Impact of Microsurgery on Vestibulopathy related to Vestibular Schwannoma

Introduction: The degree to which microsurgical excision of vestibular schwannoma (VS) relieves vestibulopathy has received little attention. There is contradictory evidence, with some reports indicating surgery alleviates vertigo and others concluding stable or worsening symptoms. Understanding the impact of surgery on vertigo could aid physicians in determining which patients may benefit from surgery.

Methods: The study included 145 patients with VS that underwent surgical excision from 2015 to 2022 at a tertiary referral center. Demographic data, comorbidities, and surgical course were collected. Balance symptoms such as presence and description of vertigo pre- and post-operatively were recorded from physician notes. Duration and severity of postoperative symptoms was ranked as present at 3 months, 6 months, 1 year and at most recent visit. Patients were stratified according to the nature of pre-operative vestibulopathy: worsening/disabling, non-disabling, or none.

Results: Out of the 145 patients, 102 (70.3%) presented with either disequilibrium, vertigo, or both, of which 18 were characterized as worsening/disabling. Of the 84 non-disabling vertigo patients, fifty (59.5%) were documented as feeling better than their preoperative baseline after surgery, with almost all of these patients experiencing complete relief within the first 3 months. Thirteen (35.1%) remained with some degree of vestibulopathy at their latest post-op visit. Of the 18 patients who presented with worsening/disabling vertigo, none reported being worse than their preoperative baseline. At 3 months follow-up, 44% (n=8) experienced complete relief of vestibulopathy, which increased to 77.8% (n=14) by 6 months. At the latest visit, 88.9% (n=16) described complete resolution of symptoms.

Conclusion : In patients with disabling vertigo preoperatively, microsurgery does appear to improve symptoms postoperatively. Of patients with less severe balance complaints preoperatively, microsurgical resection largely improved their symptoms without incurring worsening of vestibulopathy.