Symptom Changes in Sporadic Vestibular Schwannoma: Comparing Observation, Stereotactic Radiosurgery, and Microsurgery

Introduction: The purpose of this study was to compare differences in sporadic vestibular-schwannoma associated patient-reported symptom scores among the primary management modalities of observation, microsurgery, and radiosurgery.

Methods: A prospective longitudinal survey of adults from a large academic center and the Acoustic Neuroma Association diagnosed with unilateral sporadic vestibular schwannoma was conducted. Patients completed baseline and follow-up surveys on severity of tinnitus, dizziness/imbalance, and headaches graded on a 10-point numeric scale with higher scores indicating more severe symptoms; changes of ≥2 points from baseline were considered clinically important. The effects of management group on changes in severity scores were evaluated using analysis of covariance and multivariable logistic regression models.

Results: A total of 455 patients were eligible for study with a mean (SD) follow-up of 4.5 (2.4) years, including 122 (27%) managed with observation, 226 (50%) managed with microsurgery, and 107 (23%) managed with radiosurgery. Tinnitus severity scores differed significantly among management groups (p = 0.006), with severity scores increasing significantly in the radiosurgery (+0.8, p = 0.005) group, but not in the observation (+0.2, p = 0.5) or microsurgery (−0.2, p = 0.18) groups. The changes in dizziness/imbalance and headache severity scores did not differ significantly among management groups. When comparing clinically important improvements (decrease of 2 or more points), the microsurgery and observation cohorts had a greater proportion of patients experiencing a clinically important improvement in tinnitus compared to the radiosurgery cohort; no other clinically important changes were seen among treatment groups.

Conclusions: In this prospective study of 455 subjects comparing patient-reported symptoms after vestibular schwannoma management, radiosurgery was associated with worsening tinnitus severity scores overall and resulted in fewer patients reporting clinically important improvements in tinnitus compared to observation and microsurgery.