Quality-of-Life Comparing Observation, Microsurgery, and Radiosurgery for Small- to Medium-Sized Vestibular Schwannoma Using a Validated Disease-Specific Instrument

Objectives: (1) To compare long-term quality-of-life (QOL) outcomes following “wait and scan” observation (WSO), microsurgery (MS), and stereotactic radiosurgery (SRS) for small-to-medium sized vestibular schwannoma (VS) using a newly validated disease-specific instrument; (2) to identify clinical variables associated with QOL outcome scores.

Design: Cross-sectional study.

Patients/Materials and Methods: Adult patients who underwent primary MS, WSO, or SRS for sporadic small-to-medium sized (≤2.0 cm) VS between 1998 and 2008 were surveyed using the Penn Acoustic Neuroma Quality-of-Life (PANQOL) Scale 1 and the Mayo Clinic VS symptom questionnaire (MCVSSQ). The PANQOL domain and total scores and MCVSSQ responses for the three groups of interest were compared using the Kruskal-Wallis test for continuous or ordinal variables and chi-square or Fisher exact test for categorical variables. Associations between responses to the MCVSSQ and total PANQOL scores among all patients were interrogated using multivariable regression.

Results: The first 40 consecutive respondents from each group were analyzed (N = 120). The mean duration between date of treatment and time of survey was 8.2 years. Subjects managed with MS were significantly younger (P < 0.000) than those receiving WSO or SRS, and tumors followed with WSO were significantly smaller than those treated with SRS (P = 0.007). Results showed that 95% of WSO and SRS subjects and 85% of MS patients were satisfied with their overall outcome (P = 0.21). Patients managed with WSO were more likely to report useful ipsilateral hearing and normal facial motor function compared with those undergoing active treatment. There was a trend toward more frequent (P = 0.07) and severe (P = 0.1) headaches within the MS group. The frequency and perceived severity of dizziness was similar between groups. There were no statistical differences between the three study groups when investigating individual domain or total PANQOL scores (P = 0.51). When collectively analyzing all subjects, multivariable regression analysis demonstrated that headache (P < 0.000) and dizziness (P < 0.000) were most strongly associated with total QOL scores.

Conclusions: Based on these data, patients with small-to-medium sized VS enjoy comparable long-term QOL and report high outcome satisfaction whether managed with WSO, MS, or SRS. Strategies addressing dizziness and headache may provide the most impact on QOL improvement for patients with VS.