Life Quality after Vestibular Schwannoma Surgery: Importance of Facial Nerve Function?

Background: Long-term life quality in patients after vestibular schwannoma surgery is generated by a multitude of factors, such as objective general health, neurologic disturbances, especially facial nerve function, and individual subjective aspects. An analysis of those interdependences might help in optimizing counselling and selecting patients for surgery. In preparation of a planned prospective study this retrospective analysis of various parameters was undertaken.

Methods: Out of a consecutive series of 120 operated patients, excluding specific constitution such as Neurofibromatosis, 109 patients participated in a questionnaire study including SF-36 questionnaire, Nottingham Health Profile (NHP) and a disease specific questionnaire on cranial nerve symptoms, general well-being, anxieties, coping with daily and professional life. Patients’ subjective judgment of facial nerve outcome was correlated to objective (House-Brackmann-Scale HB°) and questionnaires findings.

Results: Facial function was useful (HB°1 to °3) early on in 81% and long-term in 97%, among those 70% recovered to HB°1. Subjective patient judgment differed tremendously from objective findings with only 49% judging their facial nerve function as being normal and even 17% judging it as severe palsy while there were 3% objective persistent palsies HB°4 to °6.

Subjective facial deficit coincided with a bad energy level by NHP; when adjusted for balance, energy level was significantly reduced (p = 0.033) in case of subjective palsy, while it was normal in patients with no and with some objective facial palsy. Physical activity was compromised in case of objective facial palsy (p = 0.001), but not in subjective facial palsy nor in normal function. Overall physical well-being by SF-36 was not significantly different between normal and objectively reduced facial function, but was significantly reduced in subjective palsy (p = 0.002), even after statistic adjustment for balance, auditory function and demographics.

Conclusion: Patients long-term judgment on the outcome of their treatment was not solely dependent on surgical results, but temporary morbidity as well as individual factors played a major role. The experience of having gone through temporary facial palsy may lead to a subjectively persistent problem. Reduced energy level in the absence of physical compromise is suggestive of a depressive constitution while patients with normal energy level did not show depressive signs in the presence of objective palsy.