Funktionelle Ergebnisse, Lebensqualität, kognitive und affektive Konsequenzen nach transtemporaler Exstirpation von Akustikusneurinomen

Background: The aim of the study was to evaluate postoperative hearing, facial nerve function, quality of life (QOL), affective status and neuropsychological performance after transtemporal removal of acoustic neuromas (AN). Patients and Methods: A retrospective analysis was carried out in 89 patients with AN who were operated at the ENT-Department of the Hospital Fulda between 1988 and 2004. Median follow up was 57 months. Of these 41 patients were additionally examined by a psychologist for evaluation of QOL, mnestic functions and affective disorders using several questionaires. Results: The AN were classified as follows: Type A=53%, type B = 35% and type C = 12%. One year postoperatively facial nerve function was excellent in 93.3 % of the patients (grade I and II). In 53 % of cases hearing could be preserved. The subjective QOL was expressed through depression and social withdrawal associated with deafness. However, facial nerve dysfunction did not lead to QOL effection. Objective QOL (functional level) was reduced because of verbal memory disturbances and symptoms like dizziness. In 47.5% of the patients affective and/or mnestic dysfunctions were diagnosed. Subsequent MRI evaluation showed lesions of the temporal lobe in 40.5 % of the cases. Of these 80% suffered from cognitive and/or affective disturbances. Conclusions: The cognitive and affective disturbances after transtemporal removal of AN could be to a certain degree due to the elevation of the temporal lobe during surgery. Further research, especially pre- and postoperative examination of QOL and psychological state as well as the comparison between different approaches, particularly transtemporal vs suboccipital have to clear up specific morbidity of the different approaches.