2025 Poster Presentations
P465: TIMING OF INTERVENTION AND ADVERSE OUTCOMES IN ACOUSTIC SCHWANNOMAS WITH HEARING LOSS: A RETROSPECTIVE STUDY
Hani Samarah, BS; Julian Jackson, BS; Praneet Kaki, BS; Kalena Liu, BS; Jacob Hunter, MD; Thomas Jefferson University
Background: Vestibular schwannomas (VS) are benign tumors of the eighth cranial nerve, constituting 80-90% of cerebellopontine angle tumors. Management options include early intervention via surgery or stereotactic radiosurgery (SRS) and watchful waiting. This study compares mortality risk and other adverse outcomes among patients treated at different intervals post-diagnosis.
Methods: This retrospective cohort study used the TriNetX Research Network, with data from over 130 million patients across 57 healthcare organizations. Inclusion criteria were patients aged 18 or older diagnosed with benign VS and conductive or sensorineural hearing loss. Four cohorts were analyzed: early intervention within 1 year of diagnosis (N=3,314), and treatment 1 year (N=851), 3 years (N=502), and 5 years (N=274) following diagnosis. Propensity score matching controlled confounders. Primary outcomes post-treatment included death, stroke, facial nerve palsy, vestibular dysfunction, diplopia, trigeminal neuralgia, cerebrospinal fluid (CSF) leak, meningitis, and ataxia. Exclusion criteria included diagnoses of neurofibromatosis type 1 or 2 and otologic or audiological implants.
Results: No statistically significant differences in adverse events were observed between treatment within 1-year and treatment after 1-year at 30-days, 90-days, and 1-year post-treatment. However, a significant increase in the odds ratio was observed in patients treated after 5-years compared to those treated within 1-year of diagnosis (Odds Ratio 1.947 (1.068, 3.551)) (Figure 2). No significant differences in mortality were observed for treatments delayed up to 3-years when compared to treatment within 1-year of diagnosis (Odds Ratio 1.207 (0.788, 1.848)) (Figure 2).
Conclusion: The findings suggest that delaying treatment for VS may not significantly impact most adverse outcomes within the first 1- to 3-years. However, there is an indication that delaying treatment until 5-years might increase the odds ratio for death compared to treatment within 1-year. This data supports the consideration of treatment timing in clinical decision-making, particularly for patient-specific factors.
Figure 1: Force plot of odds ratios for adverse events measured at 30-days, 90-days, and 1-year post intervention between treatment within one year and treatment after 1-year
Figure 2: Odds ratios for mortality in patients afflicted with vestibular schwannoma who delayed treatment (SRS or Surgery) 1- 3-, and 5-years after diagnosis compared to patients treated within 1-year of diagnosis. A significant increase in the odds of mortality in patients treated after 5-years was observed when compared to those treated within 1-year of diagnosis (Odds Ratio 1.947 (1.068, 3.551)).