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Patient Demographics Influencing Vestibular Schwannoma Size and Initial Management Plans.

World Neurosurgery 2020 January 11
OBJECTIVE: To explore patient demographics as to predicting vestibular schwannoma (VS) size and treatment plan within a single institution.

METHODS: Utilizing a large tertiary referral skull base center database, all sporadic VS patients who presented to the center between 2009 to 2018 were reviewed.

RESULTS: A total of 816 patients with VS over 18 years of age were included. The median age was 56.8 (range: 18.6 - 90.1 years). The median tumor diameter at diagnosis was 11.9 mm (range, 0.6 - 51.1 mm). With multivariate analysis, older age is associated with decreased tumor size (0.23 mm, 95% CI 0.17 - 0.29), while married patients had larger tumors (2.5 mm, 95% CI 0.92 - 4.09). When comparing observation, radiation, or surgery, older patients are more likely to pursue observation as compared to surgery and radiation (OR 1.08, 95% CI 1.06 - 1.10) and (OR 1.20, 95% CI 1.08 - 1.33), respectively. Married patients were less likely to pursue observation as compared to surgery (OR 0.49, 95% CI 0.29 - 0.82). Each additional mile a patient lives farther from the center increases their odds of pursuing treatment (OR 1.002, 95% CI 1.001 - 1.003).

CONCLUSIONS: Older age is associated with smaller tumors, while married patients have larger tumors at diagnosis as compared to non-married patients. Furthermore, married patients are more likely to pursue treatment, specifically surgery, as compared with non-married patients, while patients who live farther from the center are more likely to pursue treatment.

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