Comparison of Long‐term Quality‐of‐Life Outcomes in Vestibular Schwannoma Patients

Robinett, Zachary N.; Walz, Patrick C.; Miles-Markley, Beth A.; Moberly, Aaron C.; Welling, D. Bradley

doi:10.1177/0194599814524531

Cited by 64 publications

(73 citation statements)

References 33 publications

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“…In a prospective study with these three groups, Di Maio et al did not find any difference in QOL. Robinett et al found that between 1 and 5 years postmanagement, the RT group had higher QOL scores than the MS group, while there was no difference after 5 years. Pollock et al showed that within 3 months after surgery, patients had a statistically significant decline in several of the SF‐36 domains such as physical functioning, role physical, energy and overall physical.…”

Section: Discussionmentioning

confidence: 99%

Quality of life in the management of small vestibular schwannomas: Observation, radiotherapy and microsurgery

Deberge

Meyer

Pabic

et al. 2018

Clinical Otolaryngology

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Section: Discussionmentioning

confidence: 99%

Quality of life in the management of small vestibular schwannomas: Observation, radiotherapy and microsurgery

Deberge

Meyer

Pabic

et al. 2018

Clinical Otolaryngology

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“…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 …”

Section: Discussionmentioning

confidence: 99%

“…16–18 These studies have characterized treatment strategies and the differences in outcomes between surgery, radiation, and active surveillance. In addition to tumor control, prevention of malignancy, and preservation of cranial nerve function, the impact of treatment on quality of life is an important factor when deciding on treatment modality.…”

Section: Introductionmentioning

confidence: 99%

Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment

Nellis

Sharon

Pross

et al. 2017

Otology &Amp; Neurotology

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Objective To identify factors associated with treatment modality selection in acoustic neuromas. Study Design Prospective observational study Setting Tertiary care neurotology clinic Patients Data was prospectively collected from patients initially presenting to a tertiary care neurotology clinic between 2013 and 2016. Patients who did not have MRI, demographic, psychometric, or audiometric data were excluded from analysis. Intervention Demographic information, clinical symptoms, tumor characteristics, and psychometric data were collected to determine factors associated with undergoing acoustic neuroma surgical resection using univariate and multiple logistic regression analysis. Main Outcome Measure The decision to pursue acoustic neuroma surgical resection versus active surveillance. Results A total of 216 patients with acoustic neuroma (mean age 55 years, 58% female) were included. 98 patients (45.4%) pursued surgical resection, 118 patients (54.6%) pursued active surveillance. Surgical treatment was significantly associated with patient age < 65, higher grade tumors, growing tumors, larger volume tumors, lower word discrimination scores, Class D hearing, headache and vertigo as presenting symptoms, higher number of total symptoms, and higher headache severity scores (p<0.05). There was no significant association between surgical intervention and preoperative quality of life, depression, and self-esteem scores. On multiple logistic regression analysis, the likelihood of undergoing surgical resection significantly decreased for patients older than age 65 (OR 0.19; 0.05-0.69) and increased in patients with medium (OR 4.34; 1.36-13.81), moderately large (OR 33.47; 5.72-195.83), large grade tumors (OR 56.63; 4.02-518.93), tumor growth present (OR 4.51; 1.66-12.28), Class D hearing (OR 3.96; 1.29-12.16), and higher headache severity scores (OR 1.03;95% CI 1.01-1.05). The likelihood of undergoing surgical resection was completely predictive for giant grade tumors and not significant for small grade tumors and Class B or C hearing. Conclusions Non-elderly acoustic neuroma patients with larger tumors, growing tumors, significant hearing loss, and worse headaches are more likely to pursue surgical resection rather than active surveillance. Psychological factors such as quality of life, depression, and self-esteem do not seem to influence decision-making in this patient population.

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“…5 Using the same measure, Robinett et al reported a similar finding at 0-5 years of follow up; however, no statistically significant difference in pain was iden- (29) 19 (15) 56 (43) 17 (13) 116 (29) 93 (23) 155 (38) 39 (10) 1.0 (reference) 0.62 (0. tified between groups after 5 years. 34 Other studies have similarly demonstrated that differences in pain are greatest early after treatment; however, this disparity significantly declines within several years. 29 A number of studies evaluating pain after microsurgery have demonstrated that retrosigmoid craniotomy has a higher early prevalence of headache compared with translabyrinthine and middle fossa resection.…”

Section: Impact Of Treatment On Headachementioning

confidence: 94%

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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Comparison of Long‐term Quality‐of‐Life Outcomes in Vestibular Schwannoma Patients

Cited by 64 publications

References 33 publications

Quality of life in the management of small vestibular schwannomas: Observation, radiotherapy and microsurgery

Quality of life in the management of small vestibular schwannomas: Observation, radiotherapy and microsurgery

Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment

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

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