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Surgical Outcomes After Conservative Resection of Vestibular Schwannoma in the Elderly

Objective: To assess outcomes after surgery for vestibular schwannoma in patients over 70 years of age. Study Design: Retrospective chart review. Setting: Two tertiary otology and neurotology centers. Patients and Interventions: Patients undergoing primary surgery for vestibular schwannoma between 2007 and 2018. Main Outcome Measures: Postoperative complications and surgical outcomes. Results: A total of 452 patients met inclusion criteria, 31 of whom (6.9%) were over 70 years of age. Age ranged from 18 to 90 years with a mean of 53 years. Elderly patients were more likely to have pre-existing hypertension (58.1% versus 34.0%, p = 0.007) and diabetes mellitus (19.4% versus 7.4%, p = 0.02). Elderly patients were less likely to undergo gross total resections of their tumors (35.5% versus 60.6%, p = 0.05) although they were not statistically significantly more likely to undergo subtotal (<95%) resections (25.8% versus 14.7%, p > 0.05). Elderly patients were also less likely to undergo second stage procedures (0% versus 9.5%, p = 0.04). There were no significant differences between elderly and non-elderly patients in the rates of any complications, ultimate facial nerve function, or duration of surgery. No patients over 70 years of age expired within 1 year of surgery. Conclusions: Conservative surgery for vestibular schwannoma in appropriately selected elderly patients is appropriate and safe, given adequate consideration to risk-benefit analysis and goals of care.