What drives quality of life in patients with sporadic vestibular schwannoma?

Objectives/Hypothesis To investigate the influence of posttreatment audiovestibular symptoms, facial neuropathy, and headache on long-term quality-of-life outcomes in patients with sporadic vestibular schwannoma (VS) utilizing the Short Form 36 (SF-36) Health Survey and the Penn Acoustic Neuroma Quality of Life (PANQOL) scale. Study Design Cross-sectional observation study. Methods Patients with sporadic small- or medium-sized VS (< 3.0 cm) who were evaluated between 1998 and 2008 at two independent tertiary academic referral centers were surveyed. Multivariable associations with the PANQOL total score and the SF-36 physical and mental component scores evaluated using regression analysis. Results A total of 538 surveyed patients returned a completed questionnaire, providing a response rate of 79%. Two hundred forty-seven (46%) patients underwent stereotactic radiosurgery, 143 (27%) microsurgery, and 148 (28%) observation. Multivariable regression analysis revealed that ongoing dizziness was associated with the greatest reduction in PANQOL total score, followed by headache. After adjusting for all examined features, ongoing dizziness and ongoing headache were the only two variables that were associated with both the SF-36 physical and mental component scores. Patient sex and treatment modality did not significantly influence PANQOL or SF-36 scores. Conclusions Ongoing dizziness and headache are the strongest predictors of long-term quality-of-life reduction in patients with sporadic VS, while the impact of hearing loss, facial nerve function, and tinnitus are less by comparison. This information may be valuable for patient counseling, refinement of VS quality-of-life assessment instruments, and determining high-yield targets for therapy in efforts to further improve patient outcomes. Level of Evidence 4.