Quality of Life Outcomes in Vestibular Schwannoma: A Prospective Analysis of Treatment Modalities

OBJECTIVE: Management options for vestibular schwannoma include microsurgery (MS), stereotactic radiosurgery (SRS), and watch, wait, and rescan (WWR). This study aimed to evaluate changes in patient and disease-specific quality of life (QoL) outcomes over time, comparing each treatment modality in a matched cohort. METHODS: A prospective cohort study recruited adult patients with sporadic vestibular schwannomas ≤ 3 cm in size undergoing treatment between January 2012 and April 2022 in a single tertiary referral center. Questionnaires were completed at diagnosis and ≥ 12 months posttreatment to assess patient-reported changes in QoL (Hearing, Dizziness, Tinnitus Handicap Inventories; Penn Acoustic Neuroma QoL questionnaire (PANQOL) and the Short Form-36 QoL questionnaire (SF-36)). RESULTS: In total, 124 patients returned completed questionnaires (MS: 42, SRS: 42, WWR 40). The SRS group had a clinically significant deterioration in their hearing scores posttreatment (p = 0.002). Dizziness scores worsened in the MS and WWR groups posttreatment; this did not reach clinical significance. Hearing deterioration was identified in the WWR group over time using the PANQOL domain (p = 0.012). The SF-36 questionnaire showed a significant deterioration in physical functioning, role limitations, and component summary for SRS patients posttreatment (p = 0.0018, p = 0.0032, p = 0.0308). No other significant differences were seen in disease-specific or general QoL domains when comparing treatment strategies. CONCLUSION: Outcomes in similar disease-specific domains were not consistent across questionnaires. All three treatment modalities appear to result in comparable long-term disease-specific QoL outcomes. These findings will enable evidence-based patient counseling to inform decision-making.