(893) Translabyrinthine Craniotomy Improves Vestibular Symptoms in Elderly Patients with Vestibular Schwannoma

Introduction: Vestibular symptoms are common in patients with vestibular schwannoma (VS), and can be particularly problematic in older adults. We assessed the efficacy of translabyrinthine craniotomy (TLC) for resection of VS in improving vestibular symptoms in this population.

Methods: We performed a retrospective review of patients aged ≥60 years who underwent TLC for VS between January 2018 and September 2022, and with subjective report of significant preoperative vestibular symptoms. Outcomes included subjective improvement of vestibular complaints at short-term follow-up and postoperative Penn Acoustic Neuroma Quality of Life (PANQOL) survey scores. Independent variables included age, vestibulopathy as chief indication for surgery, tumor size, extent of resection, and length of stay.

Results: Our inclusion criteria yielded 51 patients. Vestibular symptoms were the primary indication for surgery in 17 patients. Overall, 39 (76.5%) reported improvement in vestibular symptoms at follow-up (median 8 days). Mean tumor size was 22 mm, with gross total resection achieved in 27 patients, near-total in 5, subtotal in 18, and partial in one, reflecting our practice of less aggressive tumor removal in elderly patients. Mean length of hospital stay was 4 days. Among 25 patients to date who have completed postoperative PANQOL surveys, mean scores were 45.6 (Balance), 50.8 (General Health), and 57.8 (Overall). Among patients whose vestibular symptoms were a primary surgical indication, 76.5% (13/17) improved subjectively at follow-up (median 8 days). Mean tumor size was 17 mm; extent of resection, length of stay, and PANQOL scores were comparable.

Conclusions: TLC is a safe and effective surgical approach for VS resection and alleviation of vestibular symptoms in elderly patients.