A critical evaluation of vestibular schwannoma surgery for patients younger than 40 years of age.
BACKGROUND
There are few published prospective data sets specifically focusing on patients younger than 40 years old undergoing microsurgery for vestibular schwannoma.


OBJECTIVE
We describe functional outcomes and long-term tumor control after surgery in patients younger than 40 years old enrolled in a prospectively collected database over a 25-year period.


METHODS
We selected all vestibular schwannoma patients from a prospectively collected database who were younger than 40 years old at the time of surgical resection for a vestibular schwannoma. Rates of tumor control and hearing preservation were analyzed using Kaplan-Meier analysis, and risk factors for facial nerve palsy, hearing loss, and trigeminal neuropathy were analyzed using multivariate logistic regression.


RESULTS
A total of 204 patients younger than 40 years of age met our inclusion criteria and were included in the analysis. Our data indicate that surgical resection leads to durable long-term freedom from tumor recurrence or progression in 89% of young patients at 15 years of follow-up. Consistent with other published series, hearing was preserved in 68% of patients with smaller tumors (<3 cm). Facial nerve function was preserved in 76% of patients with smaller tumors and 52% of patients with larger tumors (P<.001). On multivariate logistic regression, tumor size was a significant predictor of hearing loss, whereas gross total resection was nearly a significant predictor of hearing loss controlling for other variables (P=.06).


CONCLUSIONS
We present the largest prospectively studied cohort of young patients undergoing microsurgical resection of vestibular schwannoma. These data suggest that surgical resection provides excellent long-term tumor control in these patients.
Department of Neurological Surgery, University of California at San Francisco, San Francisco, California 94143, USA.
Michael E
ME
Sughrue
Rajwant
R
Kaur
Martin J
MJ
Rutkowski
Ari J
AJ
Kane
Isaac
I
Yang
Lawrence H
LH
Pitts
Andrew T
AT
Parsa
D000328:Adult; D016009:Chi-Square Distribution; D005155:Facial Nerve Diseases / Q000209:etiology; D005260:Female; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009464:Neuroma, Acoustic / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D011183:Postoperative Complications; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome