title: Surgical Treatment of Vestibular Schwannoma: Does Age Matter?
abstract: OBJECTIVE
  For older patients (>65 years) who undergo surgical treatment of vestibular schwannoma (VS), the reported rates of facial nerve preservation, hearing preservation, and complications are inconsistent. Many surgeons believe that older patients have worse outcomes than their younger counterparts and advise against surgical treatment. We analyzed a consecutive series of patients with VS treated with surgery to determine whether age was a factor in outcome.
  
  
  METHODS
  We retrospectively reviewed all patients treated for VS at our institution from January 1, 2000, to July 1, 2012. We examined how sex, age (≥65 years and <65 years), race, tumor size, tumor laterality, body mass index, Charlson Comorbidity Index, smoking status, surgical approach, and preoperative hearing and symptoms were associated with outcomes.
  
  
  RESULTS
  Two-hundred forty-three patients underwent resection of VS, including 23 patients ≥65 years (mean 68 ± 4 years) and 220 patients <65 years (mean 47 ± 11 years). The average tumor size was 16.5 mm. Older patients had a significantly lower body mass index of 26.6 vs. 29.8 (P = 0.03) and were more likely to have a CCI ≥2 (52.2% vs. 18.2%, P ≤ 0.00, preoperative facial numbness (34.8% vs. 10.1%, P = 0.03), and dizziness (78.3% vs. 49.3%, P = 0.03). There were no significant differences after surgery in facial nerve outcome, hearing preservation outcome, or general surgical complications between the 2 cohorts.
  
  
  CONCLUSIONS
  With no difference in surgical complications, facial nerve outcome, or hearing preservation rates between older and younger patients in our series, age alone may not be an absolute contraindication to surgical management of VS.
authors: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors: Christian A
authors: CA
authors: Bowers
authors: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA.
authors: Richard K
authors: RK
authors: Gurgel
authors: University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors: Cameron
authors: C
authors: Brimley
authors: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors: Gregory W J
authors: GW
authors: Hawryluk
authors: University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors: Michael
authors: M
authors: Taggart
authors: University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors: Samuel
authors: S
authors: Braden
authors: University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors: Tolbin
authors: T
authors: Collett
authors: University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors: Derrick
authors: D
authors: Gale
authors: Division of Neuroradiology, Department of Radiology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors: Karen L
authors: KL
authors: Salzman
authors: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
authors: Joel D
authors: JD
authors: MacDonald
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D004244:Dizziness / Q000209:etiology; D005155:Facial Nerve Diseases / Q000453:epidemiology; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Acoustic neuroma; Complications; Elderly; Microsurgical resection; Outcomes; Vestibular schwannoma