Patient outcomes after vestibular schwannoma management: A prospective comparison of microsurgical resection and stereotactic radiosurgery

Bruce E. Pollock, Colin L W Driscoll, Robert L. Foote, Michael J. Link, Deborah A. Gorman, Christopher D. Bauch, Jayawant Mandrekar, Karl N. Krecke, Craig H. Johnson

Research output: Contribution to journalArticle

230 Citations (Scopus)

Abstract

OBJECTIVE: The best management for patients with small- to medium-sized vestibular schwannomas (VS) is controversial. METHODS: A prospective cohort study of 82 patients with unilateral, unoperated VS less than 3 cm undergoing surgical resection (n = 36) or radiosurgery (n = 46). Patients undergoing resection were younger (48.2 yr versus 53.9 yr, P = 0.03). The groups were similar with regard to hearing loss, associated symptoms, and tumor size. The mean follow-up period was 42 months (range, 12-62 mo). RESULTS: Normal facial movement and preservation of serviceable hearing was more frequent in the radiosurgical group at 3 months (P < 0.001), 1 year (P < 0.001), and at the last follow-up examination (P < 0.01) compared with the surgical resection group. Patients undergoing surgical resection had a significant decline in the following subscales of the Health Status Questionnaire 3 months after surgery: physical functioning (P = 0.006), role-physical (P < 0.001), energy/fatigue (P = 0.02), and overall physical component (P = 0.004). Patients in the surgical resection group continued to have a significant decline in the physical functioning (P = 0.04) and bodily pain (P = 0.04) subscales at 1 year and in bodily pain (P = 0.02) at the last follow-up examination. The radiosurgical group had no decline on any component of the Health Status Questionnaire after the procedure. The radiosurgical group had lower mean Dizziness Handicap Inventory scores (16.5 versus 8.4, P = 0.02) at the last follow-up examination. There was no difference in tumor control (100 versus 96%, P = 0.50). CONCLUSION: Early outcomes were better for VS patients undergoing stereotactic radiosurgery compared with surgical resection (Level 2 evidence). Unless long-term follow-up evaluation shows frequent tumor progression at currently used radiation doses, radiosurgery should be considered the best management strategy for the majority of VS patients.

Original languageEnglish (US)
Pages (from-to)77-83
Number of pages7
JournalNeurosurgery
Volume59
Issue number1
DOIs
StatePublished - Jul 2006

Fingerprint

Acoustic Neuroma
Radiosurgery
Health Status
Pain
Neoplasms
Dizziness
Hearing Loss
Hearing
Fatigue
Cohort Studies
Prospective Studies
Radiation
Equipment and Supplies

Keywords

  • Acoustic neuroma
  • Outcome
  • Radiosurgery
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Pollock, B. E., Driscoll, C. L. W., Foote, R. L., Link, M. J., Gorman, D. A., Bauch, C. D., ... Johnson, C. H. (2006). Patient outcomes after vestibular schwannoma management: A prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery, 59(1), 77-83. https://doi.org/10.1227/01.NEU.0000219217.14930.14

Patient outcomes after vestibular schwannoma management : A prospective comparison of microsurgical resection and stereotactic radiosurgery. / Pollock, Bruce E.; Driscoll, Colin L W; Foote, Robert L.; Link, Michael J.; Gorman, Deborah A.; Bauch, Christopher D.; Mandrekar, Jayawant; Krecke, Karl N.; Johnson, Craig H.

In: Neurosurgery, Vol. 59, No. 1, 07.2006, p. 77-83.

Research output: Contribution to journalArticle

Pollock, Bruce E. ; Driscoll, Colin L W ; Foote, Robert L. ; Link, Michael J. ; Gorman, Deborah A. ; Bauch, Christopher D. ; Mandrekar, Jayawant ; Krecke, Karl N. ; Johnson, Craig H. / Patient outcomes after vestibular schwannoma management : A prospective comparison of microsurgical resection and stereotactic radiosurgery. In: Neurosurgery. 2006 ; Vol. 59, No. 1. pp. 77-83.
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AU - Driscoll, Colin L W

AU - Foote, Robert L.

