Carlson Matthew L, Tveiten Øystein Vesterli, Driscoll Colin L, Neff Brian A, Shepard Neil T, Eggers Scott D, Staab Jeffrey P, Tombers Nicole M, Goplen Frederik K, Lund-Johansen Morten, Link Michael J
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
Department of Neurosurgery, Bergen University Hospital, Bergen, Norway.
Otolaryngol Head Neck Surg. 2014 Dec;151(6):1028-37. doi: 10.1177/0194599814551132. Epub 2014 Oct 1.
(1) To characterize long-term dizziness following observation, microsurgery, and stereotactic radiosurgery (SRS) for small to medium-sized vestibular schwannoma (VS) using a validated self-assessment inventory; and (2) to identify clinical variables associated with long-term dizziness handicap.
Cross-sectional observational study.
Two independent tertiary academic referral centers: one located in the United States and one in Norway.
All patients with sporadic VS of less than 3 cm who underwent primary microsurgery, SRS, or observation between 1998 and 2008 were identified. Subjects were surveyed via a postal questionnaire using the Dizziness Handicap Inventory (DHI) and a VS symptom questionnaire.
The overall survey response rate was 79%. A total of 538 respondents (mean age, 64 years; 56% female) were analyzed, and the mean time interval between treatment and survey was 7.7 years. Pretreatment variables associated with greater dizziness handicap included female sex, older age, larger tumor size, preexisting diagnosis of headache or migraine, and symptoms of dizziness predating treatment. Significant posttreatment features strongly associated with poor long-term DHI scores included frequency and severity of ongoing headache. On multivariable analysis, treatment modality did not influence long-term dizziness handicap.
At a mean of approximately 8 years following treatment, over half of patients with VS reported ongoing dizziness. The authors have identified several baseline features that may help predict the risk of lasting dizziness. Treatment modality does not appear to influence long-term DHI score. We found a strong association between posttreatment headache and poor dizziness handicap. Future study is needed to further define this relationship.
（1）使用经过验证的自我评估量表，对小型至中型前庭神经鞘瘤（VS）接受观察、显微手术和立体定向放射外科治疗（SRS）后的长期头晕情况进行特征描述；（2）确定与长期头晕障碍相关的临床变量。
横断面观察性研究。
两个独立的三级学术转诊中心，一个位于美国，一个位于挪威。
确定所有在1998年至2008年间接受原发性显微手术、SRS或观察的散发性VS患者，肿瘤直径小于3 cm。通过邮寄问卷使用头晕障碍量表（DHI）和VS症状问卷对受试者进行调查。
总体调查回复率为79%。共分析了538名受访者（平均年龄64岁；56%为女性），治疗与调查之间的平均时间间隔为7.7年。与更严重头晕障碍相关的治疗前变量包括女性、年龄较大、肿瘤较大、既往有头痛或偏头痛诊断以及治疗前存在头晕症状。与长期DHI评分差密切相关的治疗后显著特征包括持续头痛的频率和严重程度。多变量分析显示，治疗方式不影响长期头晕障碍。
在治疗后平均约8年时，超过一半的VS患者报告仍有头晕。作者确定了几个可能有助于预测持续头晕风险的基线特征。治疗方式似乎不影响长期DHI评分。我们发现治疗后头痛与头晕障碍差之间存在密切关联。需要进一步研究以明确这种关系。
