A PREDICTIVE ANALYSIS OF THE CLINICAL AND Social Drivers of Emergent Presentation in Vestibular Schwannoma Management

Background: Vestibular schwannomas (VS) are typically managed through non-emergent referral pathways. However, a subset of patients presents emergently through the emergency department (ED), and the clinical, pathological, and socioeconomic factors distinguishing these cohorts are poorly defined. This study aimed to comprehensively characterize the differences in tumor biology, sociodemographic factors, and perioperative outcomes between patients undergoing VS surgery via emergent versus non-emergent referral. Methods: Patients who underwent vestibular schwannoma resection at a large urban tertiary care center between 2010 and 2024 were retrospectively identified. Patients were stratified by referral pathway: Emergency Department (ED; n=48) versus Non-Emergency (Non-ED; n=260). Demographic, clinical, and outcome variables were compared using Student’s t-test, Mann-Whitney U, and chi-square tests. A multivariate logistic regression model was then developed to identify independent predictors of ED referral, with results reported as adjusted odds ratios (aOR). Results: The ED cohort presented with symptoms of acute neurological compromise, most commonly related to hydrocephalus and brainstem compression, whereas the non-ED cohort typically presented with indolent otologic symptoms This was reflective of a significantly greater tumor burden in the ED cohort, including larger median tumor volumes (17.3 cm 3 vs. 6.3 cm 3 , p