Patient Demographics Influencing Vestibular Schwannoma Size and Initial Management Plans

Objective: To explore patient demographics as to predicting vestibular schwannoma (VS) size and treatment plan within a single institution. Methods: Using a large tertiary referral skull base center database, all patients with sporadic VS who presented to the center between 2009 and 2018 were reviewed. Results: A total of 816 patients with VS over 18 years of age were included. The median age was 56.8 years (range: 18.6–90.9 years). The median tumor diameter at diagnosis was 11.9 mm (range: 0.6–51.1 mm). With multivariate analysis, older age was associated with decreased tumor size (0.23 mm, 95% confidence interval [CI]: 0.17–0.29), whereas 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 with surgery and radiation (odds ratio [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 with surgery (OR: 0.49, 95% CI: 0.29–0.82). Each additional mile a patient lives farther from the center increases his or her odds of pursuing treatment (OR: 1.002, 95% CI: 1.001–1.003). Conclusions: Older age is associated with smaller tumors, whereas married patients have larger tumors at diagnosis as compared with nonmarried patients. Furthermore, married patients are more likely to pursue treatment, specifically surgery, as compared with nonmarried patients, whereas patients who live farther from the center are more likely to pursue treatment.