(815) Breaking Down Barriers: Geographic Access, Physician Specialty, and Tertiary Center Variation in Vestibular Schwannoma Care

Introduction: Vestibular Schwannomas (VS) are slow growing tumors of the vestibulocochlear nerve that though benign, can exert significant mass effect leading to debilitating symptoms like hearing loss and facial nerve palsy. VS requires specialized otologic or neurosurgical care, yet socioeconomic and systemic healthcare factors may create disparities in access and treatment approach.

Methods: A retrospective cohort study was performed on patients diagnosed with VS on MRI at a tertiary referral center between 2009 and 2025. Area Deprivation Index (ADI), insurance status, patient and physician demographics, and treatment patterns and outcomes were analyzed.

Results: 303 patients met inclusion criteria. 88.8% of patients came from affluent neighborhoods (ADI 88.8% Q1, 11.2% Q2) with no representation from highly disadvantaged areas (0% Q3, Q4). There was no significant difference in ADI across insurance types (p= 0.96). Q2 patients travelled 3x further for specialized VS care (26 vs 8.8 miles (Q1), p < 0.001) and had significantly larger tumors at presentation even when controlling for age (unadjusted p = 0.032, adjusted p = 0.035).

First physician gender distribution differed markedly by specialty. Nearly all neurosurgery first patients (94.4%) encountered male physicians, while most otology first patients (88%) saw female physicians. Neurosurgery first patients trended towards having larger tumors (1.23cm vs 0.8cm, p = 0.051) and had significantly faster time to curative treatment (30 days vs 70 days, p = 0.023). Final treatment also differed with neurosurgery first patients significantly more likely to receive radiation (31% vs 5.6%, p< 0.001).

Conclusions: The immense socioeconomic homogeneity of our cohort raises a fundamental question about the validity and generalizability of VS evidence. Tertiary centers generate majority of current VS literature and treatment guidelines, but if similar socioeconomic skewing exists across major VS centers, then our collective understanding of tumor behavior, treatment algorithms, patient preferences and outcomes may reflect only the experience of a privileged minority.