(880) Should we operate on Vestibular Schwannomas in Aging Patients?

Introduction: With an aging population and increased life expectancy, neurotologists encounter older patients with CPA lesions, and updated studies on surgical resection in this population are needed. Our study assesses clinical outcomes in patients over 70 years (yrs) at the time of vestibular schwannoma (VS) resection.

Methods: Retrospective chart review at a large referral center, on adults >70 yrs of age with VS who underwent surgical resection from 1/2019 through 12/2024, compared with patients < 70 yrs with VS who underwent surgical resection over the same timeframe. Main outcome measures include tumor size, resection approach and status, facial nerve function, hospital stay, complications and post-operative course.

Results: 42 patients aged >70 yrs (70 to 84 yrs) underwent surgical resection of VS. 96% (n=40) underwent translabyrinthine (TL) resection, with remainder via retrosigmoid (n=2), in align with patients < 70 yrs (93% TL, p= 0.752). 71% of resections were reconstructed with hydroxyapatite bone cement, while the remainder utilized abdominal fat grafting (29%). Average tumor size was 2.0 cm in largest dimension compared to 2.1 cm in those < 70 yrs (p=0.969). Average hospital stay was 3.9 days, compared to 3.2 days in patients < 70 yrs (p=0.747). All patients >70 yrs attained gross total (GTR) or near total resection of their tumors. (43% vs 47% GTR in < 70 yrs, p=0.501). 88% had normal facial nerve function (House Brackman (HB) 1/6) by 6 months post-op, similar to those < 70 yrs (82% HB 1/6, p=0.322). In patients >70 yrs, 4 experienced complications surrounding their surgery: 1 neuropathy from surgical positioning, 1 post-operative CSF leak requiring reoperation, 1 wound infection requiring reoperation, and 1 perioperative death within the first week of surgery.

Conclusions: Patients >70 yrs represent a growing proportion of the population. Our large cohort of elderly surgical patients demonstrate these patients can safely undergo surgical resection of VS with similar outcomes as younger patients. Additional counseling should advise on approach, possible extended hospital stay, and post-operative rehabilitation.