Evolution of vestibular schwannoma management in the 21st century: A national database study.

Background: Patient participation affected management decision-making trends over the past two decades. This study aimed to survey trends in vestibular schwannoma (VS) management using a large national database. Methods: This analysis collated demographic and clinical data for 23,488 VS cases from 2004 to 2021 using the national surveillance, epidemiology, and end result database. Relationships between tumor size and age were analyzed with Chi-square and logistic regression and trends over time were assessed. Results: Across the study period, a statistically significant portion of older patients was managed with observation compared to younger patients. The relationship of age to initial management persisted across tumor sizes. From 2004 to 2021, observation was increasingly popular. The strongest relationship between time and treatment modality was observed in young patients (<65), for which there was a 16.6% point increase in observation and a 10.9% point decrease in surgery between the extremes of the study period. This trend is contrasted with the trend in radiation therapy over this time in the elderly population, in whom the rate of radiation nearly halved (39.9-22.7%) from 2004 to 2018. Conclusion: This large database study demonstrates the impact that the dawn of the century had on trends in the management of VS. Over the past 20 years, treatment options have not changed greatly, but the way the options are utilized evolved with time.