Acoustic Neuroma: Postoperative Quality of Life

Objective: Evaluating patients who have had surgical management of acoustic neuroma has relied heavily on the surgeon's viewpoint for determining success. However, the perspective of the surgeon may be different from that of the patient. Thus, a recent increased interest in terms of quality of life has been documented by the literature on this specific topic essentially through the use of a questionnaire. The objective of this paper was to review this topic in our series of patients operated on for acoustic neuroma to ascertain the personal and social impact that surgery has had on their lifestyle. Design: This retrospective study was devoted to increasing statistics to provide more detailed and valid information during the counselling phase. Methods: This study was carried out on 82 patients who underwent surgery for acoustic neuroma between 1988 and 1997. Each patient was recalled and assessed for his/her postoperative quality of life. Detailed information was requested on the initial postoperative facial, vestibular, and hearing functions; their evolution; and their social consequence. Finally, at the end of the interview, each patient was invited to give a final comment on his/her opinion regarding the outcomes of surgery and preoperative information. Results: Facial function showed a grade I-III in 85.4% of cases, with postoperative neurovegetative dysfunction (taste and lacrimation) in 43%. Audiologic abnormalities (worsening hearing and tinnitus) were complained of in 90% and 57% of the cases, respectively. Twenty-three percent of the patients had various degrees of gait instability; 6% reported postoperative headache at 1-year follow-up. Social consequence (reduced work ability, vocational change, new education, state pension, etc.) was not influenced by surgery in 80%. Conclusions: Our experience is in general agreement with previously reported statistics. It is interesting to note that our patients exhibited more disturbances linked to the sensory component of facial nerve. In contrast, dysequilibrium had a less negative influence. These outcomes suggest the importance of thorough preoperative counselling in candidates for surgery for acoustic neuroma in order to motivate them and, at the same time, to reduce their psychological discomfort.