Health-related quality of life disparities among vestibular schwannoma patients under different treatment regimens : a systematic review and meta-analysis

Abstract

Introduction Vestibular schwannomas (VS) may cause hearing loss, balance disturbances, facial nerve dysfunction, and other symptoms that substantially affect health-related quality of life (HRQoL). As multiple management strategies exist, understanding treatment-specific HRQoL outcomes is essential for patient-centered decision-making. Research question How do treatment options differ with respect to patient-reported HRQoL outcomes in vestibular schwannoma? Material and methods A systematic search identified cross-sectional studies assessing HRQoL using the Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire. Eleven studies including 5156 patients met inclusion criteria. Random-effects meta-analyses were conducted for total PANQOL scores and key subdomains. Standardized mean differences (Hedges’ g) were calculated for pairwise treatment comparisons. Risk of bias was assessed using the Joanna Briggs Institute checklist. Results Microsurgery was associated with a non-significant reduction in total PANQOL scores compared with radiotherapy (g = −0.43, p = 0.09) and a significant reduction compared with observation (g = −1.58, p = 0.01). No significant difference was observed between radiotherapy and observation (g = −0.34, p = 0.26). Subdomain analyses showed that microsurgery was negatively associated with facial function, balance, hearing, and pain, while anxiety, energy, and general health did not differ significantly between treatment options. Heterogeneity across analyses was substantial (I2 = 0.90–0.98). Overall study quality was moderate. Discussion and conclusion For small to medium-sized VS, radiotherapy and observation were generally associated with better HRQoL preservation than microsurgery, particularly in facial function and pain domains. Surgery remains necessary for large or symptomatic tumors. HRQoL outcomes should be integrated into shared decision-making to inform patients about domain-specific treatment trade-offs.