of patients younger than 65 years treated for VS in the same time frame and with the same extension grade.
Results: Total tumor removal was achieved in 100% of patients. Anatomical preservation of the facial nerve was possible in 23 on 24 patients (95.8%) of the elderly group, in 34 patients (100%) of the intermediate group and in 29 on 30 patients (96.7%) of the control group. In tumors with Classes T1, T2, and T3 extension (Hannover classification), the rate of facial nerve preservation was 100%. At discharge, excellent facial nerve function (House-Brackmann Grades I and II) was present in 66.7% of patients of the elderly group, in 64.7% of patients of the intermediate group and in 76.6% of patients of control group; good function (House-Brackmann Grade III) in 8.3% of patients of the elderly group, in 8.8% of patients of the intermediate group and in 10% of patients of control group. The overall rate of functional hearing preservation was 23.9%: 5 patients (20.8%) in the elderly group, 9 patients (26.5%) in the intermediate group and 7 patients (23.3%) in the control group had a hearing level from H1 to H3 (New Hannover hearing classification). No meningitis, septic or aseptic, was diagnosed in this series. The mortality rate in this series of patients was 0%.
Conclusion: We observed no difference in complication rates, facial nerve outcome or hearing preservation between the 3 groups of patients in our series. Our results suggest that older patients not only well tolerate the surgery of VS, but they also go well postoperatively.