Background. Elderly patients with vestibular schwannoma (VS) are commonly observed. Object. Retrospective analysis of 25 patients aging ≥ 70 operated on in our neurosurgical department for unilateral VS.
Methods. American Society of Anesthesiology (ASA) Grade I-II patients and Grade III with life-threatening tumors were enrolled. Karnofsky Performance Status Scale (KPS) was used for evalutation of the quality of life. The House-Brackmann (HB) scale for facial nerve (FN) outcome was used. Tumor size was categorized according to Koos’ classification. A retrosigmoid approach was used in all cases, except one in which a translabyrinthine approach was performed. Surgical removal graduation: total (GTR), near total (NT>95%), subtotal (ST>90%). Results. Mean age: 74,4 years (70-83); 28% ASA I, 56% ASA II, 16% ASA III. Mean tumor size: 2,7cm (1,5-4,2cm). GTR/NT resection: 68%, ST 32%. Mortality was zero. Long-term FN results: HBI 68%, HBII 8%, HBIII 12%; HB IV 12% (4 cases preoperatively). Transient complications occurred only in large VS. Re-growth of residue after ST was observed in 3 cases, treated with SRS in 2 cases and observed in 1.
Conclusions. An algorithm of treatment of vestibular schwannoma in the elderly is proposed. In particular, in patients in general good conditions, age does not appear to be a major contraindication for microsurgery of VS. Long-term FN results are satisfactory and the complication rates are acceptable.