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Long-term Quality of Life Following Vestibular Schwannoma Excision Via the Translabyrinthine Approach
Stephen J Broomfield1, Ashish K Mandavia, Jack S Nicholson
1*University Hospitals Bristol NHS Foundation Trust †University of Bristol ‡School of Social and Community Medicine, University of Bristol, Bristol, UK §Department of Applied Statistics, Helwan University, Cairo, Egypt ||Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford ¶Manchester Academic Health Science Centre #University of Manchester **Central Manchester University Hospitals NHS Foundation Trust, Manchester ††Salford Royal NHS Foundation Trust, Salford, UK.
Objective:
To assess postoperative quality of life (QOL) and other patient-reported outcomes following surgery for vestibular schwannoma.
Study Design:
Cross-sectional retrospective case review using postal questionnaires.
Setting:
Tertiary referral center.
Patients:
Five hundred consecutive patients undergoing surgery for vestibular schwannoma.
Intervention(S):
Patients undergoing surgery via the translabyrinthine approach (excluding neurofibromatosis type 2) under the senior author, with a minimum of 5 years follow-up, were included.
Main Outcome Measure(S):
QOL was assessed using the Short Form 36 (SF-36) questionnaire and a disease-specific survey to assess patients' subjective outcomes.
Results:
The SF-36 scores in this group were significantly lower than the general UK population, though 24% of respondents reported a subjective improvement in overall QOL. Tumors larger than 4 cm were related to a reduced SF-36 total mental component score (p = 0.037). Increased age at time of surgery correlated with a reduced physical component of QOL (correlation coefficient = -0.26) and an improved mental component (correlation coefficient = 0.26). Subjective reports of postoperative symptoms and return to work, driving and social activities were similar to other published studies. 35% of patients reported vivid dreams or nightmares following surgery; the first reported incidence of this phenomenon in a large group of vestibular schwannoma patients.
Conclusions:
Generic measures of QOL in patients following translabyrinthine surgery for vestibular schwannoma do not always match subjective reports, reflecting the complexity of QOL assessment and the range of outcomes in this group. Increased time since surgery appears to be associated with an improvement in mental health.
