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. 2021 Feb 1;42(2):e199-e208.
doi: 10.1097/MAO.0000000000002863.

Prospective Study of Disease-Specific Quality-of-Life in Sporadic Vestibular Schwannoma Comparing Observation, Radiosurgery, and Microsurgery

Matthew L Carlson  1   2 , Jason H Barnes  1 , Ashley Nassiri  1 , Neil S Patel  1 , Nicole M Tombers  1 , Christine M Lohse  3 , Jamie J Van Gompel  1   2 , Brian A Neff  1 , Colin L W Driscoll  1   2 , Michael J Link  1   2
Affiliations

Prospective Study of Disease-Specific Quality-of-Life in Sporadic Vestibular Schwannoma Comparing Observation, Radiosurgery, and Microsurgery

Matthew L Carlson et al. Otol Neurotol. .

Abstract

Background: Previous cross-sectional studies analyzing quality of life (QOL) outcomes in patients with sporadic vestibular schwannoma (VS) have shown surprisingly little difference among treatment modalities. To date, there is limited prospective QOL outcome data available comparing baseline to posttreatment scores.

Study design: Prospective longitudinal study using the disease-specific Penn Acoustic Neuroma Quality of Life (PANQOL) scale.

Setting: Large academic skull base center.

Patients: Patients diagnosed with unilateral VS who completed a baseline survey before treatment and at least one posttreatment survey.

Main outcome measures: Change in PANQOL scores from baseline to most recent survey.

Results: A total of 244 patients were studied, including 78 (32%) who elected observation, 118 (48%) microsurgery, and 48 (20%) stereotactic radiosurgery. Patients who underwent microsurgery were younger (p < 0.001) and had larger tumors (p < 0.001) than those who underwent observation or radiosurgery; there was no significant difference in duration of follow-up among management groups (mean 2.1 yrs; p = 0.28). When comparing the total PANQOL score at baseline to the most recent survey, the net change was only -1.1, -0.1, and 0.3 points on a 100-point scale for observation, microsurgery, and radiosurgery, respectively (p = 0.89). After multivariable adjustment for baseline features, there were no statistically significant changes when comparing baseline to most recent scores within each management group for facial function, general health, balance, hearing loss, energy, and pain domains or total score. However, the microsurgical group experienced a 10.8-point improvement (p = 0.002) in anxiety following treatment, compared with 1.5 (p = 0.73) and 5.3 (p = 0.31) for observation and radiosurgery, respectively.

Conclusions: In this prospective longitudinal study investigating differences in QOL outcomes among VS treatment groups using the disease-specific PANQOL instrument, treatment did not modify QOL in most domains. Microsurgery may confer an advantage with regard to patient anxiety, presumably relating to the psychological benefit of "cure" from having the tumor removed.

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Conflict of interest statement

The authors report no relevant conflicts of interest in submitting this article for publication.

References

    1. Carlson ML, Tveiten OV, Driscoll CL, et al. Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. J Neurosurg 2015; 122:833–842.
    1. Gauden A, Weir P, Hawthorne G, et al. Systematic review of quality of life in the management of vestibular schwannoma. J Clin Neurosci 2011; 18:1573–1584.
    1. Olson JJ, Kalkanis SN, Ryken TC. Congress of neurological surgeons systematic review and evidence-based guidelines on the treatment of adults with vestibular schwannomas: executive summary. Neurosurgery 2018; 82:129–134.
    1. Broomfield SJ, O’Donoghue GM. Self-reported symptoms and patient experience: A British Acoustic Neuroma Association survey. Br J Neurosurg 2016; 30:294–301.
    1. Carlson ML, Tveiten OV, Yost KJ, et al. The minimal clinically important difference in vestibular schwannoma quality-of-life assessment: an important step beyond P < .05. Otolaryngol Head Neck Surg 2015; 153:202–208.

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