Conservative Management of Vestibular Schwannoma—A Prospective Cohort Study

Breivik, Cathrine Nansdal; Varughese, Jobin K.; Wentzel‐Larsen, Tore; Vassbotn, Flemming S.; Lund‐Johansen, Morten

doi:10.1227/neu.0b013e31823f5afa

Cited by 78 publications

(75 citation statements)

References 26 publications

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“…12 Importantly, the SF-36, GBI, and PROMIS-10 are multipurpose instruments and therefore are heavily influenced by patient comorbidity and may lack the sensitivity required to detect subtle changes after treatment or small differences between management arms. 4,9,11 In 2010 Shaffer and colleagues introduced the disease-specific PANQOL scale, a 26-item questionnaire evaluating facial function, balance, hearing, pain, anxiety, energy, and general health. Initial evaluation yielded robust face, content, criterion, and construct validity with high test-retest reliability.…”

Section: Discussionmentioning

confidence: 99%

Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

Carlson¹,

Tveiten²,

Driscoll

et al. 2015

JNS

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abbreviatioNs AAO-HNS = American Academy of Otolaryngology-Head and Neck Surgery; CPA = cerebellopontine angle; GBI = Glasgow Benefit Inventory; HRQOL = health-related quality of life; IQR = interquartile range; MCID = minimum clinically important difference; PANQOL = Penn Acoustic Neuroma Quality-of-Life; PROMIS-10 = 10-item Patient-Reported Outcomes Measurement Information System; SF-36 = 36-Item Short Form Health Survey; SRS = stereotactic radiosurgery; VS = vestibular schwannoma. submitted March 18, 2014. accepted November 11, 2014. iNclude wheN citiNg Published online January 2, 2015; DOI: 10.3171/2014.11.JNS14594. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Internal departmental funding was used without commercial sponsorship or support. obJect The optimal treatment for sporadic vestibular schwannoma (VS) is highly controversial. To date, the majority of studies comparing treatment modalities have focused on a narrow scope of technical outcomes including facial function, hearing status, and tumor control. Very few publications have investigated health-related quality of life (HRQOL) differences between individual treatment groups, and none have used a disease-specific HRQOL instrument. methods All patients with sporadic small- to medium-sized VSs who underwent primary microsurgery, stereotactic radiosurgery (SRS), or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the 36-Item Short Form Health Survey (SF-36), the 10-item Patient-Reported Outcomes Measurement Information System short form (PROMIS-10), the Glasgow Benefit Inventory (GBI), and the Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale. Additionally, a pool of general population adults was surveyed, providing a nontumor control group for comparison. results A total of 642 respondents were analyzed. The overall response rate for patients with VS was 79%, and the mean time interval between treatment and survey was 7.7 years. Using multivariate regression, there were no statistically significant differences between management groups with respect to the PROMIS-10 physical or mental health dimensions, the SF-36 Physical or Mental Component Summary scores, or the PANQOL general, anxiety, hearing, or energy subdomains. Patients who underwent SRS or observation reported a better total PANQOL score and higher PANQOL facial, balance, and pain subdomain scores than the microsurgical cohort (p < 0.02). The differences in scores between the nontumor control group and patients with VS were greater than differences observed between individual treatment groups for the majority of measures. coNclusioNs The differences in HRQOL outcomes following SRS, observation, and microsurgery for VS are small. Notably, the diagnosis of VS rather than treatment strategy most significantly impacts quality of life. Understanding that a large number of VSs do not grow following discovery, and that intervention does not...

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Section: Discussionmentioning

confidence: 99%

Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

Carlson¹,

Tveiten²,

Driscoll

et al. 2015

JNS

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185

178

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“…11,27 Previous studies have demonstrated that among patients with sporadic VS, ongoing dizziness and headache are associated with the greatest health-related quality of life (HRQOL) reduction, whereas the contributions of unilateral hearing loss, tinnitus, and facial neuropathy are generally less by comparison. [2][3][4]22,26 Despite the substantial physical and emotional burden associated with headache in patients with VS, this condition remains understudied. To our knowledge, no publications have specifically characterized headache in patients with VS receiving SRS or conservative observation.…”

