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The effect of age on acoustic neuroma surgery outcomes
John S Oghalai1, James L Buxbaum, Lawrence H Pitts
1Department of Otolaryngology- Head and Neck Surgery, University of California San Francisco, California 94143-0342, USA. oghalai@itsa.ucsf.edu
Objectives:
To ascertain the effect of age on hearing preservation, facial nerve outcome, and complication rates after acoustic neuroma surgery.
Study Design:
Retrospective chart review. Two study arms were used: a comparison of the authors' oldest patients with their youngest patients (extremes of age arm) and an analysis of all middle fossa surgical procedures (middle fossa arm).
Setting:
Tertiary referral center
Patients:
Total of 329 patients. For the extremes of age arm, 205 patients were studied in two cohorts with 150 older patients (>60 years) compared with 55 younger patients (<40 years). The approaches included 21 middle fossa (MF), 38 retrosigmoid (RS), and 91 translabyrinthine (TL) procedures in the older group versus 25 MF, 17 RS, and 13 TL in the younger. For the middle fossa arm, there were 170 patients (age range 15-76 years) who underwent the MF approach for an attempt at hearing preservation.
Main Outcome Measures:
Hearing preservation was defined as the maintenance of either class A or class B hearing (AAO-HNS class). Good facial nerve outcome was considered the maintenance of either grade 1 or 2 (House-Brackmann scale). Cerebrospinal fluid leak rates and other postoperative complications were also tabulated.
Results:
After adjustment for tumor size and surgical approach using multiple logistic regression analysis, the extremes of age study arm demonstrated that there is a lower chance of preserving good hearing in older patients (p = 0.048, odds ratio = 0.30). Age was not associated with a difference in the rate of good facial nerve outcome (p = 0.2). There was a trend toward slightly higher rates of cerebrospinal fluid leak in the older patient group (p = 0.07) but no difference in the rate of other complications (p = 0.9). The middle fossa study arm, after adjustment for tumor size and surgical approach, demonstrated that older patient age is associated with a lower rate of preservation of good hearing (p = 0.01, O.R.=1.044). There was no association between age and good facial outcome (p = 0.7).
Conclusions:
Older patient age lowers the chance of hearing preservation but does not affect facial outcomes. There is a trend toward a higher rate of cerebrospinal fluid leak in older patients, but no increased risk of other complications.