Michael J Link1,2, Morten Lund-Johansen3,4, Christine M Lohse5, Colin L W Driscoll1,2, Ehrling Myrseth3,4, Oystein Vesterli Tveiten3,4, Matthew L Carlson1,2. 1. Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota. 2. Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota. 3. Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway. 4. Department of Clinical Medicine, University of Bergen, Norway. 5. Department of Biostatistics and Informatics, Mayo Clinic School of Medicine, Rochester, Minnesota.
Abstract
BACKGROUND: The goal of microsurgical removal of a vestibular schwannoma is to completely remove the tumor, to provide long-term durable cure. In many cases, less than gross total resection (GTR) is performed to preserve neurological, and especially facial nerve function. OBJECTIVE: To analyze long-term quality of life (QoL) in a cohort of patients who received either GTR or less than GTR. METHODS: Patients operated for vestibular schwannoma less than 3.0 cm in posterior fossa diameter at 1 of 2 international tertiary care centers were surveyed using generic and disease-specific QoL instruments. RESULTS: A total of 143 patients were analyzed. GTR was performed in 122, and 21 underwent less than GTR. QoL was assessed at a mean of 7.7 yr after surgery (interquartile range: 5.7-9.6). Patients who underwent GTR had smaller tumors; otherwise, there were no baseline differences between groups. Patients who underwent GTR, after multivariable adjustment for baseline features and facial nerve and hearing outcomes, reported statistically significantly better Short Form Health Survey-36 (SF-36) physical and mental scores, Patient-Reported Outcomes Measurement Information System (PROMIS-10) physical and mental scores, and Penn Acoustic Neuroma Quality of Life (PANQOL) facial, energy, general health, and total scores compared to patients receiving less than GTR. CONCLUSION: GTR is associated with better QoL using the general QoL measures SF-36 and PROMIS-10 and the disease-specific PANQOL, even after controlling for baseline and outcome differences. This is especially significant in the assessment of mental health, indicating there may indeed be a psychological advantage to the patient that translates to overall well-being to have the entire tumor removed if microsurgical resection is undertaken.
BACKGROUND: The goal of microsurgical removal of a vestibular schwannoma is to completely remove the tumor, to provide long-term durable cure. In many cases, less than gross total resection (GTR) is performed to preserve neurological, and especially facial nerve function. OBJECTIVE: To analyze long-term quality of life (QoL) in a cohort of patients who received either GTR or less than GTR. METHODS:Patients operated for vestibular schwannoma less than 3.0 cm in posterior fossa diameter at 1 of 2 international tertiary care centers were surveyed using generic and disease-specific QoL instruments. RESULTS: A total of 143 patients were analyzed. GTR was performed in 122, and 21 underwent less than GTR. QoL was assessed at a mean of 7.7 yr after surgery (interquartile range: 5.7-9.6). Patients who underwent GTR had smaller tumors; otherwise, there were no baseline differences between groups. Patients who underwent GTR, after multivariable adjustment for baseline features and facial nerve and hearing outcomes, reported statistically significantly better Short Form Health Survey-36 (SF-36) physical and mental scores, Patient-Reported Outcomes Measurement Information System (PROMIS-10) physical and mental scores, and Penn Acoustic Neuroma Quality of Life (PANQOL) facial, energy, general health, and total scores compared to patients receiving less than GTR. CONCLUSION: GTR is associated with better QoL using the general QoL measures SF-36 and PROMIS-10 and the disease-specific PANQOL, even after controlling for baseline and outcome differences. This is especially significant in the assessment of mental health, indicating there may indeed be a psychological advantage to the patient that translates to overall well-being to have the entire tumor removed if microsurgical resection is undertaken.
Authors: Felix Arlt; Johannes Kasper; Dirk Winkler; Katja Jähne; Michael Karl Fehrenbach; Jürgen Meixensberger; Caroline Sander Journal: Front Neurol Date: 2022-05-24 Impact factor: 4.086
Authors: Ben A Strickland; Kristine Ravina; Robert C Rennert; Anna Jackanich; Ksenia Aaron; Joshua Bakhsheshian; Jonathan J Russin; Rick A Friedman; Steven L Giannotta Journal: J Neurol Surg B Skull Base Date: 2019-03-01
Authors: Christopher S Graffeo; Maria Peris-Celda; Avital Perry; Lucas P Carlstrom; Colin L W Driscoll; Michael J Link Journal: J Neurol Surg B Skull Base Date: 2019-10-28
Authors: Daniele Starnoni; Lorenzo Giammattei; Giulia Cossu; Michael J Link; Pierre-Hugues Roche; Ari G Chacko; Kenji Ohata; Majid Samii; Ashish Suri; Michael Bruneau; Jan F Cornelius; Luigi Cavallo; Torstein R Meling; Sebastien Froelich; Marcos Tatagiba; Albert Sufianov; Dimitrios Paraskevopoulos; Idoya Zazpe; Moncef Berhouma; Emmanuel Jouanneau; Jeroen B Verheul; Constantin Tuleasca; Mercy George; Marc Levivier; Mahmoud Messerer; Roy Thomas Daniel Journal: Acta Neurochir (Wien) Date: 2020-07-29 Impact factor: 2.216