Microsurgical Outcomes After Gross Total Resection on Vestibular Schwannoma in the Elderly :A Matched Cohort Study

• Published in: World neurosurgery
• Main Authors: Jiang, Nian, Wang, Zaibin, Chen, Wen, Xie, Yuanyang, Peng, Zefeng, Yuan, Jian, Wanggou, Siyi, Su, Yandong, Li, Xuejun, Yuan, Xianrui
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Neurosurgery; gross total resection; microsurgical outcomes; GTR; RS: retrosigmoid approach; elder patient; NTR; ASA; KPS; near-total resection; CPA; young patient; STR: subtotal resection; cerebellopontine angle; American Society of Anesthesiology physical status; VS; Karnofsky Performance Status Scale; vestibular schwannoma
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2017.01.120

Abstract Objectives To compare and analyze the differences in clinical manifestations and surgical outcomes after gross total resection (GTR) for vestibular schwannoma (VS) between elderly and younger patients. Methods We conducted a retrospective study of 40 elderly (≥65 years) and 40 younger (< 65 years) patients, and matched operation dates and tumor size in the 2 groups were matched. All 80 patients underwent microsurgical resection though the sigmoid approach, by the same surgeon (Professor Xianrui Yuan, M.D. Ph.D.). We then summarized clinical manifestations, image data, peri-operative complications, tumor recurrence, and functional outcomes, and assessed the differences between the 2 groups. Results The mean follow-up time was 52.64 months. Elderly patients had a poorer preoperative American Society of Anesthesiology(ASA) physical status scores than younger patients (62.5% VS 30%, P =0.004), and were more likely to have balance disorders (72.5% VS 25%, P <0.01), without other preoperative differences. Both groups of patients achieved GTR. The incidence of infection was slightly but not significantly higher in elderly patients ( P >0.05). There were also no significant differences in peri-operative complications, recurrence rate, facial nerve function, hearing level, or Karnofsky Performance Status Scale (KPS) scores between younger and older patients. Conclusions The elderly tend to suffer from poorer health (ASA score) and poor balance before the operation. However, elderly patients did not experience more complications, worse nerve function or worse quality of life in the perioperative or follow-up times. We concluded that GTR of VSs, even large or giant ones, is a safe and effective option for the elderly patients.