Management of vestibular schwannoma in the elderly.

Abstract

The elderly population has been expanding and is expected to continue to do so in the future. This, together with advances in work-up for SNHL, led to an increase in the incidence of VS, with smaller tumor sizes and older ages at the time of diagnosis. One-third of VS exhibit growth, with an average growth rate of 2mm/year. Larger extracanalicular tumors are more likely to grow independent of patient age. Patients with higher baseline SDS fare better, and those managed conservatively have a higher preservation of facial function. Despite extensive research, standardized treatment for VS has yet to be implemented, especially in the elderly population, given the many individual variations. Watchful waiting is a reasonable option for smaller tumors, especially on initial follow-up, providing the highest rates of hearing and facial nerve preservation. An alternative option, which is especially advantageous in high-risk elderly populations, is radiosurgery, providing more than 94% tumor control rate with roughly 57% hearing preservation rate on long-term follow-up. Radiosurgery may be used alone or as an adjunct to microsurgery. Finally, microsurgery remains a feasible option for properly selected elderly patients with reasonable surgical risk, and large Koos grade 4 tumors generally not amenable to radiosurgery.