AU - Link, Michael J.

AU - Gorman, Deborah A.

AU - Bauch, Christopher D.

AU - Mandrekar, Jayawant

AU - Krecke, Karl N.

AU - Johnson, Craig H.

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N2 - OBJECTIVE: The best management for patients with small- to medium-sized vestibular schwannomas (VS) is controversial. METHODS: A prospective cohort study of 82 patients with unilateral, unoperated VS less than 3 cm undergoing surgical resection (n = 36) or radiosurgery (n = 46). Patients undergoing resection were younger (48.2 yr versus 53.9 yr, P = 0.03). The groups were similar with regard to hearing loss, associated symptoms, and tumor size. The mean follow-up period was 42 months (range, 12-62 mo). RESULTS: Normal facial movement and preservation of serviceable hearing was more frequent in the radiosurgical group at 3 months (P < 0.001), 1 year (P < 0.001), and at the last follow-up examination (P < 0.01) compared with the surgical resection group. Patients undergoing surgical resection had a significant decline in the following subscales of the Health Status Questionnaire 3 months after surgery: physical functioning (P = 0.006), role-physical (P < 0.001), energy/fatigue (P = 0.02), and overall physical component (P = 0.004). Patients in the surgical resection group continued to have a significant decline in the physical functioning (P = 0.04) and bodily pain (P = 0.04) subscales at 1 year and in bodily pain (P = 0.02) at the last follow-up examination. The radiosurgical group had no decline on any component of the Health Status Questionnaire after the procedure. The radiosurgical group had lower mean Dizziness Handicap Inventory scores (16.5 versus 8.4, P = 0.02) at the last follow-up examination. There was no difference in tumor control (100 versus 96%, P = 0.50). CONCLUSION: Early outcomes were better for VS patients undergoing stereotactic radiosurgery compared with surgical resection (Level 2 evidence). Unless long-term follow-up evaluation shows frequent tumor progression at currently used radiation doses, radiosurgery should be considered the best management strategy for the majority of VS patients.

AB - OBJECTIVE: The best management for patients with small- to medium-sized vestibular schwannomas (VS) is controversial. METHODS: A prospective cohort study of 82 patients with unilateral, unoperated VS less than 3 cm undergoing surgical resection (n = 36) or radiosurgery (n = 46). Patients undergoing resection were younger (48.2 yr versus 53.9 yr, P = 0.03). The groups were similar with regard to hearing loss, associated symptoms, and tumor size. The mean follow-up period was 42 months (range, 12-62 mo). RESULTS: Normal facial movement and preservation of serviceable hearing was more frequent in the radiosurgical group at 3 months (P < 0.001), 1 year (P < 0.001), and at the last follow-up examination (P < 0.01) compared with the surgical resection group. Patients undergoing surgical resection had a significant decline in the following subscales of the Health Status Questionnaire 3 months after surgery: physical functioning (P = 0.006), role-physical (P < 0.001), energy/fatigue (P = 0.02), and overall physical component (P = 0.004). Patients in the surgical resection group continued to have a significant decline in the physical functioning (P = 0.04) and bodily pain (P = 0.04) subscales at 1 year and in bodily pain (P = 0.02) at the last follow-up examination. The radiosurgical group had no decline on any component of the Health Status Questionnaire after the procedure. The radiosurgical group had lower mean Dizziness Handicap Inventory scores (16.5 versus 8.4, P = 0.02) at the last follow-up examination. There was no difference in tumor control (100 versus 96%, P = 0.50). CONCLUSION: Early outcomes were better for VS patients undergoing stereotactic radiosurgery compared with surgical resection (Level 2 evidence). Unless long-term follow-up evaluation shows frequent tumor progression at currently used radiation doses, radiosurgery should be considered the best management strategy for the majority of VS patients.

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