Nassiri Ashley M, Lohse Christine M, Tombers Nicole M, Link Michael J, Carlson Matthew L
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic.
Department of Quantitative Health Sciences, Mayo Clinic.
Otol Neurotol. 2023 Jan 1;44(1):e42-e47. doi: 10.1097/MAO.0000000000003728. Epub 2022 Oct 14.
Management of small vestibular schwannoma (VS) remains controversial, as patients are typically candidates for all three management options including microsurgery, stereotactic radiosurgery, or wait-and-scan. This study compares patient satisfaction across treatment modalities in patients with small VS.
Cross-sectional study.
Survey distributed to members of the Acoustic Neuroma Association and Mayo Clinic patients.
Patients with small (<1 cm in any location) sporadic VS who completed at least one survey regarding treatment history and patient satisfaction were included.
Among 346 patients with small VS, 106 (31%) underwent microsurgery, 78 (23%) radiosurgery, 152 (44%) wait-and-scan, and 10 (3%) multimodal treatment. Collectively, 307 (89%) patients indicated "Yes, I am happy with my treatment type and in hindsight I would not change anything," and 39 (11%) indicated "No, in hindsight I would have chosen a different treatment type." Satisfaction differed significantly by treatment group with 85, 86, 96, and 40% of patients in the microsurgery, radiosurgery, wait-and-scan, and multimodal groups reporting that they were satisfied with treatment, respectively ( p < 0.001). Satisfaction also differed significantly among those undergoing upfront treatment with microsurgery or radiosurgery (81%), initial wait-and-scan followed by treatment (88%), and wait-and-scan only groups (96%; p = 0.001). Specifically, the wait-and-scan only group demonstrated greater satisfaction compared with the other two treatment strategies ( p < 0.05 for both).
Patient satisfaction with the management of small VS is generally high. Management with wait-and-scan, even if treatment is eventually pursued, may offer higher patient satisfaction compared with upfront treatment.
小型前庭神经鞘瘤（VS）的治疗仍存在争议，因为患者通常适合所有三种治疗选择，包括显微手术、立体定向放射外科治疗或观察等待。本研究比较了小型VS患者不同治疗方式后的患者满意度。
横断面研究。
向听神经瘤协会成员和梅奥诊所患者发放调查问卷。
纳入小型（任何部位直径<1 cm）散发性VS患者，这些患者至少完成了一项关于治疗史和患者满意度的调查。
在346例小型VS患者中，106例（31%）接受了显微手术，78例（23%）接受了放射外科治疗，152例（44%）进行了观察等待，10例（3%）接受了多模式治疗。总体而言，307例（89%）患者表示“是的，我对我的治疗方式感到满意，事后看来我不会改变任何事情”，39例（11%）表示“不，事后看来我会选择不同的治疗方式”。治疗组之间的满意度差异显著，显微手术组、放射外科治疗组、观察等待组和多模式治疗组分别有85%、86%、96%和40%的患者表示对治疗满意（p<0.001）。在接受显微手术或放射外科初始治疗的患者（81%）、初始观察等待后再治疗的患者（88%）和仅观察等待组（96%）中，满意度也存在显著差异（p = 0.001）。具体而言，仅观察等待组的满意度高于其他两种治疗策略（两者p<0.05）。
患者对小型VS治疗的满意度普遍较高。与初始治疗相比，观察等待管理方式（即使最终进行治疗）可能会提供更高的患者满意度。
