Vestibular Schwannoma Stereotactic Radiosurgery in Octogenarians: Case Series

Abstract

BACKGROUND AND OBJECTIVES: The management of octogenarians with vestibular schwannomas (VS) has received little attention. However, with the increase in octogenarian population, more effort is needed to clarify the value of stereotactic radiosurgery (SRS) in this population. The aim of this study was to evaluate the safety and efficacy of SRS in this patient age group. METHODS: A retrospective study of 62 patients aged 80 years or older who underwent single-session SRS for symptomatic VS during a 35-year interval was performed. The median patient age was 82 years, and 61.3% were male. SRS was performed as planned adjuvant management or for delayed progression after prior partial resection in 5 patients. RESULTS: SRS resulted in a 5-year tumor control rate of 95.6% with a 4.8% risk of adverse radiation effects (ARE). Tumor control was unrelated to patient age, tumor volume, Koos grade, sex, SRS margin dose, or prior surgical management. Four patients underwent additional management including 1 patient with symptomatic progression requiring surgical resection, 2 patients with symptomatic hydrocephalus requiring cerebrospinal fluid diversion, and 1 patient whose tumor-related cyst required delayed cyst aspiration. Three patients developed ARE, including 1 patient with permanent facial weakness (House-Brackmann grade II), 1 who developed trigeminal neuropathy, and 1 who had worsening gait disorder. Six patients had serviceable hearing preservation before SRS, and 2 maintained serviceable hearing preservation after 4 years. A total of 44 (71%) patients died at an interval ranging from 6 to 244 months after SRS. CONCLUSION: SRS resulted in tumor and symptom control in most octogenarian patients with VS.

Vestibular Schwannoma Surgery in the Ninth Decade of Life: a case series

“…Various management strategies, including microsurgical resection, stereotactic radiosurgery (SRS), radiotherapy, or a wait-and-scan approach for observation, are available for dealing with VS. [13,17] However, a large symptomatic tumor poses a life-threatening condition if not surgically removed, regardless of the patient's age. While many elderly patients may tend to accept the natural history of the disease, some prefer to take the risk of surgical intervention.…”

“…Small and medium-sized growing VS are treated by radiosurgery. [13,18,19,46] However, large, compressive, and symptomatic tumors are not suitable for this modality and surgery must be considered in these cases. Surgical complications from VS surgery extend beyond facial nerve function and hearing morbidities, with approximately one-quarter of patients experiencing at least one surgically attributable complication unrelated to cranial nerves VII or VIII.…”