Quality of Life and Surgical Outcomes for Patients Over the Age of 75 Undergoing Surgical Resection of a Vestibular Schwannoma

Introduction: The benefits of surgical resection of vestibular schwannoma compared to stereotactic radiosurgery, such as 10-year hearing preservation rates become less relevant with older age. Given the relative safety profile of stereotactic radiosurgery, there seems to be a trend towards offering radiosurgery as first line for elderly patients with growing vestibular schwannoma. However, the challenges of surgery in a previously radiated tumour will still exist should the tumour progress and increasing age during post-radiation observation periods may make surgery more complicated if delayed. Limited data exists on the safety and efficacy of first line surgery in this group, and even less data exists on quality of life (QoL) outcomes for these patients. Methods: A sex and sized match cohort of patients over and under 75 from a single tertiary care centre were included. All patients demonstrated tumour progression prior to surgery or were found to have large tumours requiring resection on presentation. The preoperative imaging characteristics, extent of resection, perioperative outcomes, and QoL data was assessed. Complication rates, hearing and facial nerve preservation, and recurrence rates were evaluated. Results: Surgery in selected patients ≥75 years was safe and effective. Preliminary analysis demonstrated that differences in extent of resection, complication rates, and functional outcomes were present when comparing the two cohorts. Conclusion: These findings suggest that patients over the age of 75 have reasonable outcomes following surgical resection but differences exist compared to a younger matched cohort. Comparative analysis with a size and sex matched cohort identifies patterns in outcomes by age which can be useful in clinical decision making. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany