Assessing Surgical Approaches for Acoustic Neuroma Resection: Do Patients Perceive a Difference in Quality-of-Life Outcomes?

Abstract

Objective: The objective of this study is to further patient-physician discussion regarding postoperative quality of life expectations after surgical acoustic neuroma resection. Study Design: This study is retrospective prospective. Qualifying patients were identified and administered Penn Acoustic Neuroma Quality-of-Life (PANQOL) Scale. Setting: The setting was Loyola University Chicago Health System. Patients: Three hundred twenty-six patients at our center with surgically resected acoustic neuroma between January 1990 and July 2021 completed the PANQOL. Intervention(s): During postresection follow-up visits, patients were administered the PANQOL survey. Main Outcome Measure(s): The total PANQOL is comprised of questions addressing quality of life in seven domains of hearing, balance, face, energy, pain, health, and anxiety. Univariate and multivariable analyses were performed to test for associations between surgical approach and/or patient characteristics. Results: Patients who were treated with retrosigmoid approach reported slightly higher PANQOL pain scores when compared with translabyrinthine approach. No association was found between responses on hearing PANQOL and surgical approach. No association was found between approach and total PANQOL score. However, on average female patients reported lower total PANQOL compared with male patients. Conclusion: The lack of association between patient response on hearing PANQOL and surgical approach illustrates the impact of preoperative patient counseling in appropriately setting patient expectations. The difference in pain PANQOL response may be due to a higher rate of occipital neuralgia due to incision placement and soft tissue retraction in the retrosigmoid patient group. Surgeons may consider alternative surgical incisions and soft tissue dissection to improve patient's quality of life with respect to postoperative pain.

Long-term quality of life outcomes in patients undergoing microsurgical resection of vestibular schwannoma

“… 10 Our previous study looking specifically at surgical approach and PANQOL scores showed that patients who had the retrosigmoid approach have higher PANQOL scores than those who underwent the translabyrinthine approach. 29 The two senior authors (DEA and JPL) aim for GTR while recognizing that a small amount of residual tumor as a means of functional preservation is acceptable. Inclusion of various tumor sizes in this analysis highlights a potential difference in expectations between patients with small and large tumors; patients with larger tumors have a trend towards reporting improved PANQOL health and face scores, although these were not statistically significant.…”

Accurate segmentation algorithm of acoustic neuroma in the cerebellopontine angle based on ACP-TransUNet

“…Although these tumors are typically non-life-threatening, postoperative morbidity can be associated with injury to the facial nerve, cochlear nerve, cerebrospinal fluid leaks, and other wound complications. Permanent facial paralysis can occur in 3 to 5% of cases, and up to 22% of patients may experience cerebrospinal fluid leaks ( North et al, 2022 ). Fortunately, the surgical mortality rate is low, with less than 1% of cases resulting in death ( McClelland et al, 2011 ).…”