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Long-term Dizziness Handicap in Patients with Vestibular Schwannoma: A Multicenter Cross-Sectional Study

Objectives: Previous studies have demonstrated that ongoing dizziness is a powerful predictor of reduced quality of life for patients with vestibular schwannoma (VS). The purpose of the current study is: (1) to characterize long-term dizziness following observation, microsurgery, and stereotactic radiosurgery (SRS) for small to medium sized VS using a validated self-assessment inventory and (2) to identify clinical variables associated with long-term dizziness handicap. Methods: All patients with sporadic <3 cm VS who underwent primary microsurgery, SRS, or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the Dizziness Handicap Inventory (DHI) and a VS symptom questionnaire. Results: A total of 642 respondents (mean age 56.2 years, 56.9% female) were analyzed and the average time interval between treatment and survey was 7.7 years. Female sex, older age, preexisting diagnosis of migraine, and symptoms of severe dizziness predating treatment were highly statistically significantly associated with a worse DHI score (P < .001) while type of dizziness (vertiginous vs non vertiginous), tumor size, and treatment strategy were not (P > .05). The 2 variables that were associated with the greatest deterioration in DHI scores were pre-existing migraine (24.5 vs 15.9 points) and history of severe dizziness prior to treatment (31.1 vs 14.0 points). Conclusions: These data suggest that migraine may play a major role in long-term dizziness in patients with VS. Factors including history of dizziness predating treatment and preexisting diagnosis of migraine most significantly influence dizziness handicap among subjects with VS, while management strategy is not associated with long-term DHI outcome.