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Clinical outcomes and safety of large or giant vestibular schwannoma in older patients undergoing microsurgery: a matched cohort study

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A Publisher Correction to this article was published on 29 August 2023

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Abstract

Objective

To compare the clinical outcomes of large or giant vestibular schwannomas (VSs) between older patients and younger patients who underwent microsurgery and to explore whether the incidence of postoperative complications increased and whether the postoperative hospital stay was prolonged.

Methods

We conducted a retrospective matched cohort study based on the surgical approach, maximum tumor diameter and extent of resection. Older patients (≥ 60 years) and a matched group (<60 years) who had undergone microsurgery for VSs between January 2015 and December 2021 were included. Clinical data, surgical outcomes and postoperative complications were analyzed statistically.

Results

Forty-two older patients (≥ 60 years, 66.0 ± 3.8 years) were identified and matched to younger patients (<60 years, 43.9 ± 11.2 years), and they all underwent microsurgery through a retrosigmoid approach. There were twenty-nine patients with 3–4 cm VSs and thirteen patients with > 4 cm VSs in both groups. The older patients had a higher proportion of imbalance (P = 0.016) and lower American Society of Anesthesiology scores (P = 0.003) before surgery than the younger patients. There was no significant difference in facial nerve function one week (p = 0.851) and one year (p = 0.756) after surgery and no difference in the postoperative complication incidence (40.5% vs. 23.8%, p = 0.102) between the older patients and controls. Furthermore, the older patients had longer postoperative hospital stays than the younger patients (p = 0.043). In the older group, six patients with near total resection and five with subtotal resection were administered stereotactic radiotherapy, and one had recurrence three years after surgery and received conservative treatment. The postoperative follow-up time ranged from 1 to 83 months, with an average of 33.5 ± 21.1 months.

Conclusions

For older patients (≥ 60 years) with symptomatic, large or giant -VSs, microsurgery is the only effective method to prolong lifespan, alleviate clinical symptoms and cure the tumor. However, radical resection of VSs may result in a decreased preservation rate of facial-acoustic nerve function and an increased postoperative complication incidence. Therefore, subtotal resection followed by stereotactic radiotherapy should be recommended.

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Abbreviations

nASA:

American Society of Anesthesiology

nGTR:

Gross total resection

nHB:

House Brackmann

nLOS:

Length of stay

nNTR:

Near total resection

nSTR:

Subtotal resection

VSs:

Vestibular schwannomas

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Authors and Affiliations

  1. Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No.1 Xin Si Road, 710038, Xi’an, Shaanxi Province, China

    Yingxi Wu, Qing Cai, Min Zheng, Yafei Xue, Yan Qu & Tianzhi Zhao

  2. Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi’an, China

    Junting Li

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Contributions

QY and ZTZ: chief surgeon, writing—review and editing. WYX, CQ, and ZM: writing—original draft preparation. XYF: data collection and arrangement. LJT: statistical analysis. All authors contributed to the article and approved the submitted version.

Corresponding authors

Correspondence to Yan Qu or Tianzhi Zhao.

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All authors declare no conflict of interest, no financial relationship with any organization that might have an interest in the submitted work in the previous three years.

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Tianzhi Zhao is the first corresponding author.

Yingxi Wu, Qing Cai and Min Zheng have contributed equally to this work.

The original version of this article has been revised: The copyright holder name has been corrected.

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Wu, Y., Cai, Q., Zheng, M. et al. Clinical outcomes and safety of large or giant vestibular schwannoma in older patients undergoing microsurgery: a matched cohort study. J Neurooncol 163, 429–437 (2023). https://doi.org/10.1007/s11060-023-04330-6

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