Effects of surgery, radiotherapy or surveillance on the objective vestibular function, vestibular symptoms and quality of life in vestibular schwannoma patients

Abstract Objective To evaluate the effect of active surveillance, radiotherapy and surgery on the vestibular function, vestibular symptoms, and quality of life in unilateral vestibular schwannoma (VS) patients. Methods In this prospective longitudinal study at a tertiary referral center, patients underwent caloric and video head impulse (vHIT) testing and completed the Dizziness Handicap Inventory (DHI) and Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaires before and after treatment, with treatment-specific follow-up: at 6, 12 and 24 months after surveillance start, at 6 weeks, 6 and 12 months after radiotherapy, and 1, 3, and 12 months after surgery. Longitudinal changes were analyzed using repeated-measures ANOVA. Results Compared with baseline, the percentage of abnormal caloric tests remained stable in the active surveillance (57%) and surgery groups (93%), but increased significantly in the radiotherapy group (from 77% to 92%; p = 0.02) at 12 months after intervention. All surgical patients showed abnormal vHIT gains one month after surgery, whereas abnormalities gradually increased in the active surveillance (33%) and radiotherapy (85%) groups. Vestibular symptoms remained stable during active surveillance, increased after radiotherapy, and decreased after surgery. At 12 months, DHI and PANQOL scores no longer differed significantly or clinically between groups. Conclusion Active surveillance was associated with the most stable objective and subjective vestibular function. Surgery caused immediate vestibular deterioration, whereas radiotherapy had a delayed comparable effect on mid- to long-term vestibular function. Despite baseline differences, vestibular symptoms and quality of life did not differ significantly between groups 12 months after treatment or initiation of surveillance. Level of Evidence Level II.