The Effect of Observation versus Microsurgical Excision on Quality of Life in Unilateral Vestibular Schwannoma: A Prospective Study

ABSTRACT

With the emergence of three effective management options for vestibular schwannoma and the drastic reduction in mortality rate, the last two decades have seen increasing attention being paid to health-related quality of life. The vast majority of quality of life studies have been retrospective. We prospectively assessed quality of life of vestibular schwannoma patients before and after conservative or microsurgical management. We performed a prospective observational study conducted at a tertiary referral center between October 2001 and October 2003. Patients were divided into two groups: conservative management and microsurgery. Quality of life was assessed using the Medical Outcome Study 36-Item Short Form (SF-36) and Glasgow Benefit Inventory (GBI). The questionnaires were administered at initial assessment, 1 month, 3 months, and 6 months in both groups. Thirty-three patients completed the study, 18 in the conservative group and 15 in the microsurgical group. One month after microsurgery, SF-36 scores were significantly reduced within three of eight domains; however, 3 months after microsurgery, no significant difference existed in patients' scores on any of the SF-36 domains compared with preoperatively, and at 6 months there was a significant improvement in one domain compared with preoperatively. There was no significant difference in overall quality of life alteration (GBI total score) between microsurgery and conservative management. The improved quality of life of patients 6 months after microsurgery (relative to preoperatively, and in comparison with an age- and sex- matched population) is a new finding that has not been previously documented in the literature.

KEYWORDS

Vestibular schwannoma - acoustic neuroma - quality of life - Glasgow Benefit Inventory - SF-36

REFERENCES

• 1 Irving R M, Beynon G J, Viani L, Hardy D G, Baguley D M, Moffat D A. The patient's perspective after vestibular schwannoma removal: quality of life and implications for management.  Am J Otol. 1995;  16 331-337
• 2 Nikolopoulos T P, Johnson I, O'Donoghue G M. Quality of life after acoustic neuroma surgery.  Laryngoscope. 1998;  108 1382-1385
• 3 Santarius T, D'Sousa A R, Zeitoun H M, Cruickshank G, Morgan D W. Audit of headache following resection of acoustic neuroma using three different techniques of suboccipital approach.  Rev Laryngol Otol Rhinol (Bord). 2000;  121 75-78
• 4 da Cruz M J, Moffat D A, Hardy D G. Postoperative quality of life in vestibular schwannoma patients measured by the SF36 Health Questionnaire.  Laryngoscope. 2000;  110 151-155
• 5 Martin H C, Sethi J, Lang D, Neil-Dwyer G, Lutman M E, Yardley L. Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life.  J Neurosurg. 2001;  94 211-216
• 6 Betchen S A, Walsh J, Post K D. Self-assessed quality of life after acoustic neuroma surgery.  J Neurosurg. 2003;  99 818-823
• 7 Barré P, Merle C, Conessa C, Desgeorges M, Poncet J L. [Postoperative quality of life for patients with a vestibular schwannoma].  Ann Otolaryngol Chir Cervicofac. 2004;  121 83-94
• 8 Baumann I, Polligkeit J, Blumenstock G, Mauz P S, Zalaman I M, Maassen M M. Quality of life after unilateral acoustic neuroma surgery via middle cranial fossa approach.  Acta Otolaryngol. 2005;  125 585-591
• 9 Tufarelli D, Meli A, Alesii A et al.. Quality of life after acoustic neuroma surgery.  Otol Neurotol. 2006;  27 403-409
• 10 Nicoucar K, Momjian S, Vader J P, De Tribolet N. Surgery for large vestibular schwannomas: how patients and surgeons perceive quality of life.  J Neurosurg. 2006;  105 205-212
• 11 Alfonso C, Lassaletta L, Sarriá J, Gavilán J. [Quality of life following vestibular schwannoma surgery].  Acta Otorrinolaringol Esp. 2007;  58 61-65
• 12 Browne S, Distel E, Morton R P, Petrie K J. Patients' quality of life, reported difficulties, and benefits following surgery for acoustic neuroma.  J Otolaryngol Head Neck Surg. 2008;  37 417-422
• 13 MacAndie C, Crowther J A. Quality of life in patients with vestibular schwannomas managed conservatively.  Clin Otolaryngol Allied Sci. 2004;  29 215-218
• 14 van Roijen L, Nijs HGT, Avezaat CJJ et al.. Costs and effects of microsurgery versus radiosurgery in treating acoustic neuroma.  Acta Neurochir (Wien). 1997;  139 942-948
• 15 Myrseth E, Møller P, Pedersen P H, Vassbotn F S, Wentzel-Larsen T, Lund-Johansen M. Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery.  Neurosurgery. 2005;  56 927-935 discussion 927-935
• 16 Pollock B E, Driscoll CLW, Foote R L et al.. Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery.  Neurosurgery. 2006;  59 77-85 discussion 77-85
• 17 Kelleher M O, Fernandes M F, Sim D W, O'Sullivan M G. Health-related quality of life in patients with skull base tumours.  Br J Neurosurg. 2002;  16 16-20
• 18 Sandooram D, Grunfeld E A, McKinney C, Gleeson M J. Quality of life following microsurgery, radiosurgery and conservative management for unilateral vestibular schwannoma.  Clin Otolaryngol Allied Sci. 2004;  29 621-627