Tinnitus and Vertigo before and after Microsurgery in the Cerebellopontine Angle: Assessment of Patient-Perceived Impairment

Purpose: Even with a technically brilliant operation at the cerebellopontine angle and preservation of almost all neurovascular structures your patient may not be content with the result. Often there is disagreement between the clinical assessment of success by the surgeon and the subjective well-being of the patient following surgery. Tinnitus and vertigo appear to be important factors in this context. These factors may significantly impede the patient's quality of life. Before revising therapy regimens with this study we attempted to evaluate the subjective extent of impairment by tinnitus and vertigo as rated by the patient.

Method: In a consecutive series, 48 patients underwent surgery for vestibular schwannoma (n = 33) and meningioma (n = 15) in the cerebellopontine angle. In all cases tumor removal was achieved by microsurgery through a lateral suboccipital approach. After a postoperative interval of 3 weeks to 127 weeks all patients received a questionnaire. The patients were asked to quantify the subjective extent of impairment by tinnitus and vertigo before and after surgery on a scale from 0 to 10. The return rate of the questionnaires was 64.4%, so that 31 cases could be included in the study (21 vestibular schwannoma, 10 meningioma).

Result: Almost all patients reported impairment through tinnitus and vertigo after surgery. This impairment was not related to hearing preservation, facial nerve palsy, or other comorbidities. Improvement of tinnitus after tumor removal occurred in only 2 patients (6.5%), improvement of vertigo in just 1 (3.2%). Thirteen patients without tinnitus or vertigo before surgery reported such symptoms postoperatively, including 6 patients (19.4%) suffering from tinnitus, and 7 patients (22.6%) suffering from vertigo. The mean subjective change with respect to the symptom before and after surgery for tinnitus was 2.6 (SD ± 2.96) points, and 3.8 (SD ± 3.16) points for vertigo.

Conclusion: Although more detailed analyses concerning long-term follow-up, psychologic criteria, and life quality will be required, there is clear evidence that tinnitus and vertigo are two major factors influencing the postoperative quality of life. It remains to be determined how these factors can be successfully included into interdisciplinary treatment strategies in order to minimize their impact.