Postoperative Quality of Life in Vestibular Schwannoma Surgery Patients

Overview

This study assessed quality of life (QoL) outcomes in 43 patients undergoing retrosigmoid-suboccipital surgery for unilateral vestibular schwannoma. Key findings include a significant correlation between tumor size and postoperative facial nerve function, with larger tumors associated with worse outcomes. Multiple validated QoL questionnaires were used preoperatively and postoperatively to evaluate physical, psychological, and functional status.

Background

Vestibular schwannoma (VS) is a benign tumor of the eighth cranial nerve, commonly presenting with hearing loss, tinnitus, and vertigo. Treatment options include surgery, radiotherapy, or observation, with surgical morbidity decreasing due to advances in microsurgery and imaging. Despite improved survival, postoperative complications such as facial nerve injury and hearing loss can significantly impact patients' quality of life. This study aims to identify factors influencing QoL after VS surgery using a prospective questionnaire-based approach.

Data Highlights

Key Findings

• Patients with smaller tumors (Koos grade I & II) had significantly better postoperative facial nerve function compared to those with larger tumors (grade III & IV).
• Facial nerve function was assessed preoperatively, at discharge, 3 months, and 1 year post-surgery using the House-Brackmann scale.
• Postoperative complications such as facial nerve injury and unilateral hearing loss remain common and impact quality of life.
• Despite availability of hearing rehabilitation devices (CROSS/BiCROSS, BAHD, cochlear implants), few patients utilize them postoperatively.
• Quality of life was comprehensively evaluated using 10 validated questionnaires covering physical, psychological, and functional domains.
• The retrosigmoid-suboccipital surgical approach was consistently used, with intraoperative neurophysiological monitoring to preserve cranial nerve function.

Clinical Implications

Clinicians should consider tumor size as a key predictor of postoperative facial nerve outcomes when counseling patients about surgery risks and expected quality of life. Comprehensive pre- and postoperative assessment using validated QoL instruments can guide rehabilitation strategies. Encouraging the use of hearing rehabilitation devices may improve postoperative auditory function and overall patient well-being.

Conclusion

Surgical treatment of vestibular schwannoma via the retrosigmoid-suboccipital approach yields variable postoperative quality of life outcomes largely influenced by tumor size and facial nerve preservation. Multidimensional QoL assessment is essential to optimize patient management and rehabilitation.

References

1. Vestibular Schwannoma Clinical Management References