Small vestibular schwannomas (VS) – is waiting the right thing to do?
Reviewed by Hassan Mohammed

VS management can be surgical, by radiosurgery or watchful waiting. Middle fossa approach (MCF) can be implemented in small and some medium-size tumours, and has the potential to preserve hearing. The authors measured quality of life of VS patients who underwent middle fossa surgery using Penn Acoustic Neuroma Quality of Life (PANQOL). They also assessed the hearing. Patients who underwent previous radiotherapy or surgery and those with NF2 were excluded. The study spanned 15 years. The questionnaire was filled preoperatively and one year postoperatively. Seventy-one patients out of 164 were included. They had a median age of 48 years, and 40 of them had intracanalicular VS. All of them had gross total resection and 48 of them had their hearing preserved. Preoperatively, all patients had serviceable hearing, with normal hearing in 45 patients. The mean PANQOL overall score at one year was 64.8, compared with 55 prior to surgery. There was a significant improvement in the hearing, balance, anxiety, energy, pain, and general health domains, as well as overall PANQOL score. Postoperatively, 31 patients maintained normal hearing, while 23 (32%) patients had non-serviceable hearing. When comparing patients whose hearing was not preserved, patients who maintained their hearing postoperatively had significant improvement in all PANQOL domains except for facial function. Authors concluded that MCF approach is associated with clinically meaningful improvements in patient quality of life, as well as good hearing preservation and excellent facial nerve outcomes. Authors acknowledged the lack of a control group as a limitation. It will be useful to have longer term PANQOL rather than just at one year. With one third of patients developing non-serviceable hearing after the surgery, and lack of data on deterioration of hearing in the rest, it is difficult to justify the surgical route in this group.

Quality of Life for Patients with Sporadic Small Vestibular Schwannomas Following Middle Fossa Craniotomy.
Jiramongkolchai P, Vacaru A, La Monte O, et al.
OTOL NEUROTOL
2024;45(6):684–9.