Quality of Life Issues With Acoustic Neuromas

Postoperative Headaches

Headaches have been reported to occur in up to 73% of patients following acoustic neuroma surgery. These preoperative headaches may persist for weeks or months and can be quite incapacitating. The largest study of postoperative headaches following surgical excision of acoustic neuromas was completed by the Acoustic Neuroma Association (ANA) in 2005. One thousand six hundred and fifty seven patients responded to a questionnaire distributed by the ANA and their answers shed light on some aspects of the postoperative period and quality of life issues.

Thirty three percent of the patients who responded reported experiencing postoperative headaches. Most patients (62%) rated their headaches as "moderate" but 77% rated some of the headaches as "severe". Approximately 50% of the respondents experienced headaches more than once a day which lasted between 1-4 hours. The headaches were typically treated with nonsteroidal anti inflammatory drugs (NSAIDs) or other nonprescription drugs. About 15% of patients resorted to the use of narcotic analgesics to relieve their headache pain. Some patients reported that they started experiencing headaches several weeks after the surgery.

The incidence of postoperative headaches in relation to the surgical approach was as follows:

• 66% following suboccipital surgery
• 64% following translabyrinthine surgery
• 50% following middle fossa surgery

Patients who underwent suboccipital (retrosigmoid) surgery were most likely to describe their headaches as "severe" (82%) vs. 75% of patients who underwent translabyrinthine surgery and 63% of patients who underwent cranial middle fossa surgery. Patients who underwent suboccipital surgery were also more likely to report problems related to employment.

The incidence of postoperative headaches appears to be higher in women than men. Preoperative headaches were associated more with larger tumors than smaller tumors. Patients with frequent preoperative headaches appeared to have more daily occurrences of postoperative headaches than patients who did not experience frequent headaches before surgery.

It appears that women may experience more intense headaches than men with 80% of women reporting severe headaches vs. 70% of men. Younger people experienced more severe headaches than older people (above the age of 65). Patients reported that most postoperative headaches resolved within 12 weeks. However, approximately 36% of the respondents reported that their postoperative headaches lasted longer than 12 weeks but most resolved by 3 years.

Regarding the extent that the individuals were impacted by the headaches, the responses ranged from 48% who responded that there was minimal to no impact on their quality of life to 8% who responded that there was "quite a bit" of impact. Women tended to be more affected than men. There was no relationship between the extent of impact on quality of life and surgical approach or tumor size, although as mentioned above, following suboccipital surgery patients were more likely to have problems with work. Although suboccipital surgery is favored by many neurosurgeons since is provides good visibility of the posterior fossa and the facial nerve, it is associated with the greatest morbidity in terms of persistent, debilitating headaches.

To read more about this study, please click on the following link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&listuids=15805885&queryhl=1&itool=pubmed_docsum

The studies on quality of life of patients following surgery for acoustic neuromas contain a wide range of responses to questionnaires about issues that confront them, the severity of those issues, and how much they interfere with daily living. This is partly because one person may perceive subjective issues like pain, for example, differently than another and there is no objective way to measure what each person feels. In addition, each patient has a different level of tolerance for symptoms, such as pain or vestibular imbalance, which follows surgical treatment for acoustic neuromas and, therefore, reports regarding impact on quality of life are quite variable. However, the data does offer insight into general trends of what patients have experienced that may be helpful in planning for treatment and creating realistic expectations for the postoperative period. It is important for patients to be aware of what to expect after surgery and to have a better perspective of how life may change for them after undergoing acoustic neuroma surgery.