Comparing Patient Satisfaction After Upfront Treatment Versus Wait-and-Scan for Small Sporadic Vestibular Schwannoma

ObjectiveManagement 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.Study DesignCross-sectional study.SettingSurvey distributed to members of the Acoustic Neuroma Association and Mayo Clinic patients.MethodsPatients with small (<1 cm in any location) sporadic VS who completed at least one survey regarding treatment history and patient satisfaction were included.ResultsAmong 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).ConclusionsPatient 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.