Prospective Comparison of Quality of Life before and after Observation, Surgery or Radiotherapy for Vestibular Schwannomas

The best management strategy for small to medium vestibular schwannomas (VS) remains a controversial choice between observation, radiotherapy, and microsurgery. We undertook a prospective observational cohort study comparing all three therapeutic modalities in VS patients, focusing on quality of life (QoL) outcomes.

Methods: Patients completed the SF-36 survey at regular intervals with a mean follow-up of 31.8 months. Two hundred five of 264 patients (77.7% response rate), including 47 observation, 48 radiotherapy, and 134 surgery patients (of which 37 had tumors > 3 cm diameter), completed questionnaires. Patients allocated to observation had smaller tumors (mean, 1.3 cm; P < 0.001). Radiotherapy patients were older (mean, 60.0 years; P < 0.001).

Results: There were no baseline QoL differences between observation, radiotherapy, and surgery for > 3 cm tumors. QoL remained unchanged for the observation and radiotherapy groups through follow-up. In the surgery (> 3 cm tumor) group, a significant improvement in total score and composite mental dimension was observed at 24 months. In the surgery (> 3 cm tumor) group, there was an early improvement in composite mental dimension at 1.5 months, as well as at 24 months; total score and composite physical dimension were improved at 24 months.

Conclusion: Based on our current management protocol, VS patients enjoy similar QoL through follow-up after undergoing observation, radiotherapy, or surgery.