Vestibular Schwannoma in the Elderly: A Matched Cohort Study

Abel, K. Van; Carlson, Matthew L.; Driscoll, C. L.; Neff, Brian A.; Link, M. J.

doi:10.1055/s-0032-1314142

Cited by 2 publications

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“…Samii et al 13 advised that elderly patients can still undergo GTR with excellent outcomes, and that age was not correlated with outcomes. Van Abel et al, 14 Bowers et al, 15 and Jiang et al 16 agreed by concluding that although older patients had poorer health at the time of surgery, there was no resultant increase in morbidity profile. Our results are congruent with previous reports in that we do not find increasing age to pose an elevated risk profile.…”

Section: Discussionmentioning

confidence: 96%

Surgical Outcomes Following Vestibular Schwannoma Resection in Patients over the Age of Sixty-five

Strickland

Rennert

Zada

et al. 2022

J Neurol Surg B Skull Base

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Background: Vestibular schwannoma (VS) are benign, often slow growing neoplasms. Some institutions opt for radiosurgery in symptomatic patients of advanced age versus surgical resection. Objective: To analyze surgical outcomes of VS in patients over the age of 65 that were either not candidates for or refused radiosurgery. Methods: Retrospective analysis of VS patients between 1988 – 2020. Demographics, tumor characteristics, surgical records, and clinical outcomes were recorded. Patient preference for surgery over radiosurgery was recorded in the event that patients were offered both. Facial nerve outcomes were quantified using House-Brackmann (HB) scores. Tumor growth was defined by increase in size of >2mm. Results: 64 patients were included of average age 72.4years [65-84years]. Average maximum tumor diameter was 29mm [13-55mm]. Forty-five patients were offered surgery or GKRS, and chose surgery commonly due to radiation aversion (48.4%). Gross total resection was achieved in 39.1% (n=25), near total 32.8% (n=21), and subtotal 28.1% (n=18). Average hospitalization was five days [2-17] with 75% (n=48) discharged home. Postoperative HB scores were good (HB1-2) in 43.8%, moderate (HB3-4) in 32.8%, and poor (HB5-6) in 23.4%. HB scores improved to good in 51.6%, moderate in 31.3%, and remained poor in 17.1%, marking a rate of facial nerve improvement of 10.9%. Tumor control was achieved in 95.3% of cases at an average follow up time of 37.8 months. Conclusion: VS resection can be safely performed in patients over the age of 65. Advanced age should not preclude a symptomatic VS patient from being considered for surgical resection

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Section: Discussionmentioning

confidence: 96%

Surgical Outcomes Following Vestibular Schwannoma Resection in Patients over the Age of Sixty-five

Strickland

Rennert

Zada

et al. 2022

J Neurol Surg B Skull Base

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“…Other studies have found that translabyrinthine approaches are more efficient and may be better tolerated by elderly patients. 20 21…”

Section: Discussionmentioning

confidence: 99%

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Translabyrinthine and Transcochlear Approaches

Perry,

Carlstrom,

Alexander

et al. 2024

J Neurol Surg B Skull Base

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Introduction Skull base neuroanatomy is traditionally learned through two-dimensional anatomical atlases, which while are of unquestionable value, lack the nuanced association of three-dimensional relationships between fundamental anatomical structures relevant to surgical approaches. Surgically focused step-by-step anatomical dissections can augment trainee learning of complex skull base techniques, particularly multistep and nuanced techniques such as translabyrinthine and transcochlear approaches. Methods Translabyrinthine and transcochlear approaches were performed on six sides of three formalin-fixed latex-injected specimens. The study objective was the completion and photo documentation of the steps involved in the approach in order to provide a comprehensive, intelligible, and anatomically oriented resource for multilevel trainees. Illustrative case examples were prepared to supplement approach dissections. Results The translabyrinthine and transcochlear approaches offer unique lateral windows through the temporal bone into the posterior fossa, providing excellent access to pathology at the petrous apex, internal auditory canal, Meckel's cave, and anterolateral brainstem. The transcochlear approach, which is an anterior extension of the translabyrinthine, particularly provides excellent exposure of the prepontine region and clivus. Important surgical considerations include patient position, temporal bone drilling and identification of critical landmarks, dural opening and identification of neurovascular structures, and reconstruction/closure techniques. Conclusion The translabyrinthine and transcochlear approaches are fundamental techniques for lateral skull base and posterior fossa pathologies. Both approaches are hearing-sacrificing but often require minimal to no cerebellar retraction and deliver unique visualization of prepontine neurovascular structures. This step-by-step approach guide provides a unique practical and high-yield surgically oriented learning resource for neurosurgery and otolaryngology trainees.

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Vestibular Schwannoma in the Elderly: A Matched Cohort Study

Cited by 2 publications

References 0 publications

Surgical Outcomes Following Vestibular Schwannoma Resection in Patients over the Age of Sixty-five

Surgical Outcomes Following Vestibular Schwannoma Resection in Patients over the Age of Sixty-five

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Translabyrinthine and Transcochlear Approaches

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