Health-related quality of life in patients with vestibular schwannoma managed with observation, stereotactic radiosurgery or microsurgery: a systematic review and single-arm meta-analysis

Abstract

Background: Health-related quality of life (HRQoL) is a key outcome in the management of vestibular schwannoma (VS). Although wait-and-scan (W&S), stereotactic radiosurgery (SRS), and microsurgery (MS) are established management strategies, their comparative effects on HRQoL remain unclear. This systematic review and meta-analysis aimed to synthesize HRQoL outcomes using the Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire and to pool PANQOL scores for W&S, SRS, and MS. Methods: A systematic search of PubMed and Embase was conducted up to February 2025. Eligible studies included patients with unilateral sporadic VS managed with W&S, SRS, or MS, with HRQoL assessed by PANQOL at least one year after diagnosis or intervention. Pooled mean PANQOL scores were calculated using single-arm meta-analyses. Minimal clinically important differences (MCIDs) were applied to assess relevance. Results: 16 studies including 3745 patients were analyzed. The pooled PANQOL total score was 69.1 (95% CI 66.0–72.2) for W&S (n = 1,430), 66.9 (95% CI 62.7–71.2) for SRS (n = 864), and 61.3 (95% CI 57.2–65.4) for MS (n = 1451). Across domains, scores were the lowest for hearing and energy and the highest for facial function and anxiety. None of the between-strategy differences in total or domain scores exceeded established MCID thresholds. Substantial heterogeneity was present across all analyses (I2 > 75%). Conclusion: Patients with unilateral VS report broadly comparable HRQoL following W&S, SRS, or MS. Although numerical differences in PANQOL scores exist, they are not clinically meaningful. The observed heterogeneity highlights the need for standardized, prospective studies and international collaboration to better inform patient-centered decision-making.