Objective: To determine quality of life (QoL) differences between patients undergoing conventional single-stage acoustic neuroma microsurgery, staged acoustic neuroma microsurgery, and multimodality acoustic neuroma treatment.
Study Design: Retrospective Review.
Setting: Tertiary Neurotologic Practice.
Subjects and Methods: Thirty patients undergoing staged acoustic neuroma microsurgery (group 1) and 15 patients undergoing multimodality therapy (group 2), microsurgery plus radiosurgery, were identified. Age, sex, preoperative videonystagmography, surgical approach, tumor size, comorbidities, and postoperative facial nerve function were collected for each group. Age, sex, and facial nerve function matched controls were identified for group 1 and group 2; control group patients underwent conventional single-stage microsurgery. All patients, including controls, completed and returned Penn Acoustic Neuroma Quality of Life (PANQOL) surveys. Intra- and intergroup results were analyzed to determine if patient factors or survey results demonstrated statistically significance differences.
Results: Average tumor size for staged surgery and multimodality treatment group was >3cm and 2.3cm, respectively. Postoperative facial nerve function was the strongest predictor of QoL for each group. No significant differences in QoL existed between control (matched single-stage microsurgery) and either staged acoustic neuroma microsurgery or multimodality acoustic neuroma therapy despite tumor size differences.
Conclusions: Facial nerve function is the greatest predictor of QoL in patients after acoustic neuroma surgery. Staged surgery and multimodality treatment are effective therapies in selected patients with large acoustic neuromas or difficulty to dissect tumors that achieve comparable QoL results to patients undergoing single-stage surgery for smaller tumors.
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