Vestibular function and quality of life in vestibular schwannoma: does size matter?

Abstract

Objectives: Patients with vestibular schwannoma (VS) frequently suffer from disabling vestibular symptoms. This prospective follow-up study evaluates vestibular and auditory function and impairment of quality of life due to vertigo, dizziness, and imbalance in patients with unilateral VS of different sizes before/after microsurgical or radiosurgical treatment. Methods: Thirty-eight patients with unilateral VS were included. Twenty-two received microsurgery, 16 CyberKnife radiosurgery. Two follow-ups took place after a median of 50 and 186.5 days. Patients received a standardized neuro-ophthalmological examination, electronystagmography with bithermal caloric testing, and pure-tone audiometry. Quality of life was evaluated with the Dizziness Handicap Inventory (DHI). Patient data was grouped and analyzed according to the size of the VS (group 1: <20 mm vs group 2: ≥20 mm). Results: In group 1, the median loss of vestibular function was +10.5% as calculated by Jongkees Formula (range −43 to +52; group 2: median +36%, range −56 to +90). The median change of DHI scores was −9 in group 1 (range −68 to 30) and +2 in group 2 (−54;+20). Median loss of hearing was 4 dB (−42; 93) in group 1 and 12 dB in group 2 (5; 42). Conclusion: Loss of vestibular function in VS clearly correlates with tumor size. However, loss of vestibular function was not strictly associated with a long-term deterioration of quality of life. This may be due to central compensation of vestibular deficits in long-standing large tumors. Loss of hearing before treatment was significantly influenced by the age of the patient but not by tumor size. At follow-up 1 and 2, hearing was significantly influenced by the size of the VS and the manner of treatment.

Vestibulo-Ocular Reflex Stabilization after Vestibular Schwannoma Surgery: A Story Told by Saccades

“…This PR score reflects the amount of organization of refixation saccades across sequential head impulses and, indirectly, the level of vestibular disability of the patients as measured by the Dizziness Handicap Inventory (8). Saccadic reorganization is thus a useful marker of vestibular compensation following a complete unilateral vestibular ablation (18, 20). Although all patients suffer from dizziness after a vestibular schwannoma surgery, the manifestation of individual symptoms and therefore compensatory mechanisms is variable, despite a homogenous clinical syndrome (vestibular nerve transection).…”

Clinical Evaluation of CyberKnife in the Treatment of Vestibular Schwannomas

“…In other words, the CK system is an improvement over the prior frame-based and single-staged techniques for patients with VS, but its clinical outcomes and risk factors in VS patients are still limited to the best of our knowledge [15, 17–19]. …”

Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms

“…These lesions may cause variable degrees of hearing loss, tinnitus, dizziness, gait instability, vertigo, and, with large tumors, signs of brainstem and cerebellar compression, multiple cranial nerves dysfunction, and hydrocephalus. 5,13,[16][17][18][19][20][21][22]27,30,31 Vestibular schwannomas are generally slow-growing tumors that cause gradual loss of the vestibular nerve function over a long period of time. This loss of the vestibular functions is accompanied by gradual parallel central compensation.…”