Conservative treatment of vestibular schwannoma: a follow-up study on clinical and quality-of-life outcome.

OBJECTIVE: To determine the natural history and long-term quality-of-life (QOL) outcome after conservative treatment for vestibular schwannoma. STUDY DESIGN: Prospective study conducted in a university-based tertiary referral center. PATIENTS: A total of 70 vestibular schwannoma patients who were initially included in the wait and scan protocol between January 2002 and December 2003 were followed with a mean observation time of 43 months. All patients had small- or medium-sized tumors when they were included in the protocol. QOL was measured at diagnosis and at the end of follow-up in those patients who were still conservatively treated using the Short Form 36 Health Survey (SF-36). The study group was characterized by nongrowing small tumors and relatively stable symptoms over time. MAIN OUTCOME MEASURES: Clinical, audiometric, radiologic, and QOL results. RESULTS: In 44 patients (63%), growth of the tumor was not observed, and 25 (36%) tumors did grow. Of the 70 included patients, 27 patients (39%) required treatment. Forty-one patients (59%) were still conservatively treated at the end of follow-up (mean 47 +/- 16 mo). Hearing was preserved in 16 (57%) of the 28 patients with useful hearing at diagnosis. At the end of follow-up, SF-36 scores were only slightly deteriorated for almost all subscales when compared with scores at diagnosis; however, differences were statistically not significant (p > 0.05). There was no significant correlation between the presence of cochleovestibular symptoms and QOL scores (p > 0.05). CONCLUSION: Conservative observation of small vestibular schwannomas may be regarded as a reasonable management option because most of these tumors do not grow during an initial period of observation. Conservative treatment of this subset of patients with small, nongrowing tumors does not significantly affect life functioning, as reflected in SF-36 survey data. However, hearing loss did progress in this population. Thus, patients should be counseled regarding this risk and generic QOL measures such as the SF-36 should be used with caution in future assessments. This study emphasizes the importance of combining generic and disease-specific QOL measures in future studies of protocols of vestibular schwannoma management.