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Microsurgical treatment of symptomatic vestibular schwannomas in patients under 40: different results before and after age of 30

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Abstract

In 10–15% of cases of vestibular schwannoma (VS), age at diagnosis is 40 years or less. Little is known about the differences in natural history, surgical findings, and postoperative outcomes of such younger patients as compared to those of greater age. To analyze clinical and surgical and imaging data of a consecutive series of n = 50 patients with unilateral sporadic VS, aged 40 years or younger — separated in a very young group (15–30 years) and a moderately young group (31–40 years). Retrospective case series. Fifty consecutive patients under 40 years of age underwent microsurgical resection of unilateral sporadic VS via the retrosigmoid approach. The study cohort was subdivided into two groups according to the age range: group A, age range 15–30 years (n = 23 patients), and group B, age range 31–40 years (n = 27 patients). The adherence of VS capsule to surrounding nervous structures and the tendency of the tumors to bleed were evaluated by reviewing video records; the course of the FN in relation to the tumor’s surface was assessed in each case. Microsurgical removal of tumor was classified as total (T), near total (residual tumor volume < 5%), subtotal (residual tumor volume 5–10%), or partial (residual tumor volume > 10%). Mean tumor size of entire cohort was 2.53 (range: 0.6–5.8) cm: 2.84 cm in group A and 2.36 cm in group B (p = NS). Facial nerve course and position within the cerebellopontine angle did not differ significantly between the two groups. At 6-month follow-up, FN functional outcome was HBI-II in 69.5% in group A, versus 96.3% in group B (p < .001). Hearing preservation was achieved in 60.0% of patients of group A and in 58.3% of group B (p = NS). Total and near-total resection was feasible in 95.6% of cases of group A and in 88.9% of group B (p = NS). Tumor capsule was tightly adherent to nervous structures in 69.6% patients of group A and in 22.2% of group B (p < .05). Significant bleeding was encountered in 56.5% of group A tumors, and in 29.6% of group B tumors (p < .01). Microsurgery of VS in patients aged 40 or less is associated with good functional results, and with high rates of total and near total tumor removal. Patients < 30 years of age have more adherent tumor capsules. Furthermore, their tumors exhibit a tendency to larger sizes, to hypervascularization, to profuse intraoperative bleeding and they present worse long-term functional FN results when compared to patients in their fourth decade of life. Our limited experience seems to suggest that a near total resection in very young VS patients with large tumors should be preferred in adherent and hypervascularized cases, in order to maximize resection and preserve function.

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Authors and Affiliations

  1. Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy

    Luciano Mastronardi, Alberto Campione, Guglielmo Cacciotti, Ettore Carpineta, Carlo Giacobbo Scavo, Raffaele Roperto & Giovanni Stati

  2. Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University Under Ministry of Health, Moscow, Russian Federation

    Luciano Mastronardi & Albert A. Sufianov

  3. Federal Centre of Neurosurgery, Tyumen, Russian Federation

    Albert A. Sufianov

  4. Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Karl Schaller

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  1. Luciano Mastronardi
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Contributions

LM: study design, study conception, data analysis, manuscript writing.

AC: data extraction, data analysis.

CGS: data extraction, data analysis, radiological measurement.

EC: data extraction, data analysis, radiological measurement.

GC: data extraction, data analysis, statistical analysis.

RR: data analysis, statistical analysis, critical review of the manuscript.

AAS: critical review of the manuscript, study supervision.

KS: critical review of the manuscript, study supervision.

Corresponding author

Correspondence to Luciano Mastronardi.

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The authors declare no competing interests.

Ethics approval

The study involves human participants: therefore, it has been reviewed and approved by local ethics committee of the Hospital. A written consent for scientific treatment of personal data was obtained from any patient before surgery. No potentially identifiable human images or data are presented in this study. All procedures performed in this study were in accordance with the ethical standards of the internal institutional ethics committee (“Comitato Etico Lazio 1” Members of ASLRoma1: Dr. Marco Tubaro, Dr. Teresa Calamia, Dr. Francesco Meo). A written consent was obtained from any patient included in the study.

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Mastronardi, L., Campione, A., Cacciotti, G. et al. Microsurgical treatment of symptomatic vestibular schwannomas in patients under 40: different results before and after age of 30. Neurosurg Rev 45, 873–882 (2022). https://doi.org/10.1007/s10143-021-01603-4

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