gms | German Medical Science

Objective: Patients with vestibular schwannomas (VS) suffer from different symptoms despite the benign nature of the tumour. Predominantly, these are cranial nerve deficits. The aim of this prospective study was to evaluate the impact of cranial nerve deficits on the quality of life (QOL).

Methods: 50 patients (23 males, 27 females, mean age 51 y) with retro-sigmoid VS surgery were included. The clinical evaluation was conducted 1–2 days before surgery, 1 week after surgery and 3.5 months after surgery and included following investigations: Gustatory sense, examined using cotton strips with standardized taste solutions; lacrimation, tested by Schirmer I test; facial function, graded according to the House-Brackmann-Classification. Tone and speech discrimination tests were graded by Hannover Classification; vertigo was examined by clinical evaluation. QOL was examined with the Penn Acoustic Neuroma Quality-Of-Life (PANQOL) questionnaire, which consists of 7 domains and 1 Composite Score, the sum of the domains. Normality of the data was tested using the Shapiro-Wilk-Test, correlations were analysed by Spearman’s Correlation Test.

Results: 3 cases with small (T1/2), 20 cases with medium (T3A) and 27 cases with large (T3B/T4) tumours were included. The mean Composite Score of the QOL decreased from 67 points before surgery (BS) to 61 points after surgery (AS) to 59 points at the follow up (FU). The QOL of patients with VS did not correlate in general with the neural functions except for the symptom vertigo (correlation coefficient r=0.421). The gustatory sense of the nervus intermedius and the motor portion of the facial nerve correlated with the QOL domain “facial symptoms” after surgery (r=0.319; r=0.583) and at the follow up (r=0.633; r=0.570). Vertigo correlated with the domains “balance” (r(BS)=0.515; r(AS)=0.429; r(FU)=0.468) and “energy” (r(BS)=0.517; r(AS)=0.371; r(FU)=0.364). The composite scores of QOL correlated between each other on all investigations (r(BS*AS)=0.634; r(BS*FU)=0.423; r(AS*FU)=0.646).

Conclusion: The greatest influence on QOL was identified for vertigo. But the composite scores of the questionnaires correlate between each other on all investigations. Hence a good QOL before surgery is associated with a good QOL after surgery and at follow up. Therefore, the patients’ general attitude towards life might have a higher impact for the QOL than the symptoms themselves.