Abstract
An audit of surgery for acoustic neuroma was carried out to determine the frequency and nature of postoperative symptoms and their impact upon the patient's quality of life and vocation. Fifty-six patients were interviewed between 6 months and 5 years (mean 26 months) after surgical excision of an acoustic neuroma. The objective surgical results in these patients are good, with normal or near normal functional preservation rates of 80% for the facial nerve (House-Brackmann grade I/II), and 27.3% for a previously functioning acoustic nerve. Despite this there was no significant overall reduction in the reported occurrence of balance problems, tinnitus, headache and other neurological sequelae of the tumour after surgical excision. In 20% of the patients persistent symptoms, including deafness and facial weakness, had prevented the resumption of former social activities. As a result of these symptoms 8.6% of the patients were certified medically unfit for work, but of those employed preoperatively over 70% had returned to their jobs. The success of neuro-otological surgical management of acoustic neuroma is offset by some degree of chronic morbidity. Our patients expressed the need to know whether their symptoms would resolve, but were often too afraid to ask. Patients can be reassured that the majority resume their former social and vocational activities, but should be advised that some symptoms can persist or occur de novo after surgery. Our data suggest that early intervention would reduce the incidence of these troublesome sequelae.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Chandler C. L., Ramsden R. T. Acoustic schwannoma. Br J Hosp Med. 1993 Mar 3;49(5):335–343. [PubMed] [Google Scholar]
- Fletcher A., Gore S., Jones D., Fitzpatrick R., Spiegelhalter D., Cox D. Quality of life measures in health care. II: Design, analysis, and interpretation. BMJ. 1992 Nov 7;305(6862):1145–1148. doi: 10.1136/bmj.305.6862.1145. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Haines S. J., Levine S. C. Intracanalicular acoustic neuroma: early surgery for preservation of hearing. J Neurosurg. 1993 Oct;79(4):515–520. doi: 10.3171/jns.1993.79.4.0515. [DOI] [PubMed] [Google Scholar]
- House J. W., Brackmann D. E. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985 Apr;93(2):146–147. doi: 10.1177/019459988509300202. [DOI] [PubMed] [Google Scholar]
- Jones K. D. Summary: vestibular schwannoma (acoustic neuroma) consensus development conference. Neurosurgery. 1993 May;32(5):878–879. doi: 10.1227/00006123-199305000-00037. [DOI] [PubMed] [Google Scholar]
- Lee T. K., Lund W. S., Adams C. B. Factors influencing the preservation of the facial nerve during acoustic surgery. Br J Neurosurg. 1990;4(1):5–8. doi: 10.3109/02688699009000675. [DOI] [PubMed] [Google Scholar]
- Nadol J. B., Jr, Chiong C. M., Ojemann R. G., McKenna M. J., Martuza R. L., Montgomery W. W., Levine R. A., Ronner S. F., Glynn R. J. Preservation of hearing and facial nerve function in resection of acoustic neuroma. Laryngoscope. 1992 Oct;102(10):1153–1158. doi: 10.1288/00005537-199210000-00010. [DOI] [PubMed] [Google Scholar]
- Parving A., Tos M., Thomsen J., Møller H., Buchwald C. Some aspects of life quality after surgery for acoustic neuroma. Arch Otolaryngol Head Neck Surg. 1992 Oct;118(10):1061–1064. doi: 10.1001/archotol.1992.01880100053013. [DOI] [PubMed] [Google Scholar]
- Samii M., Tatagiba M., Matthies C. Acoustic neurinoma in the elderly: factors predictive of postoperative outcome. Neurosurgery. 1992 Oct;31(4):615–620. doi: 10.1227/00006123-199210000-00001. [DOI] [PubMed] [Google Scholar]
- Selesnick S. H., Jackler R. K., Pitts L. W. The changing clinical presentation of acoustic tumors in the MRI era. Laryngoscope. 1993 Apr;103(4 Pt 1):431–436. doi: 10.1002/lary.5541030412. [DOI] [PubMed] [Google Scholar]
- Wiegand D. A., Fickel V. Acoustic neuroma--the patient's perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients. Laryngoscope. 1989 Feb;99(2):179–187. doi: 10.1288/00005537-198902000-00010. [DOI] [PubMed] [Google Scholar]
- Zakrzewska J. M., Thomas D. G. Patient's assessment of outcome after three surgical procedures for the management of trigeminal neuralgia. Acta Neurochir (Wien) 1993;122(3-4):225–230. doi: 10.1007/BF01405533. [DOI] [PubMed] [Google Scholar]