gms | German Medical Science

Objective: The level of evidence to provide treatment recommendations for vestibular schwannoma (VS) is low. Even less studies have focused on the treatment of VS in the Elderly (> 65 years) and therefore there is no community standard for the treatment of VS in the elderly. However, with the increase in the elderly population finding an optimum treatment strategy is important to provide personalized care.

Methods: This matched cohort study analyzed all consecutive Elderly patients with VS treated at our institution. A separate cohort of patients younger than 65 years served as matched controls, and pairing was based on extent of resection (EOR) surgical approach, and tumor size (closest match). Recorded patient comorbidities were assessed using the Charlson Comorbidity Index. Clinical state was reported by Karnofsky Performance Score and House and Brackmann (H&B) scale. Recurrence-free-survival (RFS) was assessed radiographically by contrast-enhanced MR imaging and Kaplan-Meier-Analysis.

Results: Among 2,191 patients with VS seen at our institution between 2005 and 2020, 322 (15%) patients were classified as Elderly. 133 (41%) Elderly patients were treated surgically. Other 189 were treated non-surgically: 27% by radiotherapy and 73% by “Wait-and-Scan” protocol. Elderly patients presented with worse initial KPS more comorbidities (p<0.001). Although initial KPS was significantly worse in the Elderly, this did not carry on in the postop KPS, which was similar in both groups. Elderly patients suffered from gait uncertainty more often than their controlled matches (p<0.001) but complained of less tinnitus then the young (p = 0.016). The incidence of perioperative complication was comparable in both groups with 13% and 4% in the Elderly and Control respectively (p=0.858). Functional facial outcome measured in H&B was not significantly different in either group. There was no difference in discharge modality (home, rehabilitation or other hospital). EOR was significantly associated with RFS (p<0.001) and median time to recurrence was < 5 years, when only decompressive surgery was performed.

Conclusion: This study indicates that microsurgical resection of VS in the Elderly is safe. The perioperative complication rate is not higher, even though the incidence of relevant comorbidities is higher. EOR is significantly associated with RFS in this patient group. Therefore, we suggest that even in the Elderly, the aim of surgical management of VS should be gross total tumor resection to assure tumor control.