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

Abstract

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.

Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment

“…44, 45 Patients have reported headache as one of the most common presenting symptoms after unilateral hearing loss and balance disturbance and as one of the most difficult aspects of the acoustic neuroma experience. 41 In our patient population, the presence of headache and higher headache severity was significantly associated with pursuing surgical intervention.…”

“…This is an important misconception that should be addressed during the informed consent process, as surgery increases the short-term risk of headache, and long-term headache outcomes do not seem to differ between different treatment modalities. 18, 45 …”

Translabyrinthine microsurgical resection of small vestibular schwannomas

“…Dizziness and balance disturbance are common complaints independent of method of treatment. 9 Vestibulopathy cannot be easily measured or quantified. With surgical treatment, vestibular symptoms improve in some patients and worsen in others, and patients with worse vestibulopathy preoperatively are more likely to improve.…”

Incidental Findings and Normal Anatomical Variants on MRI of the Brain in Adults for Primary Headaches

“…68 In a study of 148 consecutively observed patients with vestibular schwannomas as compared to general population controls, the perceived severity of ongoing headaches was significantly greater in the observation group with the risk of having severe headache disability with a small or mediumsized untreated tumor about twice that of the general population. 69 Headache most commonly lateralizes to the side with the tumor. 70 The explanation for the increased headache disability from a small tumor may be dural traction within the internal auditory canal and at the porus acusticus.…”