Quality of life in postoperative vestibular schwannoma patients

Cheng, Sheila; Naidoo, Yuresh; Cruz, María de la; Dexter, Mark

doi:10.1002/lary.20217

Cited by 57 publications

(43 citation statements)

References 17 publications

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“…2,8,16,44 Facial function at discharge is strongly suggestive of the nerve's final level of function. 8 Delayed facial nerve dysfunction has been documented in many reports, 7,8,11,53 potentially related to delayed ischemia, edema, 7,53 or viral reactivation (Bell palsy).…”

Section: Facial Nerve Functionmentioning

confidence: 99%

Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

260

216

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Object Various studies report outcomes of vestibular schwannoma (VS) surgery, but few studies have compared outcomes across the various approaches. The authors conducted a systematic review of the available data on VS surgery, comparing the different approaches and their associated complications. Methods MEDLINE searches were conducted to collect studies that reported information on patients undergoing VS surgery. The authors set inclusion criteria for such studies, including the availability of follow-up data for at least 3 months, inclusion of preoperative and postoperative audiometric data, intraoperative monitoring, and reporting of results using established and standardized metrics. Data were collected on hearing loss, facial nerve dysfunction, persistent postoperative headache, CSF leak, operative mortality, residual tumor, tumor recurrence, cranial nerve (CN) dysfunction involving nerves other than CN VII or VIII, and other neurological complications. The authors reviewed data from 35 studies pertaining to 5064 patients who had undergone VS surgery. Results The analyses for hearing loss and facial nerve dysfunction were stratified into the following tumor categories: intracanalicular (IC), size (extrameatal diameter) < 1.5 cm, size 1.5–3.0 cm, and size > 3.0 cm. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors < 1.5 cm (hearing loss in 43.6% vs 64.3%, p < 0.001). All other size categories showed no significant difference between middle cranial fossa and retrosigmoid approaches with respect to hearing loss. The retrosigmoid approach was associated with significantly less facial nerve dysfunction in patients with IC tumors than the middle cranial fossa method was; however, neither differed significantly from the translabyrinthine corridor (4%, 16.7%, 0%, respectively, p < 0.001). The middle cranial fossa approach differed significantly from the translabyrinthine approach for patients with tumors < 1.5 cm, whereas neither differed from the retrosigmoid approach (3.3%, 11.5%, and 7.2%, respectively, p = 0.001). The retrosigmoid approach involved less facial nerve dysfunction than the middle cranial fossa or translabyrinthine approaches for tumors 1.5–3.0 cm (6.1%, 17.3%, and 15.8%, respectively; p < 0.001). The retrosigmoid approach was also superior to the translabyrinthine approach for tumors > 3.0 cm (30.2% vs 42.5%, respectively, p < 0.001). Postoperative headache was significantly more likely after the retrosigmoid approach than after the translabyrinthine approach, but neither differed significantly from the middle cranial fossa approach (17.3%, 0%, and 8%, respectively; p < 0.001). The incidence of CSF leak was significantly greater after the retrosigmoid approach than after either the middle cranial fossa or translabyrinthine approaches (10.3%, 5.3%, 7.1%; p = 0.001). The incidences of residual tumor, mortality, major non-CN complications, residual tumor, tumor recurrence, and dysfunction of other cranial nerves were not significantly different across the approaches. Conclusions The middle cranial fossa approach seems safest for hearing preservation in patients with smaller tumors. Based on the data, the retrosigmoid approach seems to be the most versatile corridor for facial nerve preservation for most tumor sizes, but it is associated with a higher risk of postoperative pain and CSF fistula. The translabyrinthine approach is associated with complete hearing loss but may be useful for patients with large tumors and poor preoperative hearing.

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Section: Facial Nerve Functionmentioning

confidence: 99%

Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

260

216

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“…However, there was a significant improvement in those who underwent surgery for smaller tumors as well as the larger ones. In a retrospective study comparing postoperative QOL with QOL in the normal healthy Australian population, Cheng et al, 6 showed that following surgery patients reported a QOL nearly equivalent to the healthy population in all domains except for that of physical role limitation.…”

