gms | German Medical Science

Objective: Life quality in patients after vestibular schwannoma (VS) surgery may be influenced by general surgical sequels, cranial nerve morbidity and general constitution. In order to improve patient selection, management and counselling patients' postsurgical evolution and personal judgement were investigated.

Methods: Out of a series of patients operated for VS from 2005 to 2007 84 agreed on participating in a long-term evaluation by neurological examination, SF-36 questionnaire and a specific disease related questionnaire on cranial nerve symptoms, general status, anxieties and coping in profession and everyday life. Patients were grouped by overall outcome into Class A (satisfied with procedure and outcome), Class B (satisfied with procedure and outcome, suffering from mild symptoms) and Class C (not satisfied, suffering from certain symptoms). These groups were analyzed for facial nerve function (House-Brackmann Scale, HB), overall well-being and personal complaints.

Results: 62 patients were grouped as Class A, 14 as Class B and 8 as Class C. Stress in professional activity was reported by 26% (A), 3% (B) and 38% (C). None of the patients suffered from a permanent severe facial palsy except one; temporary severe facial palsy (HB° 4–5) occurred in 12 patients (19%) in Class A, 3 (21%) in Class B, 4 (50%) in Class C. Facial palsy resolved in the majority to HB°1, but was reported as a lasting burden in 9% (A), in 14% (B) and in 38%(C). These rates were significantly higher than the rates of persisting palsies. Auditory function was indicated as an important problem in 17 patients (27%) in Class A, 4 patients (29%) in Class B, and 4 (50%) in Class C. Most of these patients had deafness or seriously impaired hearing before surgery. Hearing is mentioned as the most important factor in coping with everyday life and professional activity. Comparing patients' attitudes towards their tumour disease, there is more worry about the tumour and possible recurrences before as well after surgery in Class B (64% / 57%) than in Class A (32% / 35%).

Conclusions: Patients' long-term attitude towards their treatment is not solely dependent on their individual surgical outcome, but on temporary morbidity and expectations by family and professional conditions. After experience of a facial palsy for some time, patients persist to feel a lasting problem. Pre-operative deafness or functionally non-useful hearing functions are regarded as a lasting problem related to treatment rather than to the underlying disease.