Review of the quality of life for observation, microsurgical resection, and radiosurgery for small and medium-sized vestibular schwannomas

Introduction: Vestibular schwannomas (VSs) are benign tumors originating from the vestibular branch of CNVIII. Despite being benign, they can impact hearing, balance, and pose life-threatening risks. Treatment options include observation, microsurgery, and stereotactic radiosurgery (SRS). The most appropriate treatment for smaller tumors ( < 30mm) remains a controversial topic. This review explores the impact of different treatment modalities on the quality of life (QoL) of patients with VS smaller than 30mm.

Methods: We conducted a Medline search from the date of inception through January of 2023 for relevant articles. The search strategy included various terms for observation, microsurgery, SRS, VS, and quality of life. Studies were included if they reported on comparing QoL of patients diagnosed with VS who were managed with at least two of the following: observation, microsurgical resection, and SRS. Studies with the following criteria were excluded: 1) case reports and abstracts; 2) non-English; 3) not explicitly analyzing smaller tumor sizes.

Results: Initial searches for quality-of-life articles demonstrated 442 search results. After the title and abstract screening, twenty-seven articles were fully assessed for eligibility. A full-text evaluation of articles yielded seven relevant articles. Four of the seven studies showed a higher composite QoL (encapsulates various QoL measures for physical and mental health) for patients treated via observation or SRS compared to microsurgery and three studies showed no baseline difference in QoL measures. Regarding subdomain scores, one study demonstrated a marked decline in physical functioning, role-physical, and energy for the microsurgical group but not SRS.

Conclusion : Although studies investigating QoL scores in the management of VS demonstrate mixed results, none of the studies demonstrated a higher QoL for microsurgery-treated groups compared to SRS and observation in small and medium-sized tumors. These results suggest that patients with smaller size VSs can avoid microsurgery and maintain a higher QoL compared to those who undergo surgical treatment.