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

OBJECTIVES: To compare and analyze the differences in clinical manifestations and surgical outcomes after gross total resection (GTR) for vestibular schwannoma 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 (X.Y.). We then summarized clinical manifestations, image data, perioperative 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 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 greater in elderly patients (P > 0.05). There were also no significant differences in perioperative complications, recurrence rate, facial nerve function, hearing level, or Karnofsky Performance Status Scale scores between younger and older patients. CONCLUSIONS: Elderly patients tended to suffer from poorer health (American Society of Anesthesiology score) and poor balance before the operation; however, they did not experience more complications, worse nerve function, or worse quality of life in the perioperative or follow-up times. We conclude that GTR of vestibular schwannomas, even large or giant ones, is a safe and effective option for elderly patients.