Quality of Life Assessment among Vestibular Schwannoma Patients Treated with Microsurgery versus Stereotactic Radiosurgery versus Observation

Introduction: Vestibular schwannoma (VS) is a benign and slow-growing tumor of cranial nerve VIII. Patients usually present with hearing loss, balance difficulty, tinnitus, and facial nerve dysfunction. There are multiple treatment options available including surgical resection, stereotactic radiosurgery, and observation. In spite of benign nature of the tumor, VS is associated with high rate of morbidity due to its anatomical location, in close proximity of the brainstem. Therefore, it is important to choose a modality with significant favorable benefit to risk ratio, which makes the decision for the management particularly difficult. Assessment of quality of life among VS patients is critical for functional outcome analysis of each treatment modality.

Objectives: We aim to assess the quality of life among VS patients who underwent microsurgical resection, stereotactic radiosurgery, or observation.

Methods: We prospectively collected data by asking the VS patients to fill out disease-specific quality of life (Penn Acoustic Neuroma Quality of Life—PANQOL) survey who visited the clinic between January 2019 and August 2019, treated by the senior author. We only included patients who had undergone the treatment/or had follow-up visit in case of observation. For the patients who underwent multiple treatment modalities, the recent treatment was considered. PANQOL was divided into eight domains including hearing, tinnitus, balance, facial symptoms, anxiety, general symptoms, pain, and energy and analysis was performed accordingly. While comparing the parameters for each modality, the total mean of the cohort was considered as reference.

Results: We enrolled 28 patients through survey. Mean age was 57 years (SD: 15.89 years) with male:female ratio of 1:1.45. The mean difference of duration between the time of diagnosis and survey was reported to be 39 months and mean clinical follow-up was calculated as 22 months (SD: 55.29 months). Around one-half of the patients were being observed, whereas 10 (35.71%) and 3 (10.71) patients underwent microsurgery and radiosurgery, respectively.

The mean PANQOL score for our cohort was 53.5 and no significant difference between all the three modalities was found, p-value > 0.05 (details in the Table). An in-depth analysis of all 8 domains of the PANQOL revealed better scores for the patients undergoing observation. Patients who underwent microsurgery reported poor scores for balance and pain. Patients who underwent radiosurgery reported poor scores in hearing, tinnitus, and facial symptoms (Fig. 1).

Conclusion: An in-depth analysis of the quality of life provides useful insight to the functional outcomes following vestibular schwannoma treatment. It helps choose the treatment modality to ensure better functional outcomes.