Quality of life after treatment of vestibular schwannomas

Over the last two decades, health-related quality of life (QOL) in vestibular schwannoma patients has gained increasing attention among caretakers, and patient-reported outcomes are frequently included in clinical studies, as a secondary or even primary outcome. Numerous general and disease-specific questionnaires exist, as well as questionnaires directed toward specific symptoms, such as hearing loss or vestibular complaints. When evaluating score outcomes, a small, statistically significant difference may not be clinically relevant. For several scoring systems such as the PANQOL questionnaire, the minimal clinically identifiable difference (MCID) has been identified and should be used when analyzing data. The main generator of generally reduced QOL in VS patients is vestibular complaints, in particular dizziness. When comparing groups receiving observation, or radiosurgery or surgery, differences in response tend to be minor, both between groups as well as before and after treatment. In most studies, patients operated tend to report somewhat lower than others, but the differences are quite small. In one study including non-VS responders, there were, however, highly significant differences in score outcomes between patients and controls; thus, it seems that being a VS patient is the main driver of outcome and that treatment modality has a lower impact. Future research on QOL in VS patients should direct toward a refinement of instruments, and toward prospectively designed studies with baseline and follow-up recordings.