Vestibular schwannoma microneurosurgery in patients over 70: a single institution experience and proposal of a treatment algorithm.

Autor: Michelini S; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy., Campione A; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy., Carpineta E; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy., Fraschetti F; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy., Scavo CG; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy., Boccacci F; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy., Cacciotti G; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy., Stati G; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy., Roperto R; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy., Alomari AA; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy., Mastronardi L; Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy. mastronardinch@gmail.com.
Jazyk: angličtina
Zdroj: Neurosurgical review [Neurosurg Rev] 2024 Aug 08; Vol. 47 (1), pp. 410. Date of Electronic Publication: 2024 Aug 08.
DOI: 10.1007/s10143-024-02615-6
Abstrakt: Background: Elderly patients with vestibular schwannoma (VS) are commonly observed.
Object: Retrospective analysis of 25 patients aging ≥ 70 operated on in our neurosurgical department for unilateral VS. The purpose of our study is to propose an algorithm for the treatment of VS in elderly patients.
Methods: American Society of Anesthesiology (ASA) Grade I-II patients and Grade III with life-threatening tumors were enrolled. Karnofsky Performance Status Scale (KPS) was used for evalutation of the quality of life. The House-Brackmann (HB) scale for facial nerve (FN) outcome was used. Tumor size was categorized according to Koos' classification. A retrosigmoid approach was used in all cases, except one in which a translabyrinthine approach was performed. Surgical removal graduation: total (GTR), near total (NTR > 95%), subtotal (STR > 90%). The clinical and radiological follow-up period was set first at six months and then at one year after surgery. FN results evaluation was performed at one year, categorized according to House-Brackmann grades I-VI.
Results: Mean age: 74,4 years (70-83); 28% ASA I, 56% ASA II, 16% ASA III. Mean tumor size: 2,7 cm (1,5-4,2 cm).
Gtr/ntr: 68%, STR 32%. Mortality was zero. At last follow-up (one year after surgery) FN results were: HBI 81%, HBII 9.5%, HBIII 9.5%; HB IV 0%. Only 4 patients had preoperative HB IV, of whom one improved from HB IV to HB III. Transient complications occurred only in large VS. Re-growth of residue after STR was observed in 3 cases, treated with SRS in 2 cases and observed in 1.
Conclusions: An algorithm of treatment of vestibular schwannoma in the elderly is proposed. In particular, in patients in general good conditions, age does not appear to be a major contraindication for microsurgery of VS. FN results at last follow-up are satisfactory and the complication rates are acceptable.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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