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Otology/Neurotology

Quality of Life Following Middle Fossa Craniotomy for Vestibular Schwannomas

Tuesday, October 3, 2023
8:42 AM - 8:48 AM East Coast USA Time
Location: 104BC

    Presenting Author(s)

  • Pawina Jiramongkolchai, MD

    Neurotology and Skull Base Fellow
    UCSD
    San Diego , CA, United States

    • Co-Author(s)

  • OL

    Olivia A. La Monte, BS

    Medical Student
    UC San Diego Department of Otolaryngology
    San Diego, CA, United States

  • Joshua Lee, BS

    Medical Student (NYMC)
    UC San Diego Department of Otolaryngology
    Valhalla, NY, United States

  • Peter R. Dixon, MD MSc

    Assistant Professor
    MUSC Department of Otolaryngology
    Charleston, SC, United States

  • Omid Moshtaghi, MD

    MD - UCSD Resident Physician
    University of California Irvine
    Orange, California, United States

  • MS

    Marc Schwartz, MD

    UC San Diego Department of Neurosurgery, USA

    • Senior Author(s)

  • Rick A. Friedman, MD PhD

    Professor of Otolaryngology and Neurosurgery
    Department of Otolaryngology - Head & Neck Surgery, University of California San Diego
    La Jolla, CA, United States

Disclosure(s):
Pawina Jiramongkolchai, MD: No relevant relationships to disclose.
Introduction: Understanding quality of life (QOL) outcomes for patients with vestibular schwannomas (VSs) undergoing microsurgical resection is important for patient counseling and management of post-operative expectations. The objective of this study is to report QOL outcomes for patients with small sporadic VSs treated with microsurgical resection.

Methods: A single-institution retrospective cohort study of patients with sporadic VSs undergoing middle fossa craniotomies between 2017 and 2022 was performed. The primary outcome measure was the change in Penn Acoustic Neuroma Quality-of-life (PANQOL) scores from pre-operative assessment compared to 1 year post-surgery. Secondary outcome measures included post-operative hearing preservation (WRS ≥50%) and facial nerve function (House-Brackmann scale).

Results: Of the forty-two patients analyzed, 35 were female (83%) and the median age was 46 (range, 23–71) years. The median tumor size was 0.8 (range, 0.2–1.5) cm. At 1-year post-surgery, there was a statistically significant improvement in the hearing (mean difference of 8.4, 95% CI 0.7 to 16.2), anxiety (mean difference of 18.5, 95% CI 10.8 to 26.1), and energy domains (mean difference of 11.0, 95% CI 3.5 to 18.6) as well as the overall total PANQOL score (mean difference of 7.4, 95% CI 2.2 to 12.5). A meaningful clinically important difference (MCID) was also achieved in the hearing and anxiety domains and there was a trend towards a meaningful clinical improvement for the overall total PANQOL score. Hearing was preserved in 27 (64%) patients. In patients with hearing preservation, there was no statistically significant difference in pre- and post-operative WRS (95.7% versus 95.6%, p=0.887). Forty (95%) patients achieved a HB I/II at post-operative follow-up.

Conclusions: Based on our institution’s experience, proactive surgical intervention for patients with small VSs via a MCF approach is associated with clinically meaningful improvement in patient quality of life, as well as good hearing preservation and excellent facial nerve outcomes.