Trading mental and physical health in vestibular schwannoma treatment decision

Abstract

ObjectiveObservation, radiotherapy and surgery are treatment options in vestibular schwannomas (VS). Decision making differs between centers and is usually based on tumor characteristics (e.g., size) and the expected physical health (PH) outcome (i.e., hearing and facial function). However, mental health (MH) is often under-reported. The objective of the present study was to ascertain the impact of VS treatment on PH and MH.MethodsPH and MH were assessed in a prospective cross-sectional study including 226 patients with unilateral sporadic VS before and after surgical removal (SURG). Quality-of-life (QoL) was estimated by self-rating questionnaires: general Short-Form Health Survey (SF-36), Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL), Dizziness Handicap Inventory (DHI), Hearing Handicap Inventory (HHI), Tinnitus Handicap Inventory (THI), and Facial Disability Index (FDI). QoL changes over time as well as predictive factors were accessed by multivariate analyses of covariance (MANCOVA).ResultsIn total, 173 preoperative and 80 postoperative questionnaires were analyzed. There was a significant PH deterioration related to facial function (FDI, PANQOL-face) after surgery. In line with facial rehabilitation, however, FDI improved within the first five years after surgery and did not differ compared to the preoperative patient cohort, eventually. In contrast, MH (i.e., PANQOL-anxiety) and general health (i.e., PANQOL-GH) improved with surgery and correlated with the extent-of-resection.ConclusionPhysical and mental health is significantly influenced by VS surgery. While PH might decrease after surgery, MH potentially increases when patient is cured. Practitioners should take MH into account before advising an incompletely VS treatment (e.g., subtotal resection, observation or radiosurgery).

Sex Differences in Vestibular Schwannoma

“…We routinely administered several quality-of-life surveys during the outpatient presentation or inpatient admission in our department, as previously described [23]: the disease-specific Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL), the general Short-Form Health Survey (SF-36) as well as the symptom-specific Hearing Handicap Inventory (HHI), Tinnitus Handicap Inventory (THI), Dizziness Handicap Inventory (DHI), and Facial Disability Index (FDI).…”

Outpatient care for facial palsy—a survey on patient satisfaction in uni- and interdisciplinary approaches

“…The occurrence of facial palsy is an impactful life event compromising patients' mental and physical quality of life (4)(5)(6)34). Treatment objectives should provide patients with the most holistic care possible, exhausting the full regenerative potential of the facial nerve.…”

“…The SF-36 is a very common and extensively researched instrument designed to measure health-related QoL ( 30 , 31 ). Grouped into the two main categories “mental health” and “physical health,” its 36 items can be divided into eight distinct health domains: vitality/energy (SF36-VT), social functioning (SF36-SF), role limitations due to emotional problems (SF36-RE) and mental health/psychological distress (SF36-MH), physical functioning (SF36-PF), role limitation due to physical health problems (SF36-RP), bodily pain (SF36-BP), general health perceptions (SF36-GH) ( 6 ). Each of the eight domain is scored from 0 to 100, with a lower score corresponding to a lower QoL.…”

“…Temporary and permanent facial palsy (FP) might be induced by a broad spectrum of disorders, including stroke, tumor, trauma, iatrogenic (e.g., resection of vestibular schwannomas or tumors of the parotid gland) or idiopathic paralysis (i.e., Bell's Palsy) (1,2). It is a debilitating and highly visible condition that can lead to physical complaints (e.g., corneal irritation, problems with drinking) and psychological problems due to appearance-affecting facial asymmetry and resulting stigmatization (3)(4)(5)(6)(7). In skull base surgery, the current EANO guidelines for vestibular schwannomas therefore more often recommend irradiation or-in case of large tumors-partial resection followed by irradiation to prevent FP (8,9).…”

Predictive value of facial motor–evoked potential and electromyography for facial motor function in vestibular schwannoma surgery

“…Continuous intraoperative neuromonitoring (IONM) and advances in surgical techniques have improved anatomical facial nerve (FN) preservation. However, literature suggests that severe FP still occurs in 7–15% of the cases, with tumor size as the most important predictive factor [ 15 ] and potential reduction of physical and mental health as clinical consequence [ 21 ].…”