Patient Outcomes After Vestibular Schwannoma Management: a Prospective Comparison of Microsurgical Resection and Stereotactic Radiosurgery

Abstract

The best management for patients with small- to medium-sized vestibular schwannomas (versus) is controversial. Prospective cohort study of 82 patients with unilateral, unoperated versus less than 3 cm having surgical resection (n = 36) or radiosurgery (n = 46). Patients having resection were younger (48.2 yr versus 53.9 yr, P = 0.03). The groups were similar with regard to hearing loss, associated symptoms, and tumor size. The mean follow-up was 42 months (range, 12 to 62). Normal facial movement and preservation of serviceable hearing was more frequent in the radiosurgical group at three months (P‹0.001), 1-year (P‹0.001), and at last follow-up (P‹0.01) compared to the surgical resection group. Patients having surgical resection had a significant decline in the following subscales of the Health Status Questionnaire (HSQ) three months after surgery: physical functioning (P = 0.006), role-physical (P‹0.001), energy/fatigue (P = 0.02), and overall physical component (P = 0.004). Patients in the surgical resection group continued to have a significant decline in the physical functioning (P = 0.04) and bodily pain (P = 0.04) subscales at one-year, and in bodily pain (P = 0.02) at last follow-up. The radiosurgical group had no decline on any component of the HSQ after the procedure. The radiosurgical group had lower mean Dizziness Handicap Inventory scores (16.5 versus 8.4, P = 0.02) at last follow-up. There was no difference in tumor control (100% versus 96%, P = 0.50). Early outcomes were better for versus patients having stereotactic radiosurgery compared to surgical resection (Level 2 evidence). Unless long-term follow-up shows frequent tumor progression at currently used radiation doses, radiosurgery should be considered the best management strategy for the majority of versus patients.