mentioning

confidence: 99%

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study

Carlson¹,

Tveiten

Driscoll³

et al. 2015

JNS

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O ver the last 100 years, the treatment of vestibular schwannoma (VS) has undergone tremendous evolution. 32 With the increasing use of less invasive management methods including observation, stereotactic radiosurgery (SRS), or radiotherapy and subtotal or neartotal resection, incidences of disease-associated mortality, stroke, and permanent facial neuropathy have been substantially reduced. 12,27,32,41 obJect The primary goals of this study were: 1) to examine the influence of disease and treatment on headache in patients with sporadic vestibular schwannoma (VS); and 2) to identify clinical predictors of long-term headache disability.methods This was a cross-sectional observational study with international multicenter enrollment. Patients included those with primary sporadic < 3-cm VS and a separate group of general population control subjects without tumors. Interventions included a postal survey incorporating the Headache Disability Inventory (HDI), the Hospital Anxiety and Depression Scale, and a VS symptom questionnaire. The main outcome measures were univariate and multivariable associations with HDI total score. results The overall survey response rate was 79%. Data from 538 patients with VS were analyzed. The mean age at time of survey was 64 years, 56% of patients were female, and the average duration between treatment and survey was 7.7 years. Twenty-seven percent of patients received microsurgery, 46% stereotactic radiosurgery, and 28% observation. Patients with VS who were managed with observation were more than twice as likely to have severe headache disability compared with 103 control subjects without VS. When accounting for baseline differences, there was no statistically significant difference in HDI outcome between treatment modalities at time of survey. Similarly, among the microsurgery cohort, the long-term risk of severe headache disability was not different between surgical approaches. Multivariable regression demonstrated that younger age, greater anxiety and depression, and a preexisting diagnosis of headache were the primary predictors of severe long-term headache disability, while tumor size and treatment modality had little influence. coNclusioNs At a mean of almost 8 years following treatment, approximately half of patients with VS experience headaches of varying frequency and severity. Patient-driven factors including age, sex, mental health, and preexisting headache syndrome are the strongest predictors of long-term severe headache disability. Tumor size and treatment modality have less impact. These data may assist with patient counseling regarding long-term expectations following diagnosis and treatment.

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“…Whitmore et al 39 suggested that conservative management is associated with a significantly higher incidence of functional hearing loss; however, at this point, the comparison of hearing outcomes between conservative management and other forms of therapy is largely inconclusive. 3 The latest prospective study on conservative management by Breivik et al 4 suggested that hearing deteriorates in patients over time, regardless of treatment or tumor growth.…”

Section: Outcomes Of Conservative Managementmentioning

confidence: 99%

Incidental vestibular schwannomas: a review of prevalence, growth rate, and management challenges

Schmidt¹,

Boghani²,

Choudhry³

et al. 2012

FOC

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With the relatively recent increase in the use of MRI techniques, there has been a concurrent rise in the number of vestibular schwannomas (VSs) detected as incidental findings. These incidental VSs may be prevalent in up to 0.02%–0.07% of individuals undergoing MRI and represent a significant portion of all diagnosed VSs. The management of these lesions poses a significant challenge for practitioners. Most incidental VSs tend to be small and associated with minimal symptoms, permitting them to be managed conservatively at the time of diagnosis. However, relatively few indicators consistently predict tumor growth and patient outcomes. Furthermore, growth rates have been shown to vary significantly over time with a large variety of long-term growth patterns. Thus, early MRI screening for continued tumor growth followed by repeated MRI studies and clinical assessments throughout the patient's life is an essential component in a conservative management strategy. Note that tumor growth is typically associated with a worsening of symptoms in patients who undergo conservative management, and many of these symptoms have been shown to significantly impact the patient's quality of life. Specific indications for the termination of conservative management vary across studies, but secondary intervention has been shown to be a relatively safe option in most patients with progressive disease. Patients with incidental VSs will probably qualify for a course of conservative management at diagnosis, and regular imaging combined with the expectation that the tumor and symptoms may change at any interval is crucial to ensuring positive long-term outcomes in these patients. In this report, the authors discuss the current literature pertaining to the prevalence of incidental VSs and various considerations in the management of these lesions. It is hoped that by incorporating an understanding of tumor growth, patient outcomes, and management strategies, practitioners will be able to effectively address this challenging disease entity.

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Conservative Management of Vestibular Schwannoma—A Prospective Cohort Study

Cited by 78 publications

References 26 publications

Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study

Incidental vestibular schwannomas: a review of prevalence, growth rate, and management challenges

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