Comparing Patient Satisfaction After Upfront Treatment Versus Wait-and-Scan for Small Sporadic Vestibular Schwannoma

Abstract

Objective: Management of small vestibular schwannoma (VS) remains controversial, as patients are typically candidates for all three management options including microsurgery, stereotactic radiosurgery, or wait-and-scan. This study compares patient satisfaction across treatment modalities in patients with small VS. Study Design: Cross-sectional study. Setting: Survey distributed to members of the Acoustic Neuroma Association and Mayo Clinic patients. Methods: Patients with small (<1 cm in any location) sporadic VS who completed at least one survey regarding treatment history and patient satisfaction were included. Results: Among 346 patients with small VS, 106 (31%) underwent microsurgery, 78 (23%) radiosurgery, 152 (44%) wait-andscan, and 10 (3%) multimodal treatment. Collectively, 307 (89%) patients indicated "Yes, I am happy with my treatment type and in hindsight I would not change anything," and 39 (11%) indicated "No, in hindsight I would have chosen a different treatment type." Satisfaction differed significantly by treatment group with 85, 86, 96, and 40% of patients in the microsurgery, radiosurgery, waitand-scan, and multimodal groups reporting that they were satisfied with treatment, respectively ( p < 0.001). Satisfaction also differed significantly among those undergoing upfront treatment with microsurgery or radiosurgery (81%), initial wait-and-scan followed by treatment (88%), and wait-and-scan only groups (96%; p = 0.001). Specifically, the wait-and-scan only group demonstrated greater satisfaction compared with the other two treatment strategies ( p < 0.05 for both). Conclusions: Patient satisfaction with the management of small VS is generally high. Management with wait-and-scan, even if treatment is eventually pursued, may offer higher patient satisfaction compared with upfront treatment.

Quality of Life for Patients with Sporadic Small Vestibular Schwannomas Following Middle Fossa Craniotomy

“…Overall, there was a trend toward improvement in all PANQOL domains and overall score and clinical meaningful differences were achieved for the hearing and anxiety domains (asterisks). (3,6,(10)(11)(12)(13)(14). In a single-institution, prospective study of 244 patients with sporadic VS, Carlson et al compared changes in PANQOL scores preintervention and postintervention (3).…”

“…To date, studies that have examined quality of life for VS patients have primarily focused on comparison between the three treatment modalities of conservative management with observation, stereotactic radiosurgery, or microsurgery. Furthermore, studies that have examined the impact of microsurgical resection of VS via MCF on patient reported outcomes have been limited by retrospective design, small sample sizes, use of non-disease specific QOL measures or non-validated VS disease-specific questionnaires (3,6,10–14). In a single-institution, prospective study of 244 patients with sporadic VS, Carlson et al compared changes in PANQOL scores preintervention and postintervention (3).…”

“…While quality of life remains comparable between the three management strategies, there is a lack of uniform data regarding impact of type of microsurgical approach on patient quality-of-life (QOL). Furthermore, studies that have focused on QOL and microsurgery have often not looked at specific types of approaches in detail, limiting the generalizability of study findings (3,6,(10)(11)(12)(13)(14). The objective of our study was to evaluate PANQOL outcomes for patients with small sporadic VS undergoing microsurgical resection via a middle cranial fossa approach in order to better counsel patients and facilitate informed decision making.…”