Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy.
Neurosurg Rev. 2024 Aug 8;47(1):410. doi: 10.1007/s10143-024-02615-6.
Elderly patients with vestibular schwannoma (VS) are commonly observed.
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.
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.
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.
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.
老年前庭神经鞘瘤（VS）患者较为常见。
对我神经外科部门 25 例年龄≥70 岁的单侧 VS 患者进行回顾性分析。本研究旨在为老年患者 VS 的治疗提出一种算法。
纳入美国麻醉医师协会（ASA）分级 I-II 级和 III 级但危及生命的肿瘤患者。卡诺夫斯基绩效状态量表（KPS）用于评估生活质量。采用 House-Brackmann（HB）面神经（FN）预后量表。根据 Koos 分类对肿瘤大小进行分类。所有病例均采用乙状窦后入路，1 例采用经迷路入路。手术切除分级：全切除（GTR）、近全切除（NTR＞95%）、次全切除（STR＞90%）。临床和影像学随访时间最初设定为术后 6 个月，然后为 1 年。FN 结果评估在术后 1 年进行，根据 House-Brackmann 分级 I-VI 进行分类。
平均年龄：74.4 岁（70-83 岁）；ASA I 级占 28%，ASA II 级占 56%，ASA III 级占 16%。平均肿瘤大小：2.7cm（1.5-4.2cm）。GTR/NTR：68%，STR 32%。死亡率为零。最后一次随访（术后 1 年）FN 结果为：HBI 81%，HBII 9.5%，HBIII 9.5%；HB IV 0%。仅 4 例患者术前 HB IV，其中 1 例从 HB IV 改善至 HB III。仅在大型 VS 中出现暂时性并发症。3 例 STR 后残留复发，2 例接受 SRS 治疗，1 例观察。
提出了一种老年前庭神经鞘瘤的治疗算法。特别是在一般情况良好的患者中，年龄似乎不是 VS 显微手术的主要禁忌证。最后一次随访时 FN 结果令人满意，并发症发生率可接受。