Section: Improvement In Qol After Surgerymentioning

confidence: 99%

“…Most of the QOL studies in patients undergoing surgery for VS are retrospective and include patients with small tumors. [1][2][3][4][5][6][7]14,18,21,23,27,28,31 Few studies have reported QOL following surgery for large VS, but even those have mostly been retrospective in nature. 22,25 One of the major deficiencies in QOL studies on VS patients is the lack of a planned prospective comparison between QOL values before and after treatment in large cohorts of patients.…”

mentioning

confidence: 99%

Quality of life following surgery for large and giant vestibular schwannomas: a prospective study

Turel¹,

Thakar²,

Rajshekhar³

2015

JNS

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A discrepAncy between surgeon-assessed and patient-perceived outcomes of vestibular schwannoma (VS) surgery has been reported. 16,19,22 Hence, there is a need for greater emphasis on quality of life (QOL) outcomes (which are patient reported) following surgery for VS. Most of the QOL studies in patients undergoing surgery for VS are retrospective and include patients with small tumors. [1][2][3][4][5][6][7]14,18,21,23,27,28,31 Few studies have reported QOL following surgery for large VS, but even those have mostly been retrospective in nature. 22,25One of the major deficiencies in QOL studies on VS patients is the lack of a planned prospective comparison between QOL values before and after treatment in large cohorts of patients. 10,11 The few published prospective studies involved patients with small VSs (< 3 cm). 20,24,26 To our knowledge there is only one prospective report of QOL in patients with larger tumors (> 3 cm), and that study involved 37 patients. 8None of the reports of QOL in patients with VS have included the proportion of patients showing a minimum clinically important difference (MCID) in the different QOL domains. Surgeons need to know whether an observed change in score represents a clinically important improvement or deterioration rather than merely an inconsequential fluctuation. Differences in scores smaller than the MCID are considered unimportant, regardless of whether statistical significance is reached. To date, such information has not been provided in any published report on QOL in VS patients.We aimed to study the factors affecting QOL in pa- OBJect Prospective studies of quality of life (QOL) are infrequently performed in patients undergoing surgery for vestibular schwannoma (VS). The authors designed this to study to investigate health-related QOL (HR-QOL) in patients with large and giant VSs before and after surgery. methOdS Between January 2009 and December 2012, HR-QOL was measured prospectively before and after surgery, using the 36-Item Short Form Health Survey (SF-36), in 100 patients who underwent surgery for unilateral large or giant VS (tumor size ≥ 3 cm). The Glasgow Benefit Inventory (GBI) was also used to evaluate the effect of surgery. reSultS A total of 100 patients were included in the study (65 men and 35 women). Their mean age (± SD) was 44.2 ± 11.5 years. The preoperative QOL was decreased in all SF-36 domains. A 1-year follow-up evaluation was conducted for all patients (mean 13.5 ± 5.3 months after surgery). The results showed an improvement in HR-QOL compared with preoperative status in all cases, with 63%-85% of patients showing a minimum clinically important difference (MCID) in various domains. A second follow-up evaluation was performed in 51 cases (mean time after surgery, 29.0 ± 8.3 months) and showed sustained improvement in SF-36 scores. In some domains there was further improvement beyond the first follow-up. On the GBI, 87% of patients reported improvement, 1% felt no change, and 12% of patients reported deterioration. cONcluSiONS Patients harboring l...

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“…First, a high proportion of vestibular schwannomas do not grow or grow very slowly following the diagnosis. Second, there is little evidence that active treatment of a non-growing lesion is beneficial to the patient, but it is well documented that active treatment may cause additional complaints and decrease quality of life (Martin et al 2001, Myrseth et al 2006, Cheng et al 2009, Myrseth et al 2009). Therefore, in spite of increasing hearing loss in many patients, the conservative approach may be a reasonable option for patients with small and medium sized tumours (Yamakami et al 2003, Sandooram et al 2004, Zverina, 2010, Sughrue et al 2011.…”

Section: Vestibular Schwannomamentioning

confidence: 99%

Minimally Invasive Endoscopic and Endoscopy-Assisted Microsurgery of Vestibular Schwannoma

Betka¹,

Chovanec²,

Zvĕrina³

et al. 2011

Advances in Endoscopic Surgery

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Quality of life in postoperative vestibular schwannoma patients

Cited by 57 publications

References 17 publications

Surgery for vestibular schwannomas: a systematic review of complications by approach

Surgery for vestibular schwannomas: a systematic review of complications by approach

Quality of life following surgery for large and giant vestibular schwannomas: a prospective study

Minimally Invasive Endoscopic and Endoscopy-Assisted Microsurgery of Vestibular Schwannoma

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