Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery.
OBJECTIVE
The best management for patients with small- to medium-sized vestibular schwannomas (VS) is controversial.


METHODS
: A prospective cohort study of 82 patients with unilateral, unoperated VS less than 3 cm undergoing surgical resection (n = 36) or radiosurgery (n = 46). Patients undergoing 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 period was 42 months (range, 12-62 mo).


RESULTS
Normal facial movement and preservation of serviceable hearing was more frequent in the radiosurgical group at 3 months (P < 0.001), 1 year (P < 0.001), and at the last follow-up examination (P < 0.01) compared with the surgical resection group. Patients undergoing surgical resection had a significant decline in the following subscales of the Health Status Questionnaire 3 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 1 year and in bodily pain (P = 0.02) at the last follow-up examination. The radiosurgical group had no decline on any component of the Health Status Questionnaire after the procedure. The radiosurgical group had lower mean Dizziness Handicap Inventory scores (16.5 versus 8.4, P = 0.02) at the last follow-up examination. There was no difference in tumor control (100 versus 96%, P = 0.50).


CONCLUSIONS
Early outcomes were better for VS patients undergoing stereotactic radiosurgery compared with surgical resection (Level 2 evidence). Unless long-term follow-up evaluation shows frequent tumor progression at currently used radiation doses, radiosurgery should be considered the best management strategy for the majority of VS patients.
Pollock
Bruce E
BE
Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. pollock.bruce@mayo.edu
Driscoll
Colin L W
CL
Foote
Robert L
RL
Link
Michael J
MJ
Gorman
Deborah A
DA
Bauch
Christopher D
CD
Mandrekar
Jayawant N
JN
Krecke
Karl N
KN
Johnson
Craig H
CH
D015331:Cohort Studies; D004244:Dizziness / Q000209:etiology / Q000503:physiopathology; D005152:Facial Muscles / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006309:Hearing; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000592:standards; D008875:Middle Aged; D009068:Movement; D009464:Neuroma, Acoustic / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010149:Postoperative Pain / Q000503:physiopathology; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D016634:Radiosurgery / Q000009:adverse effects / Q000592:standards; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome