Surgical Outcomes of Translabyrinthine and Retrosigmoid Approaches for Vestibular Schwannoma Across Age Groups: A Propensity-Matched Analysis

Introduction: While prior studies compare surgical approaches for vestibular schwannoma resection, outcomes in elderly patients remain underexplored. This study evaluates postoperative outcomes of translabyrinthine (TL) versus retrosigmoid (RS) approaches in this vulnerable population. Methods: A retrospective analysis was conducted using the TriNetX Research Network, a multi-institutional database of de-identified patient records. Included patients had a diagnosis of benign neoplasm of cranial nerve (ICD-10 D33.3) and conductive or sensorineural hearing loss (ICD-10 H90), while those with neurofibromatosis type 2 (ICD-10 Q85.02) were excluded. Four cohorts were defined by surgical approach and age: TL ≥ 65, TL < 65, RS ≥ 65 and RS < 65 years. Propensity score matching (PSM) was performed for each comparison. 90-day postoperative outcomes were analyzed including gait abnormalities, headache, dizziness, vertigo, facial nerve injury/disorder, other cranial nerve injury, meningitis, CSF leak, hydrocephalus, tinnitus, dysarthria, aphagia/dysphagia, and stroke. Results: A total of 1,591 TL and 1,685 RS patients were identified. Among them, 255 TL and 288 RS patients were ≥ 65, while 1,336 TL and 1,397 RS patients were < 65. After PSM, 241 TL ≥ 65 (mean age 69.7 ± 4.45) and 241 RS ≥ 65 (mean age 70.2 ± 4.34) patients were compared. Elderly TL patients had higher odds of headache (Odds ratio [OR] 2.44; p = 0.019), dizziness (OR 1.97; p = 0.008), and CSF leak (OR 2.31; p = 0.009), but lower odds of aphagia/dysphagia (OR 0.58; p = 0.046) post-operatively compared with elderly RS patients. In the younger cohort, 1,187 TL < 65 (mean age 47.5 ± 12.1) and 1,187 RS < 65 (mean age 47.1 ± 12.4) patients were compared after PSM. Younger TL patients had higher odds of gait abnormalities (OR 1.37; p = 0.009) and tinnitus (OR 2.34; p < 0.0001), but lower odds of hydrocephalus (OR 0.63; p = 0.006) and aphagia/dysphagia (OR 0.40; p < 0.0001) than younger RS patients. Direct comparison of the TL ≥ 65 and TL < 65 cohorts (247 matched patients; mean age 69.8 ± 4.47 vs 47.1 ± 12.5), showed that elderly TL patients had higher odds of hydrocephalus (OR 2.06; p = 0.027) and aphagia/dysphagia (OR 2.67; p = 0.009), but lower odds of tinnitus (OR 0.43; p = 0.006). Comparison of RS ≥ 65 and < 65 cohorts (287 matched patients; mean age 70.1 ± 4.26 vs 47.2 ± 12.2) showed that the elderly RS cohort had higher odds of gait abnormalities (OR 1.76; p = 0.018) but lower odds of headache (OR 0.25; p < 0.0001), dizziness (OR 0.57; p = 0.019), and tinnitus (OR 0.40; p = 0.013). Discussion: This study demonstrates that complication risk profiles for vestibular schwannoma resection vary with surgical approach and patient age. These findings may inform surgical decision-making, patient counseling, and preoperative risk assessment in the elderly patient population. However, patient-specific characteristics such as tumor volume were not available in this database and should be examined in future institutional studies. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany