No surgery, but headache exists? Quality of life with vestibular schwannoma.

OBJECTIVE

The aim of this study was to analyze self-reported pain symptoms on the side of the vestibular schwannoma (VS) and their impact on health-related quality of life (HRQoL) in conservatively managed VS- patients.

STUDY

DESIGN

Prospective clinical study.

SETTING

Department of Otorhinolaryngology, Department of Neurosurgery, Single-center University Hospital, Certified skull base center, Germany.

PATIENTS: A total of 163 conservatively managed patients at the time of initial diagnosis or during wait-and-scan strategy with radiologically confirmed unilateral VS. Exclusion criteria: prior surgery, radiotherapy, or bilateral tumors, as well as neurofibromatosis type II (NFII).

INTERVENTIONS: Assessment using the Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL), and for a subset of patients (n = 80/163), the Short-Form McGill Pain Questionnaire (SF-MPQ).

MAIN OUTCOME MEASURES: Prevalence of pain; differences in HRQoL scores; correlations between pain and age, tumor size, and psychosocial factors via t-test and ANOVA; assessment of clinical relevance using the Minimal Clinically Important Difference (MCID).

RESULTS

Overall, 48.75% of patients reported experiencing pain. Patients with pain showed a significantly reduced HRQoL in the domains of "anxiety", "energy", and the overall PANQOL score (each p < 0.0001). Patients under 58 years of age reported significantly more pain than those over 58 years (p = 0.000380). Tumor size, gender, educational or occupational status showed no significant correlations.

CONCLUSION

Pain can significantly impair HRQoL even in conservatively managed VS patients. The cause of the reported pain remains unclear; psychosomatic factors may contribute to or modulate pain perception. It is however also possible, that reported pain is not solely attributable to the tumor itself, but could instead reflect underlying psychosocial factors such as heightened anxiety and reduced energy levels.