Impact of Treatment on Vestibular Schwannoma–Associated Symptoms: A Prospective Study Comparing Treatment Modalities

Abstract

Objective The degree to which various treatment modalities modify vestibular schwannoma (VS)–associated symptoms has received limited attention. The purpose of this study was to determine how different treatment modalities affect subjective symptoms in those presenting with VS. Study Design Prospective survey. Setting Tertiary neurotology referral center. Methods Patients with sporadic VS who received treatment at our institution were prospectively surveyed with a VS symptom questionnaire. Those who completed a baseline survey prior to treatment and at least 1 posttreatment survey were included. The prospective survey evaluated the severity of self-reported symptoms (Likert scale, 1-10), including tinnitus, dizziness or imbalance, headaches, and hearing loss. Results A total of 244 patients were included (mean age, 57 years). The mean duration of follow-up was 2.1 years, and the median number of surveys completed was 2 (interquartile range, 1-3). Seventy-eight (32%) cases were managed with observation, 118 (48%) with microsurgery, and 48 (20%) with radiosurgery. Multivariable analyses revealed no statistically significant difference in the change in tinnitus ( P = .15), dizziness or imbalance ( P = 0.66), or headaches ( P = .24) among treatment groups. Evaluation of clinically important differences demonstrated that microsurgery leads to significant bidirectional changes in headaches. Conclusions Limited prospective data exist regarding the progression or resolution of subjective symptoms in those presenting with VS. This study suggests that tinnitus, dizziness or imbalance, and headaches are unlikely to be significantly modified by treatment modality and generally should not be used to direct treatment choice.

Outcomes of Initial Observation Versus Upfront Microsurgical Resection for Small to Medium-sized Vestibular Schwannomas

“…Furthermore, of 120 initially observed patients in this study, only 9 (8%) proceeded with surgery due to worsening symptoms without tumor growth. Given that the choice of observation, microsurgery, and radiosurgery does not modify symptoms, the use of tinnitus, dizziness, imbalance, vertigo, and headache for directing VS management should be cautioned (31,32). Our results are consistent with these prospective studies which support the low incidence of symptoms driving surgical management.…”

Skull Base Registries: A Roadmap

“…But it is usually also necessary to characterize the status of the lesion, including anatomical involvement, radiographic features, and disease-specific symptoms that have a significant impact on the anatomical approach, extent of maximal safe resection, and associated morbidities. 2,[21][22][23][24][25] Clearly, radiologic assessments will play an extremely important role in a successful skull base registry, but these are still lacking in some areas. In particular, our increasing ability to visualize cranial nerve involvement will hopefully lead to a consensus on classification systems for perineural spread of skull base lesions that have clinical or prognostic significance 26 .…”

Single-fraction stereotactic radiosurgery versus microsurgical resection for the treatment of vestibular schwannoma: a systematic review and meta-analysis

“…Patient characteristics allowing an assessment of the comparability of groups were not available. We ultimately included 3 studies reporting evaluable results on patient-relevant outcomes (Carlson 2021 [ 18 , 19 ], Myrseth 2009 [ 20 ], and Pollock 2006 [ 21 ]).…”

“…The 3-arm, single-centre US study by Carlson (2021) [ 18 , 19 ] included patients with unilateral vestibular schwannoma who completed both a baseline survey before the intervention and at least one post-treatment survey. Patient preference was the determining factor for assignment to treatment groups.…”