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Conservative Management of Vestibular SchwannomaA Prospective Cohort Study: Treatment, Symptoms, and Quality of Life

Breivik, Cathrine Nansdal MD*; Varughese, Jobin K. MD; Wentzel-Larsen, Tore MSc§; Vassbotn, Flemming MD, PhD‡,‖; Lund-Johansen, Morten MD, PhD*,‡

doi: 10.1227/NEU.0b013e31823f5afa
Research-Human-Clinical Studies
CNS University of Neurosurgery

BACKGROUND: One hundred ninety-three patients with sporadic unilateral vestibular schwannoma given conservative management were enrolled in a prospective study.

OBJECTIVE: To evaluate the efficacy of conservative management and to determine the effect of an initial conservative management on the quality of life (QOL) and severity of audio vestibular symptoms.

METHODS: The patients underwent magnetic resonance imaging scans, clinical examination, and QOL assessment by 2 validated questionnaires, the Short Form-36 (SF-36) and Glasgow Benefit Inventory (GBI). Using regression analysis of clustered data, we analyzed possible associations between tumor growth and symptoms and tested whether our earlier finding that vertigo is associated with reduced QOL could be verified.

RESULTS: The median follow-up time was 43 months (range, 9-115 months; SD, 21.48 months). Results are based on 703 clinical controls and 642 (SF-36) and 638 (GBI) questionnaires. Seven patients were lost to follow-up. Approximately 40% of patients were in need of treatment during follow-up. We found a statistically significant association between tinnitus and vertigo and tumor growth. Vertigo was found to significantly reduce QOL. There was a significant drop in the Social Function subscales of both SF-36 and GBI, possibly attributable to progressive hearing loss. Otherwise, there was no overall trend toward any change in QOL during the observation period. In addition, QOL seemed to be little affected by treatment.

CONCLUSION: There was a small but statistically significant improvement in vestibular complaints and no change in the occurrence of tinnitus. Except for hearing loss caused by surgery, treatment did not affect symptoms or QOL significantly. Growth was associated with the occurrence of tinnitus and balance problems.

*Department of Neurosurgery and

§Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway

Institute of Surgical Science, University of Bergen, Bergen, Norway

Department of ENT, Haukeland University Hospital, Bergen Norway

Correspondence: Cathrine Nansdal Breivik, MD, Department of Neurosurgery, Haukeland University Hospital, N-5021 Bergen, Norway. E-mail:

Received February 4, 2011

Accepted October 14, 2011

Copyright © by the Congress of Neurological Surgeons