In 10–15% of cases of vestibular schwannoma (VS), age at diagnosis is 40 years or less. Little is known about the differences in natural history, surgical findings, and postoperative outcomes of such younger patients as compared to those of greater age. To analyze clinical and surgical and imaging data of a consecutive series of n = 50 patients with unilateral sporadic VS, aged 40 years or younger — separated in a very young group (15–30 years) and a moderately young group (31–40 years). Retrospective case series. Fifty consecutive patients under 40 years of age underwent microsurgical resection of unilateral sporadic VS via the retrosigmoid approach. The study cohort was subdivided into two groups according to the age range: group A, age range 15–30 years (n = 23 patients), and group B, age range 31–40 years (n = 27 patients). The adherence of VS capsule to surrounding nervous structures and the tendency of the tumors to bleed were evaluated by reviewing video records; the course of the FN in relation to the tumor’s surface was assessed in each case. Microsurgical removal of tumor was classified as total (T), near total (residual tumor volume < 5%), subtotal (residual tumor volume 5–10%), or partial (residual tumor volume > 10%). Mean tumor size of entire cohort was 2.53 (range: 0.6–5.8) cm: 2.84 cm in group A and 2.36 cm in group B (p = NS). Facial nerve course and position within the cerebellopontine angle did not differ significantly between the two groups. At 6-month follow-up, FN functional outcome was HBI-II in 69.5% in group A, versus 96.3% in group B (p < .001). Hearing preservation was achieved in 60.0% of patients of group A and in 58.3% of group B (p = NS). Total and near-total resection was feasible in 95.6% of cases of group A and in 88.9% of group B (p = NS). Tumor capsule was tightly adherent to nervous structures in 69.6% patients of group A and in 22.2% of group B (p < .05). Significant bleeding was encountered in 56.5% of group A tumors, and in 29.6% of group B tumors (p < .01). Microsurgery of VS in patients aged 40 or less is associated with good functional results, and with high rates of total and near total tumor removal. Patients < 30 years of age have more adherent tumor capsules. Furthermore, their tumors exhibit a tendency to larger sizes, to hypervascularization, to profuse intraoperative bleeding and they present worse long-term functional FN results when compared to patients in their fourth decade of life. Our limited experience seems to suggest that a near total resection in very young VS patients with large tumors should be preferred in adherent and hypervascularized cases, in order to maximize resection and preserve function.

在 10-15% 的前庭神经鞘瘤 (VS) 病例中，诊断年龄为 40 岁或更短。与年龄较大的患者相比，这些年轻患者在自然史、手术结果和术后结果方面的差异知之甚少。分析连续系列n  = 50 名 40 岁或以下的单侧散发性 VS 患者的临床、手术和影像学数据，分为非常年轻组（15-30 岁）和中青年组（31-40 岁） ）。回顾性案例系列。连续 50 名 40 岁以下的患者通过乙状结肠后入路接受了单侧散发性 VS 的显微手术切除。研究队列根据年龄范围分为两组：A组，年龄范围15-30岁（n = 23 名患者），B 组，年龄范围 31-40 岁（n  = 27 名患者）。通过回顾视频记录评估VS胶囊对周围神经结构的粘附性和肿瘤出血的趋势；在每种情况下都评估了与肿瘤表面相关的 FN 过程。显微手术切除肿瘤分为全部（T）、接近全部（残余肿瘤体积<5%）、次全（残余肿瘤体积5-10%）或部分（残余肿瘤体积>10%）。整个队列的平均肿瘤大小为 2.53（范围：0.6-5.8）cm：A 组为 2.84 cm，B 组为 2.36 cm（p = NS）。面神经走行和桥小脑角内的位置在两组之间没有显着差异。在 6 个月的随访中，A 组 69.5% 的 FN 功能结果为 HBI-II，而 B 组为 96.3% ( p  < .001)。A 组 60.0% 的患者和 B 组 58.3% 的患者（p  = NS）实现了听力保留。在 A 组 95.6% 的病例和 B 组 88.9% 的病例中，全切除和近全切除是可行的（p  = NS）。A 组 69.6% 的患者和 B 组 22.2% 的患者的肿瘤包膜与神经结构紧密贴附（p  < .05）。56.5% 的 A 组肿瘤和 29.6% 的 B 组肿瘤出现明显出血（p < .01)。在 40 岁或以下的患者中进行 VS 显微手术与良好的功能结果相关，并且肿瘤完全切除率和接近完全切除率高。< 30 岁的患者有更多的粘附肿瘤胶囊。此外，与 40 岁的患者相比，他们的肿瘤呈现出更大尺寸、血管过度形成、大量术中出血的趋势，并且它们的长期功能性 FN 结果更差。我们有限的经验似乎表明，在贴壁和血管丰富的病例中，应首选对具有大肿瘤的非常年轻的 VS 患者进行近乎全切除，以最大限度地切除并保留功能。