Prospective Quality of Life in Patients with Sporadic Vestibular Schwannoma: A Comparison of Observation, Microsurgery, and Radiation Treatment Modalities

Background and Objectives: While treatment for vestibular schwannoma (VS) can have a significant impact on a patient's quality of life (QOL), prior studies have reported similar QOL outcomes among treatment modalities. This prospective study utilizes the disease-specific Penn Acoustic Neuroma Quality-of-Life (PANQOL) survey instrument to compare QOL outcomes across three treatment modalities: observation, microsurgery, and stereotactic radiosurgery (SRS).

Methods: Adult patients diagnosed with unilateral sporadic VS at a large academic skull base center were prospectively identified and enrolled. Patients who completed a baseline survey before treatment and at least one post-treatment survey were included for analysis. Changes in PANQOL scores between baseline and most recent scores were compared among treatment groups.

Results: A total of 244 patients met inclusion criteria: 78 (32%) elected observation, 118 (48%) elected microsurgery, and 48 (20%) elected SRS. The mean follow-up length was 2.1 years and the median number of follow-up surveys was 2, neither of which differed significantly among the groups (p = 0.28 and p = 0.72, respectively). Patients in the microsurgery group were younger at baseline (p < 0.01), while those in the observation group had smaller tumors when compared to the other groups (p < 0.01). With a higher score indicating better QOL, the net change in scores when comparing baseline to most recent survey was −1.1, −0.1, and 0.3 for observation, microsurgery, and SRS, respectively (p = 0.89). The microsurgery group exhibited a 10.8 point improvement from baseline in the anxiety domain, which was greater than the improvements noted in the observation (1.5 points) and SRS (5.3 points) groups (p = 0.002). There were no statistically significant changes between baseline and most recent scores within each management group for the other PANQOL domains including facial function, general health, balance, hearing loss, energy, and pain.

Conclusions: A prospective analysis comparing three treatment groups did not identify significant differences in disease-specific QOL across most domains. Patients who underwent microsurgery experienced a greater improvement in the anxiety domain. This finding may be related to the psychological benefit of having been “cured” after tumor removal.

Publication History

Article published online:
12 February 2021