{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:04:08Z","timestamp":1787069048518,"version":"build-2736575974"},"reference-count":14,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,1]]},"abstract":"\n Object<\/jats:title>\n The authors' objective was 2-fold: 1) to compare outcomes of microsurgical resection for vestibular schwannoma (VS) between patients aged 70 years or older and patients younger than 70 years and 2) to test the hypothesis that symptomatic tumors in elderly patients represent a more aggressive variant of VS than those in younger adults, resulting in increased morbidity and a higher rate of recurrence after subtotal resection (STR).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective matched cohort study was conducted. Patients aged 70 years or older who had undergone microsurgical resection of VS were matched to adult patients younger than 70 years; the matching was performed on the basis of surgical approach, completeness of resection, and tumor size. Associations between clinical, radiographic, and surgical data and postoperative outcome were analyzed using conditional logistic regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Twenty patients aged 70 years or older (mean age \u00b1 SD 75.9 \u00b1 5.3, range 70\u201386 years) were identified and matched to a cohort of younger adult patients (mean age \u00b1 SD 55.7 \u00b1 13.8, range 25\u201369 years). The mean tumor size in both groups was approximately 3 cm. Overall, the elderly patients had a poorer preoperative American Society of Anesthesiology physical status score (p = 0.038), were more likely to report imbalance (OR 9.61, p = 0.016), and more commonly exhibited compromised balance and coordination (OR 9.61, p = 0.016) than patients in the younger cohort.<\/jats:p>\n There were no differences between the 2 cohorts in perioperative complications (p = 0.26) or facial nerve function (p > 0.5) at any time. The elderly patients were 13 times more likely to have long-term postoperative imbalance (OR 13.00, p = 0.013) than the younger patients. Overall, 9 tumors recurred among 32 patients undergoing STR; 6 of these patients underwent additional interventions (stereotactic radiosurgery in 5 patients and microsurgery in 1) and showed no evidence of tumor progression at the last follow-up. The median growth rate of the recurrent tumor in the 6 elderly patients was 4.8 mm\/year (range 2.1\u201314.9 mm\/year) and, in the 3 control patients, 2.2 mm\/year (range 1.9\u20134.0 mm\/year). Overall, the mortality data showed a trend toward statistical significance (p = 0.068) with a higher risk of death in the elderly.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n As the number of elderly patients with VS increases, microsurgical resection will remain an important management option for these patients. Despite a poorer preoperative physical status in elderly patients, their morbidity profiles are similar to those in adult patients younger than 70 years. However, elderly patients may require longer convalescence due to prolonged postoperative imbalance. Not surprisingly, overall diminished functional reserve and advanced comorbidities may increase the mortality risk associated with surgical intervention in the elderly patients. Finally, there was a high risk of further tumor growth following STR in the elderly patients (6 [37.5%] of 16), underscoring the need for close postoperative radiological surveillance and consideration of early stereotactic radiosurgery for the tumor remnant following the STR.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2013.6.jns122433","type":"journal-article","created":{"date-parts":[[2013,7,19]],"date-time":"2013-07-19T09:56:45Z","timestamp":1374227805000},"page":"207-217","source":"Crossref","is-referenced-by-count":39,"title":["Vestibular schwannoma surgery in the elderly: a matched cohort study"],"prefix":"10.3171","volume":"120","author":[{"given":"Kathryn M.","family":"Van Abel","sequence":"first","affiliation":[{"name":"Departments of Otolaryngology\u2013Head and Neck Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology\u2013Head and Neck Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin L.","family":"Driscoll","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology\u2013Head and Neck Surgery and"},{"name":"Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian A.","family":"Neff","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology\u2013Head and Neck Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Link","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology\u2013Head and Neck Surgery and"},{"name":"Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns122433","series-title":"Arch Intern Med","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1001\/archinternmed.2009.66","article-title":"Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001\u20132004","volume":"169","author":"Agrawal","year":"2009"},{"key":"b2-jns122433","series-title":"Laryngoscope","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1002\/lary.22411","article-title":"Magnetic resonance imaging surveillance following vestibular schwannoma resection","volume":"122","author":"Carlson","year":"2012"},{"key":"b3-jns122433","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/S0194-5998(95)70101-X","article-title":"Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma)","volume":"113","author":"Committee on Hearing and Equilibrium","year":"1995"},{"key":"b4-jns122433","series-title":"Am J Otol","first-page":"236","article-title":"Management of acoustic neuroma in the elderly population","volume":"18","author":"Glasscock","year":"1997"},{"key":"b5-jns122433","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1177\/019459988509300202","article-title":"Facial nerve grading system","volume":"93","author":"House","year":"1985"},{"key":"b6-jns122433","series-title":"Anaesth Intensive Care","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1177\/0310057X0203000516","article-title":"The ASA physical status classification: inter-observer consistency","volume":"30","author":"Mak","year":"2002"},{"key":"b7-jns122433","series-title":"Eur Arch Otorhinolaryngol","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s00405-011-1566-2","article-title":"Surgical management of vestibular schwannoma in elderly patients","volume":"269","author":"Nuseir","year":"2012"},{"key":"b8-jns122433","series-title":"Otol Neurotol","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1097\/00129492-200305000-00020","article-title":"The effect of age on acoustic neuroma surgery outcomes","volume":"24","author":"Oghalai","year":"2003"},{"key":"b9-jns122433","series-title":"Ear Nose Throat J","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1177\/014556130308200512","article-title":"Management of acoustic neuromas in the elderly: retrospective study","volume":"82","author":"Piazza","year":"2003"},{"key":"b10-jns122433","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"944","DOI":"10.3171\/jns.1998.89.6.0944","article-title":"Vestibular schwannoma management. 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