Is quality of life (QOL) better after surgical removal of vestibular schwannoma or after gamma knife surgery?
Background: Gamma knife surgery is becoming an increasingly popular method to manage vestibular schwannoma. As a less invasive modality, gamma knife surgery should improve QOL over surgical intervention.
Explore this issue:October 2011
Study design: Prospective study.
Setting: Gamma Knife Center, Michigan.
Synopsis: Researchers relied on QOL measures and audiograms to prospectively study 59 patients with vestibular schwannoma treated with gamma knife surgery over an 18-month period. QOL measures included the Dizziness Handicap Inventory, the Hearing Handicap Inventory, the Tinnitus Handicap Inventory and the Short-Form Health Survey. Median follow-up was 15 months.
Serviceable hearing was maintained over 12 months in 47 percent of patients who presented with serviceable hearing. There were no significant changes in QOL measures with a median follow-up of 15 months. These findings compare favorably with other studies of gamma knife surgery, with the exception of the hearing preservation rate.
The significant limitation of this study is the length of follow-up. First, only 35 patients had a follow-up of 12 months or more, and 16 had 18 months or more. Careful review of the literature regarding hearing preservation in gamma knife surgery indicates that a five-year follow-up is necessary to accurately assess hearing preservation rates. Obviously, further loss of hearing over time will affect the QOL surveys.
Bottom line: Long-term follow-up studies of hearing preservation after gamma knife surgery for vestibular schwannoma are necessary before this modality can be accurately compared to surgical intervention.
Citation: Park SS, Grills IS, Bojrab D, et al. Longitudinal assessment of quality of life and audiometric test outcomes in vestibular schwannoma patients treated with gamma knife surgery. Otol Neurotol. 2011:32(4):676-679.
—Reviewed by John Kveton, MD